DCE-MRI联合IVIM定量参数在布氏杆菌性脊柱炎治疗评价中的应用

Application of DCE-MRI combined with IVIM quantitative parameters in the treatment evaluation of brucellosis spondylitis

目的应用动态对比增强MRI(dynamic contrast-enhanced MRI,DCE-MRI)联合体素内不相干运动(intravoxel incoherent motion,IVIM)定量参数评估布氏杆菌性脊柱炎急性期治疗效果,观察各定量参数在疾病治疗过程中的变化情况,筛选出最佳评估定量参数。材料与方法前瞻性招募首次确诊的布氏杆菌性脊柱炎急性期患者30例,所有患者在首次确诊及治疗后3个月接受常规MRI、DCE-MRI和IVIM扫描,对照研究病变最显著区(强化最明显区域)容积转运常数(Ktrans)、血管外细胞外容积分数(Ve)、速率常数(Kep)、慢速扩散系数(D)、快速扩散系数(D*)、灌注分数(f);采用SPSS 25.0统计学软件进行数据分析,各定量参数均呈非正态分布,以中位数±四分位数间距(M±Q)表示,采用Wilcoxon秩和检验对各定量参数进行统计学分析。结果布氏杆菌性脊柱炎首次确诊及治疗后3个月Ktrans值分别为(0.53±0.02)、(0.22±0.01)min-1,Ve值分别为0.45±0.01、0.48±0.03,Kep值分别为(1.18±0.04)、(0.46±0.04)min-1,D值分别为(0.53±0.01)×10-3、(0.91±0.01)×10-3 mm2/s,D*值分别为(6.01±0.26)×10-3、(5.81±0.21)×10-3 mm2/s,f值分别为0.32±0.04、0.29±0.03;Ktrans、Kep、D值组内差异均有统计学意义(Z值分别为-4.784、-4.783、-4.786,P均<0.01)。结论本研究首次应用DCE-MRI联合IVIM定量参数评估布氏杆菌性脊柱炎急性期治疗效果,从微观角度评估病变微环境变化更科学、客观,为指导临床用药提供了新的依据。

Objective:To evaluate the therapeutic effect of Brucella spondylitis in the acute phase,we used dynamic contrast-enhanced MRI(DCE-MRI)combined with intravoxel incoherent motion(IVIM)quantitative parameters to observe the changes of various quantitative parameters during the disease treatment process and to select the best evaluation quantitative parameters.Materials and Methods:We prospectively enrolled 30 patients with acute phase of first confirmed Brucella spondylitis.What's more,all patients underwent routine MRI,DCE-MRI,and IVIM scans 3 months after initial diagnosis and treatment.Measurement of volume transport constant(Ktrans),extracellular volume fraction(Ve),rate constant(Kep),slow diffusion coefficient(D),fast diffusion coefficient(D*),and perfusion fraction(f)in the most significant area of the lesion(most significantly enhanced area)in a controlled study;We used SPSS 25.0 statistical software for data analysis,and all indicators showed a non-normal distribution,represented by the median±interquartile interval(M±Q).Wilcoxon rank sum test was used for statistical analysis of various quantitative parameters.Results:Ktrans values were(0.53±0.02),(0.22±0.01)min-1,Ve values were 0.45±0.01,0.48±0.03,Kep values were(1.18±0.04),(0.46±0.04)min-1,D values were(0.53±0.01)×10-3,(0.91±0.01)×10-3 mm2/s,D*values were(6.01±0.26)×10-3,(5.81±0.21)×10-3 mm2/s,and f values were 0.32±0.04,0.29±0.03,respectively,after the first diagnosis and treatment of Brucella spondylitis;The differences in Ktrans,Kep,and D values within the group were statistically significant(Z were-4.784,-4.783,and-4.786,respectively,with P<0.01).Conclusions:The first application of DCE-MRI combined with IVIM quantitative parameters to evaluate the treatment effect of Brucella spondylitis in the acute phase provides a more scientific and objective evaluation of the microenvironmental changes from a microscopic perspective,providing a new basis for guiding clinical medication.