IVIM-DWI与定量DCE-MRI对股骨头坏死微循环的评价及与ARCO分期的相关性

Evaluation of Quantitative Parameters of IVIM-DWI and DCE-MRI on the Microcirculation of Femoral Head Necrosis and Their Correlation with ARCO Staging

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)和动态增强磁共振成像(DCE-MRI)定量参数评估不同病程阶段股骨头坏死(ONFH)微循环灌注特征,分析灌注参数与国际骨循环研究会(ARCO)分期的相关性。方法搜集2019年11月至2020年11月广州中医药大学第一附属医院经骨科确诊的ONFH初治患者60例100髋,行常规MR、IVIM-DWI及DCE-MRI检查。根据ARCO分期标准分为五组,经图像后处理软件获得ONFH区IVIM-DWI定量参数真实扩散系数(D)、假性扩散系数(D^(*))、灌注分数(f)值,DCE-MRI定量参数容量转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e))值。比较不同组别间各灌注参数值的差异,分析IVIM-DWI和DCE-MRI各灌注参数间的相关性、灌注参数与ARCO分期的相关性。结果根据常规MR图像及ARCO分期标准分为未坏死对照组21髋、ARCOⅠ期组18髋、Ⅱ期组22髋、Ⅲ期组20髋、Ⅳ期组19髋。IVIM-DWI定量参数f值和DCE-MRI定量参数K;值在不同组别间差异有统计学意义(P<0.05),除对照组与Ⅳ期差异无统计学意义(P>0.05)外,其余两两比较差异均有统计学意义(P<0.05);D、D^(*)、K_(ep)、V_(e)值各组间差异没有统计学意义。f值、K^(trans)值与ARCO分期呈正相关(r=0.223、0.243,P<0.05)。f值与K^(trans)值呈显著正相关(r=0.987,P<0.05),V;值与D值呈弱相关性(r=0.207,P=0.039)。结论 IVIM-DWI和DCE-MRI定量参数可评估ONFH不同病程阶段微循环灌注特征;f值与K^(trans)值是反映ONFH微循环灌注的主要指标;f值、K^(trans)值与ARCO分期有一定的相关性。

Objective To explore the quantitative parameters of IVIM-DWI and DCE-MRI to evaluate the microcirculation characteristics of femoral head necrosis in different stages of the disease, and analyze the correlation between the perfusion parameters and the ARCO stage. Methods A total of 100 hips were collected from 60 patients with ONFH diagnosed by the Department of Orthopedics in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from November 2019 to November 2020,and completed routine MR,IVIM-DWI and DCE-MRI examinations. According to the ARCO staging standard, they were divided into 5 groups.The IVIM-DWI quantitative parameters(D,D^(*),f value) and the DCE-MRI quantitative parameters(K^(trans),K_(ep),V_(e)) values of the femoral head necrosis area were obtained by image post-processing software.We compared the difference of the perfusion parameter values between different groups, analyzed the correlation between the perfusion parameters of IVIM-DWI and DCE-MRI,and the correlation between perfusion parameters and ARCO staging. Results According to the ARCO staging standard, they were divided into 21 hips in the non-necrotic control group, 18 hips in the ARCO stage Ⅰ group, 22 hips in the stage Ⅱ group, 20 hips in the stage Ⅲ group, and 19 hips in the 1 stage Ⅳ group.The IVIM-DWI quantitative parameter f value and the DCE-MRI quantitative parameter K^(trans)value were statistically different among different groups(P<0.05),except for the difference between the control group and stage IV,which was not statistically significant(P>0.05).There was no statistically significant difference in the values of D,D^(*),K_(ep),and V_(e) between the groups.The f value and K^(trans) value were positively correlated with ARCO staging(r=0.223,0.243,P<0.05).There was a significant positive correlation between f value and K^(trans) value(r=0.987,P<0.05),and a weak correlation between V_(e) value and D value(r=0.207,P=0.039). Conclusion The quantitative parameters of IVIM-DWI and DCE-MRI can evaluate the characteristics of microcirculation perfusion in different stages of ONFH;f value and K^(trans) value are the main indicators reflecting the microcirculation perfusion of ONFH;the f value and K^(trans) value have a certain correlation with ARCO staging.