磁共振FLAIR-FS序列成像在诊断早期膝关节滑膜炎中的应用研究

Application of Magnetic Resonance FLAIR-FS Sequence Imaging in the Diagnosis of Early Knee Synovitis

目的探讨磁共振(MRI)脂肪抑制液体衰减反转恢复(FLAIR-FS)序列成像对早期膝关节滑膜炎(KS)诊断价值。方法选择郑州大学附属郑州中心医院于2020年12月至2021年6月期间收治的50例KS患者(膝关节53个)设为观察组,50例健康志愿者(膝关节50个)设为对照组。入组受检者均接受双膝关节MRI检查,实施横轴位与矢状位FLAIR-FS序列、脂肪抑制质子密度加权(PDWI-FS)序列检查。记录滑膜厚度测量及分级的可重复评估结果,对比两组FLAIR-FS序列测定滑膜厚度、对滑膜定量评估结果;记录两种序列对KS患者的滑膜评分情况。结果FLAIR-FS图像测定15个膝关节的两次滑膜分级评估的一致性一般(Kappa值为0.376);测量滑膜厚度的组内相关系数(ICC)为0.984,95%CI为0.954~0.993;研究组滑膜厚度为(3.04±0.62)mm,高于对照组的(1.10±0.29)mm,有统计学差异(t值=20.042,P值<0.001);PDWI-FS序列、FLAIR-FS序列对滑膜评分0-1分的一致性一般(kappa值=0.352,P值=0.001),对滑膜评分2分的一致性较差(kappa值=0.475,P值<.001),对滑膜评分3分的一致性极低(kappa值=0.113,P值=0.074);3级滑膜评分者的滑膜厚度为(4.56±1.33)mm,明显高于1级者的(2.05±0.46)mm和2级者的(2.32±0.49)mm,有统计学差异(P值<0.05);1级、2级滑膜评分者的滑膜厚度相比,无统计学差异(P值>0.05)。结论MRI FLAIR-FS序列对KS滑膜形态和信号评估有一定优势,可用于评价KS分期。

Objective To investigate the diagnostic value of FFL-FS sequence imaging in early knee synovitis(KS).Methods Fifty patients with KS(53 knees)admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from December 2020 to June 2021 were selected as the observation group,and 50 healthy volunteers(50 knees)were selected as the control group.All enrolled subjects underwent MRI examination of both knee joints.Fly-fs and PDWI-FS sequences were performed in transverse and sagittal positions and adipose inhibition proton density weighted(PDWIFS)sequences.Reproducible evaluation results of synovial thickness measurement and grading were recorded.The results of synovial thickness measurement and quantitative evaluation of synovial membrane were compared between two groups with FLA-FS sequence.The synovial score of KS patients with two sequences was recorded.Results The consistency of the two synovial-grade evaluation of 15 knee joints determined by FLY-FS images was general(Kappa value was 0.376).The intragroup correlation coefficient(ICC)was 0.984,95%CI was 0.954~0.993.The synovial thickness of the study group was(3.04±0.62)mm,which was higher than that of the control group(1.10±0.29)mm,with statistical difference(t=20.042,P<0.001).PDWI-FS sequence and FLA-FS sequence had general consistency for synovial score 0-1(kappa=0.352,P=0.001),but poor consistency for synovial score 2(kappa=0.475,P<0.001).The consistency of the synovial score of 3 points was very low(kappa=0.113,P=0.074).The synovial thickness of grade 3 was(4.56±1.33)mm,which was significantly higher than that of grade 1(2.05±0.46)mm and grade 2(2.32±0.49)mm,with statistical difference(P<0.05).There was no statistical difference between grade 1 and grade 2 synovial thickness(P>0.05).Conclusion MRI FLAIR-FS sequence has certain advantages in the evaluation of KS synovial morphology and signal,and can be used to evaluate KS staging.