MRI对新型冠状病毒肺炎的应用价值初探

Application value of pulmonary MRI for COVID-19

目的:探讨MRI对新型冠状病毒肺炎(新冠肺炎)的应用价值。方法:回顾性分析58例新冠肺炎患者的CT及MRI图像。MRI序列包括T2WI、超短TE回波时间(UTE)序列、T1WI。以CT检查结果为金标准,分析、比较MRI单一序列及联合序列对肺内不同性质病变(磨玻璃病变、实变影、条索影)的检出及显示情况,其中MRI序列所示肺内病变进行5分法评分,≥4分认为满足临床诊断需求。结果:58例患者中,CT共检出185个病灶,其中磨玻璃病变138个,实变影32个,条索影15个。T2WI对病变的检出率为92.43%(171/185),与联合序列相等,略高于UTE序列[87.57%(162/185)],T1WI检出率较低,仅59.46%(110/185),各序列比较,差异有统计学意义(P<0.001)。其中对于磨玻璃病变的检出,T2WI与联合序列相等[89.86%(124/138)],稍优于UTE[83.33%(115/138)],T1WI检出率较低,仅45.65%(63/138),各序列比较,差异有统计学意义(P<0.001)。对磨玻璃病变显示评分≥4分者,T2WI、UTE、T1WI及联合序列分别为80.65%(100/124)、85.22%(98/115)、65.08%(41/63)及91.94%(114/124),各序列比较,差异有统计学意义(P<0.001),以联合序列与UTE对磨玻璃病变的显示较理想,其中联合序列最佳。对实变影及条索影的显示各序列均达到100.00%,图像评分均≥4分,检出及显示性能与CT等同。结论:T2WI及UTE对新冠肺炎肺内病变,特别是磨玻璃病变的检出率均较高;对于磨玻璃病变的显示,UTE效能较理想,最接近CT图像,而各序列联合进一步提升了对磨玻璃病变的显示效能;对实变影及条索影各序列的检出与显示均较理想。因此,MRI各序列联合可作为新冠肺炎检查及随访的有效替代工具,可应用于辐射敏感人群。

Objective:To explore the application value of pulmonary MRI in COVID-19.Methods:The CT and MRI images of 58 COVID-19 patients were retrospectively analyzed.MRI scanning sequences included T2WI,ultrashort echo time(UTE)sequence and T1WI.Taking the CT results as the gold standard,the detection of single sequence and combined sequences for pulmonary lesion(ground-glass,solid and cord lesions)was analyzed and compared.The imaging quality of 3 types of lesions was scored on a 5-point scale,≥4 points was considered to meet clinical diagnostic needs.Results:Among the 58 patients,a total of 185 lesions were detected by CT,including 138 ground-glass lesions,32 solid lesions and 15 cord lesions.For the detection of lesions,the detection rate of T2WI and combined sequence was 92.43%,slightly higher than UTE sequence[87.57%(162/185)].The detection rate of T1WI sequence was only 59.46%(110/185),which had a statistical difference compared with other sequences(P<0.001).Consider the imaging quality score for ground-glass lesions≥4 points,T2WI,UTE,T1WI and the combined sequence had the proportions of 80.65%(100/124),85.22%(98/115),65.08%(41/63)and 91.94%(114/124),and there was a statistical difference among 4 sequences(P<0.001).The combined sequence and UTE were ideal for displaying ground-glass lesions and the combined sequence was the best.The display of solid and cord lesions was achieved with 100.00%probability in each sequence and up to 4 points,with detection and display performance equivalent to CT.Conclusions:To pulmonary MRI scans for COVID-19,the detection rates for lung lesions of T2WI and UTE have reached a higher level.The UTE sequence is ideal for displaying ground-glass lesions,which is closest to CT,and the combined sequence further improves the imaging efficiency of ground-glass lesions.All solid and cord lesions can be ideally detected by all sequences.MRI can be used as a follow-up tool for COVID-19 cases to avoid of the high radiation in CT scans.