联合磁化传递成像和脂肪抑制T_(2)WI评估Graves眼病临床活动性的价值

Integrating magnetization transfer imaging and fat suppression T_(2)WI for predicting the clinical activity of Graves ophthalmopathy

目的探讨磁化传递成像(MTI)和脂肪抑制T_(2)WI(FS-T_(2)WI)在评估Graves眼病(GO)临床活动性的价值。方法前瞻性收集2020年10月至2021年7月南京医科大学第一附属医院临床诊断为GO的患者64例,根据临床活动性评分(CAS),分为活动期组(CAS≥3分,39例,78眼)和非活动期组(CAS<3分,25例,50眼),行冠状面MTI和FS-T_(2)WI检查。分别测量并计算每只眼的眼外肌磁化传递率(MTR)及眼外肌与同侧颞肌信号强度比(SIR)。采用独立样本t检验比较MRI定量参数的组间差异。采用Spearman相关分析评估MRI定量参数与CAS的相关性。采用受试者操作特征(ROC)曲线评估MTR、SIR及两者联合预测GO临床活动性的效能,曲线下面积(AUC)比较采用DeLong检验。结果活动期组和非活动期组眼外肌MTR分别为0.45±0.04和0.51±0.04,差异有统计学意义(t=7.62,P<0.001);SIR分别为3.4±0.6和2.6±0.5,差异有统计学意义(t=-8.20,P<0.001)。MTR与CAS呈负相关(r=-0.46,P<0.001),SIR与CAS呈正相关(r=0.63,P<0.001)。MTR、SIR及联合MTR和SIR评估GO活动性的AUC分别为0.840、0.845、0.905,联合MTR和SIR的效能优于单独使用MTR和SIR,差异有统计学意义(Z=2.61,P=0.009;Z=2.15,P=0.032)。结论MTI和FS-T_(2)WI的定量参数MTR和SIR均可用于评估GO临床活动性,两者联合可提高评估效能。

Objective To investigate the value of magnetization transfer imaging(MTI)and fat suppression T_(2)WI(FS-T_(2)WI)in predicting the clinical activity of Graves ophthalmopathy(GO).Methods From October 2020 to July 2021,64 GO patients were prospectively enrolled in the First Affiliated Hospital of Nanjing Medical University.According to the clinical activity score(CAS),the patients were divided into active group(CAS≥3,39 patients and 78 eyes)and inactive group(CAS<3,25 patients and 50 eyes).The coronal MTI and FS-T_(2)WI were scanned for pre-treatment assessment.Magnetization transfer ratio(MTR)of extraocular muscles,and signal intensity ratio(SIR)between extraocular muscles and temporalis were measured,respectively.The independent-sample t-test was used to compare the MTR and SIR between two groups.The correlations between MRI parameters and CAS were analyzed using Spearman correlation analysis.The receiver operating characteristic(ROC)curve was performed to evaluate the value of each and combined parameters for predicting the clinical activity of GO.The DeLong test was used to compare the area under the curve(AUC).Results The MTR of active group and inactive group were 0.45±0.04 and 0.51±0.04,respectively,the difference was statistically significant(t=7.62,P<0.001).The SIR were 3.4±0.6 and 2.6±0.5,respectively,and the difference was also statistically significant(t=-8.20,P<0.001).MTR was negatively correlated with CAS(r=-0.46,P<0.001),while SIR was positively correlated with CAS(r=0.63,P<0.001).The AUC of MTR,SIR and the combination of MTR and SIR for predicting the clinical activity of GO were 0.840,0.845 and 0.905,respectively.The combination of MTR and SIR showed higher performance than MTR or SIR alone,and the differences were statistically significant(Z=2.61,P=0.009;Z=2.15,P=0.032).Conclusions The quantitative parameters of MTI and FS-T_(2)WI,namely MTR and SIR,can be used to evaluate the clinical activity of GO.Integrating MTI and FS-T_(2)WI can improve the diagnostic efficiency.