MRI 4种不同序列对ARCOⅠ期股骨头缺血性坏死诊断比较研究

Comparative study of MRI different sequence in evaluating ARCO stageⅠavascular necrosis of the femoral head

目的:探讨MRI T_(1)WI、T_(2)WI、PDW及PDW-SPAIR序列对ARCOⅠ期股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)诊断价值的差异。方法:32例一侧临床确诊的ANFH患者行MRI检查,发现对侧为ARCOⅠ期ANFH,2周内再行DSA检查,以DSA为金标准,分析T_(1)WI、T_(2)WI、PDW及PDW-SPAIR序列对ARCOⅠ期ANFH的诊断价值。结果:ARCOⅠ期ANFH在MRI平扫上表现为股骨头区异常信号、骨髓水肿、髋关节积液。PDW-SPAIR序列对股骨头信号异常、骨髓水肿、关节积液的检出均高于T_(1)WI序列、T_(2)WI和PDW序列。DSA发现30例患者滋养动脉异常改变,确诊为ANFH,2例因股骨头滋养动脉未见明显异常而排除了ANFH。T_(1)WI序列诊断符合率50.00%、灵敏度46.67%、特异度100%、阳性预测值100%、阴性预测值11.11%;T_(2)WI序列上述各值分别为75.00%、73.33%、100%、100%、20.00%;PDW序列各值分别为78.13%、76.67%、100%、100%、22.22%;PDW-SPAIR序列各值分别为90.63%、96.43%、50%、93.10%、66.67%。诊断效能之间统计学分析表明T_(1)WI序列与T_(2)WI、PDW以及PDW-SPAIR序列之间差异均有统计学意义(P<0.05)。T_(2)WI、PDW序列与PDW-SPAIR序列之间差异均有统计学意义(P<0.05),T_(2)WI、PDW序列间差异无统计学意义(P>0.05)。结论:T_(2)WI、PDW及PDW-SPAIR序列均可用来检出ARCOⅠ期ANFH,PDW-SPAIR序列是最佳序列,从而有效指导临床早期诊断及治疗。在一侧确诊ANFH时,对侧尽量考虑做DSA检查,为可能介入治疗创造条件。

Objective:To explore the comparative value of MRI T_(1)WI,T_(2)WI,PDW and PDW-SPAIR sequences in evaluating association for research on osseous circulation(ARCO)stageⅠavascular necrosis of the femoral head(ANFH).Methods:The clinical data of 32 patients with clinically proved ANFH on one side underwent MRI,and ARCO stageⅠANFHs were found on the other side.They also underwent digital subtraction angiography(DSA)in two weeks.Based on the results of DSA,the golden standard,we analyzed the diagnostic value of T_(1)WI,T_(2)WI,PDW and PDW-SPAIR sequences for detecting ARCO stageⅠANFH.Results:On MRI scanning,the ANFHs of ARCO stageⅠwere manifested as abnormal signal of femoral head area,bone marrow edema or hip joint effusion.The PDW-SPAIR sequence was the best method in displaying the detection of abnormal signal of femoral head,bone marrow edema and hip joint effusion.30 patients with abnormal nourish blood vessels of femoral head were diagnosed by DSA,confirmed as ANFH,and 2 patients with no obvious abnormalities of nourish blood vessels were excluded the diagnosis of ANFH.For the diagnosis of the ANFHs of ARCO stageⅠ,the diagnostic accuracy,sensitivity,specificity,positive predictive value and negative predictive value of T_(1)WI sequence were 50.00%,46.67%,100%,100%and 11.11%respectively,those were 75.00%,73.33%,100%,100%and 20.00%respectively of T_(2)WI sequence,78.13%,76.67%,100%,100%and 22.22%respectively of PDW sequence,however,90.63%,96.43%,50%,93.10%and 66.67%respectively of PDW-SPAIR sequence.Statistically significant differences in the diagnostic efficiency existed between T_(1)WI and T_(2)WI sequence,T_(1)WI and PDW sequence as well as T_(1)WI and PDW-SPAIRsequence(all P<0.05).Statistically significant differences in the diagnostic efficiency existed between T_(2)WI and PDW-SPAIR sequences,PDW and PDW-SPAIR sequences also(all P<0.05),although no significant difference was found between T_(2)WI and PDW sequences(P>0.05).Conclusion:T_(2)WI,PDW and PDW-SPAIR sequences can be all used to reveal the ANFH of ARCO stageⅠ,and PDW-SPAIR sequences the best scanning sequence,thus effectively guiding clinical early diagnosis and treatment.After patients with clinically proved ANFH on one side underwent MRI,DSA should be referred to as soon as possible for further detail information as well as for possible transcatheter arterial infusion(TAI)on the other side.