DWI、DCE-MRI及脂肪定量技术在强直性脊柱炎骶髂关节病变活动性评价中的应用价值

Clinical application of MR diffusion weighted imaging,dynamic contrast enhanced MRI and fat quantification for evaluation of sacroiliac joints in ankylosing spondylitis active lesions

目的:探讨扩散加权成像(DWI)、动态对比增强MRI(DCE-MRI)及定量非对称回波的最小二乘估算法迭代水脂分离序列(IDEAL-IQ)评估强直性脊柱炎(AS)患者骶髂关节病变活动性的价值。方法:59例AS患者(活动期41例,稳定期18例)行骶髂关节DWI、DCE-MRI及IDEAL-IQ检查,测量感兴趣区(ROI)的ADC值、Ktrans、Kep、Ve、FF值,各参数值的组间比较采用两独立样本t检验,采用Pearson相关性分析评价Bath强直性脊柱炎疾病活动度指数(BASDAI)评分、C-反应蛋白(CRP)、红细胞沉降率(ESR)与ADC值、Ktrans、Kep、Ve、FF值的相关性。结果:活动期组与稳定期组的BASDAI评分、CRP、ESR、ADC值、Ktrans、Kep、Ve、FF值分别为(6.56±1.48)、(46.60±4.84)mg/L、(33.05±8.15)mm/h、(1.23±0.14)×10-3/mm2/s、(0.74±0.09)/min、(1.07±0.19)/min、(0.49±0.15)、(44.44±8.60)%与(2.83±0.99)、(24.06±2.45)mg/L、(17.83±6.31)mm/h、(0.78±0.08)×10-3/mm2/s、(0.22±0.11)/min、(0.55±0.11)/min、(0.36±0.10)、(64.13±13.21)%。活动期组的BASDAI评分、CRP、ESR、ADC值、Ktrans、Kep、Ve值显著高于稳定组,差异有统计学意义(t值分别为11.632、23.688、7.036、14.896、19.084、13.240、3.611,P值均<0.05);活动期组的FF值显著低于稳定组,差异有统计学意义(t值为-6.831,P值<0.05)。BASDAI评分与ADC值、Ktrans、Kep、Ve、FF值存在相关性(r值分别为0.706、0.729、0.673、0.366、-0.623,P值均<0.05);CRP与ADC值、Ktrans、Kep、Ve、FF值亦存在相关性(r值分别为0.728、0.869、0.778、0.375、-0.583,P值均<0.05);ESR与ADC值、Ktrans、Kep、Ve、FF值亦存在相关性(r值分别为0.641、0.657、0.656、0.364、-0.526,P值均<0.05)。结论:DWI、DCE-MRI及IDEAL-IQ定量参数有助于判定AS骶髂关节病变的活动状态。

Objective:The purpose of this study was to investigate the value of quantitative evaluation the activity of sacroiliac joints lesions in patients with ankylosing spondylitis(AS)using diffusion weighted imaging(DWI),dynamic contrast enhanced MRI(DCE-MRI)and iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence(IDEAL-IQ).Methods:A total of 59 patients with AS involving sacroiliac joints were included in this study,and divided in two groups:41 cases with active AS(active group)and 18 cases with stable AS(stable group).All patients underwent DWI,DCE-MRI and IDEAL-IQ at the same MR scanner.The ADC,K trans,K ep,V e and FF values of region of interest(ROI)of sacroiliac joints were measured and the intergroup differences were compared.Pearson correlation analysis was performed to analyze the correlation of the ADC,K trans,K ep,V e and FF values with the Bath ankylosing spondylitis disease activity score index(BASDAI)scores,CRP and ESR.Results:The BASDAI scores,CRP,ADC,ESR,K trans,K ep,V e and FF values were(6.56±1.48),(46.60±4.84)mg/L,(33.05±8.15)mm/h,(1.23±0.14)×10-3/mm 2/s,(0.74±0.09)/min,(1.07±0.19)/min,(0.49±0.15),(44.44±8.60)%;(2.83±0.99),(24.06±2.45)mg/L,(17.83±6.31)mm/h,(0.78±0.08)×10-3/mm 2/s,(0.22±0.11)/min,(0.55±0.11)/min,(0.36±0.10),(64.13±13.21)%for active group and stable group,respectively.The results of the active group(BASDAI scores,CRP,ESR,ADC,K trans,K ep and V e values)were significantly higher than the stable group(t=11.632,23.688,7.036,14.896,19.084,13.240 and 3.611,respectively;all P<0.05).The results of the active group(FF values)were significantly lower than the stable group(t=-6.831;P<0.05).Strong correlations existed between ADC,K trans,K ep,V e,FF and BASDAI scores(r value was 0.706,0.729,0.673,0.366 and-0.623,respectively;all P<0.05).Strong correlations existed between ADC,K trans,K ep,V e,FF and CRP(r value was 0.728,0.869,0.778,0.375 and-0.583,respectively;all P<0.05).Strong correlations existed between ADC,K trans,K ep,V e,FF and ESR(r value was 0.641,0.657,0.656,0.364 and-0.526,respectively;all P<0.05).Conclusion:Quantitative parameters of DWI,DCE-MRI and IDEAL-IQ are useful for evaluation the activity of the ankylosing spondylitis involving sacroiliac joints.