MRI不同征象对股骨头坏死Ⅱ和ⅢA期分期的临床价值探讨

Clinicall Value About Different MRI Signs Between ARCO Stages 2 and 3A in Osteonecrosis of the Femoral Head

目的提高磁共振成像对股骨头坏死Ⅱ和ⅢA期的诊断准确性。方法回顾性分析股骨头坏死Ⅱ和ⅢA期的患者142例,以CT作为股骨头坏死Ⅱ和ⅢA期分期的参考标准,评价5个磁共振成像单一征象(股骨头关节面不光整、坏死-存活截面最大宽度、股骨头骨髓水肿、股骨头囊性改变及患侧坐骨-股骨间隙)及联合征象[联合征象1=股骨头关节面不光整(基本征象)+坏死-存活截面最大宽度(>3 mm);联合征象2=股骨头关节面不光整(基本征象)+股骨头骨髓水肿;联合征象3=股骨头关节面不光整(基本征象)+股骨头不规则高信号]对分期的评价准确性。结果4个磁共振成像单一征象[股骨头关节面不光整、坏死-存活截面最大宽度(>3 mm)、股骨头骨髓水肿、股骨头囊性改变]对股骨头坏死Ⅱ和ⅢA期分期具有统计学意义(P<0.05),其中,股骨头关节面不光整是最有价值的(AUC=0.921),且联合征象1可进一步提高分期准确性(AUC=0.967)。而患侧坐骨-股骨间隙对股骨头坏死Ⅱ和ⅢA期分期不具有统计学意义(P>0.05)。结论磁共振成像征象中股骨头关节面不光整、坏死-存活截面最大宽度(>3 mm)、股骨头骨髓水肿、股骨头囊性改变对鉴别股骨头坏死分期Ⅱ和ⅢA期有价值,且联合征象1可进一步提高分期诊断价值,值得临床推广。

Objectivee To improve the diagnostic accuracy of MR for ARCOⅡandⅢA.Methods 142 patients with ARCOⅡandⅢA in our hospital were retrospectively analyzed.CT was used as the reference standard for the staging of ARCOⅡandⅢA.Five MR(incomplete articular surface of the femoral head,maximum width of necrotic-survival cross section,femoral head bone marrow edema,femoral head cystic changes and affected sciatic-femur gap)and combined signs(combined sign 1=incomplete articular surface of the femoral head(basic sign)+maximum width of necrotic-survival cross section(>3 mm)were evaluated.Combined sign 2=incomplete articular surface of femoral head(basic sign)+BME;Combined sign 3=uneven articular surface of the femoral head(basic sign)+irregular high signal of the femoral head)to evaluate the accuracy of staging.Results Four MR signs(incomplete articular surface of the femoral head,maximum width of necrotic survival cross section(>3 mm),bone marrow edema of the femoral head,and cystic changes of the femoral head)had statistical significance for ARCOⅡandⅢA(P<O.05).Among them,incomplete articular surface of the femoral head was the most valuable(AUC=0.921).Combined sign 1 could further improve staging accuracy(AUC=0.967).There was no significant difference between the ischium and femur gap on ARCOⅡandⅢA stage(P>0.05).Conclusion MRI findings of incomplete articular surface of femoral head,maximum width of necrotic survival cross section(>3 mm),bone marrow edema of femoral head and cystic changes of femoral head are of value in differentiating ARCOⅡandⅢA of femoral head necrosis,and combined with sign 1 can further improve the diagnostic value of staging,which is worthy of clinical promotion.