体素内不相干运动弥散加权成像定量评价轻中度症状性膝骨关节炎患者髌下脂肪垫

Intravoxel incoherent motion diffusion weighted imaging for quantiation of infrapatellar fat pad in patients with mild to moderate symptomatic knee osteoarthritis

目的评价体素内不相干运动弥散加权成像(IVIM-DWI)定量分析轻中度症状性膝骨关节炎(KOA)患者髌下脂肪垫(IPFP)的价值。方法纳入74例轻中度症状性KOA患者(KOA组)及30名健康人(对照组),采集膝关节质子密度加权成像(PdWI)及IVIM-DWI,于KOA组IPFP内PdWI高信号区、邻近正常信号区及对照组IPFP勾画ROI,比较真弥散系数(D)、假性弥散系数(D)及灌注分数(f)差异;采用Pearson相关性分析评价KOA组IVIM各参数与疼痛评分的相关性。结果KOA组55例(55/74,74.32%)PdWI显示IPFP内存在高信号区,其D、D均明显高于PdWI正常信号区及对照组(P均<0.05),且PdWI正常信号区D明显高于对照组(P<0.05);KOA组PdWI高信号区、正常信号区及对照组IPFP的f差异均无统计学意义(P均>0.05)。KOA组IPFP内PdWI高信号区的D与疼痛评分呈中度正相关(r=0.770,P<0.001),D与疼痛评分呈弱正相关(r=0.387,P=0.047)。结论IVIM-DWI可无创定量评估IPFP内水分子弥散和微循环灌注信息;D或可成为评价轻中度症状性KOA病变严重程度的生物学标记物。

Objective To observe the value of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)for quantitative analysis of infrapatellar fat pad(IPFP)in patients with mild to moderate symptomatic knee osteoarthritis(KOA).Methods A total of 74 patients with mild to moderate symptomatic KOA(KOA group)and 30 healthy subjects(control group)were enrolled.Proton density weighted image(PdWI)and IVIM-DWI of the knee were collected.ROI of PdWI hyperintense area and the adjacent normal signal area of IPFP in KOA group and of IPFP in control group were delineated,and the true diffusion coefficient(D),pseudo diffusion coefficient(D)and perfusion fraction(f)were compared.Pearson correlation analysis was used to evaluate the correlation of IVIM parameters and pain score in KOA group.Results PdWI hyperintense area of IPFP were observed in 55 patients(55/74,74.32%)of KOA group.D and D of PdWI hyperintense areas in KOA group were significantly higher than those of normal signal areas and control group(all P<0.05),while D of PdWI normal signal areas were significantly higher than that of control group(P<0.05).There was no significant difference of f among PdWI hyperintense area,normal signal area of KOA group and control group(all P>0.05).In KOA group,D of IPFP PdWI hyperintense areas were moderately positively correlated with pain scores(r=0.770,P<0.001),while D were weakly positively correlated with pain scores(r=0.387,P=0.047).Conclusion IVIM-DWI could noninvasively and quantitatively evaluate the diffusion of water molecules and the microcirculation perfusion of IPFP.D might become a biomarker for evaluating the severity of mild to moderate symptomatic KOA.