Intravoxel incoherent motion diffusion-weighted imaging for monitoring chemotherapeutic efficacy in gastric cancer

AIM: To assess intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for monitoring early efficacy of chemotherapy in a human gastric cancer mouse model.METHODS: IVIM-DWI was performed with 12 b-values (0-800 s/mm2) in 25 human gastric cancer-bearing nude mice at baseline (day 0), and then they were randomly divided into control and 1-, 3-, 5- and 7-d treatment groups (n = 5 per group). The control group underwent longitudinal MRI scans at days 1, 3, 5 and 7, and the treatment groups underwent subsequent MRI scans after a specified 5-fluorouracil/calcium folinate treatment. Together with tumor volumes (TV), the apparent diffusion coefficient (ADC) and IVIM parameters [true water molecular diffusion coefficient (D), perfusion fraction (f) and pseudo-related diffusion coefficient (D*)] were measured. The differences in those parameters from baseline to each measurement (ΔTV%, ΔADC%, ΔD%, Δf% and ΔD*%) were calculated. After image acquisition, tumor necrosis, microvessel density (MVD) and cellular apoptosis were evaluated by hematoxylin-eosin (HE), CD31 and terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) staining respectively, to confirm the imaging findings. Mann-Whitney test and Spearman’s correlation coefficient analysis were performed.RESULTS: The observed relative volume increase (ΔTV%) in the treatment group were significantly smaller than those in the control group at day 5 (ΔTVtreatment% = 19.63% ± 3.01% and ΔTVcontrol% = 83.60% ± 14.87%, P = 0.008) and day 7 (ΔTVtreatment% = 29.07% ± 10.01% and ΔTVcontrol% = 177.06% ± 63.00%, P = 0.008). The difference in ΔTV% between the treatment and the control groups was not significant at days 1 and 3 after a short duration of treatment. Increases in ADC in the treatment group (ΔADC%treatment, median, 30.10% ± 18.32%, 36.11% ± 21.82%, 45.22% ± 24.36%) were significantly higher compared with the control group (ΔADC%control, median, 4.98% ± 3.39%, 6.26% ± 3.08%, 9.24% ± 6.33%) at days 3, 5 and 7 (P = 0.008, P = 0.016, P = 0.008, respectively). Increases in D in the treatment group (ΔD%treatment, median 17.12% ± 8.20%, 24.16% ± 16.87%, 38.54% ± 19.36%) were higher than those in the control group (ΔD%control, median -0.13% ± 4.23%, 5.89% ± 4.56%, 5.54% ± 4.44%) at days 1, 3, and 5 (P = 0.032, P = 0.008, P = 0.016, respectively). Relative changes in f were significantly lower in the treatment group compared with the control group at days 1, 3, 5 and 7 follow-up (median, -34.13% ± 16.61% vs 1.68% ± 3.40%, P = 0.016; -50.64% ± 6.82% vs 3.01% ± 6.50%, P = 0.008; -49.93% ± 6.05% vs 0.97% ± 4.38%, P = 0.008, and -46.22% ± 7.75% vs 8.14% ± 6.75%, P = 0.008, respectively). D* in the treatment group decreased significantly compared to those in the control group at all time points (median, -32.10% ± 12.22% vs 1.85% ± 5.54%, P = 0.008; -44.14% ± 14.83% vs 2.29% ± 10.38%, P = 0.008; -59.06% ± 19.10% vs 3.86% ± 5.10%, P = 0.008 and -47.20% ± 20.48% vs 7.13% ± 9.88%, P = 0.016, respectively). Furthermore, histopathologic findings showed positive correlations with ADC and D and tumor necrosis (rs = 0.720, P < 0.001; rs = 0.522, P = 0.007, respectively). The cellular apoptosis of the tumor also showed positive correlations with ADC and D (rs = 0.626, P = 0.001; rs = 0.542, P = 0.005, respectively). Perfusion-related parameters (f and D*) were positively correlated to MVD (rs = 0.618, P = 0.001; rs = 0.538, P = 0.006, respectively), and negatively correlated to cellular apoptosis of the tumor (rs = -0.550, P = 0.004; rs = -0.692, P < 0.001, respectively).CONCLUSION: IVIM-DWI is potentially useful for predicting the early efficacy of chemotherapy in a human gastric cancer mouse model.

Intravoxel Incoherent Motion Diffusion Weighted Imaging for the Therapeutic Response of Transarterial Chemoembolization for Hepatocellular Carcinoma

Background: Intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) can not only observe the diffusion of tissue water molecules but also reflect the blood perfusion information of tissue microcirculation. IVIM-DWI has been applied in many clinical areas. However, few studies have addressed the use of IVIM-DWI for the evaluation of transarterial chemoembolization (TACE) response in hepatocellular carcinoma (HCC) patients. Objectives: The purpose of the present study was to explore the role of IVIM-DWI for the therapeutic response of TACE for HCC. Materials and Methods: Twenty patients underwent IVIM-DWI scan on a 3.0T magnetic resonance imaging instrument 1 - 3 days before and 30 to 40 days after TACE. The values of IVIM-DWI parameters, including standard apparent diffusion coefficient (ADC), pure diffusion coefficient (Dslow), pseudo-diffusion coefficient (Dfast) and perfusion fraction (f) were measured. The values of IVIM-DWI parameters before and after TACE were compared using paired t tests. The values between responsive and non-responsive groups were compared using independent-samples t test. P 0.05 indicated statistical significance. Results: After TACE, the ADC and Dslow values in the tumors increased significantly, and the values of Dfast decreased significantly, while the values of f value did not change obviously. The ADC values in responsive group were remarkably higher than those in non-responsive group, the Dfast values in responsive group were significantly lower than those in non-responsive group, but the values of Dslow and f between the two groups were not different significantly. Conclusions: IVIM-DWI parameters can be used as potential markers for the therapeutic response of TACE for HCC.

Intravoxel incoherent motion magnetic resonance imaging for diagnosis of cervical cancer and evaluation of response of uterine cervical cancer to radiochemotherapy: A pilot study

Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.

Updates in advanced diffusion-weighted magnetic resonance imaging techniques in the evaluation of prostate cancer

Diffusion-weighted magnetic resonance imaging(DWMRI) is considered part of the standard imaging protocol for the evaluation of patients with prostate cancer.It has been proven valuable as a functional tool for qualitative and quantitative analysis of prostate cancer beyond anatomical MRI sequences such as T2-weighted imaging. This review discusses ongoing controversies in DW-MRI acquisition, including the optimal number of b-values to be used for prostate DWI, and summarizes the current literature on the use of advanced DWMRI techniques. These include intravoxel incoherent motion imaging, which better accounts for the nonmono-exponential behavior of the apparent diffusion coefficient as a function of b-value and the influence of perfusion at low b-values. Another technique is diffusion kurtosis imaging(DKI). Metrics from DKI reflect excess kurtosis of tissues, representing its deviation from Gaussian diffusion behavior. Preliminary results suggest that DKI findings may have more value than findings from conventional DW-MRI for the assessment of prostate cancer.

Evaluation Value of Intravoxel Incoherent Motion Diffusion-Weighted Imaging on Early Efficacy of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Ablation for Uterine Adenomyoma

To investigate the evaluation value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)on the early efficacy of magnetic resonance-guided high-intensity focused ultrasound(MRgFUS)ablation for uterine adenomyoma.The clinical and magnetic resonance imaging(MRI)data of 36 patients with uterine adenomyoma before and after MRgFUS treatment in our hospital from January 2018 to December 2018 were retrospectively analyzed.All the 36 patients underwent MRI examination one day before operation and immediately after operation using GE Discovery MR7503.0T MRI,including conventional sequences(T1WI,T2WI,and T2 fat suppression sequences)plain scan,IVIM-DWI sequences with 9 b values,and contrast enhanced-MRI sequences.The IVIM-DWI quantitative parameters(true diffusion coefficient D,perfusion related diffusion coefficient D*,and perfusion fraction f)of double-exponential model were obtained by using GE ADW 4.7 functool,a postprocessor.SPSS 24.0 software was used to analyze the difference in parameter between the ablation and non-ablation areas of uterine adenomyoma.DWI signal in the ablation area of uterine adenomyoma was increased,and manifested as heterogeneous diffuse high signal,with low central signal and high edge signal.Values of D,D*and f in the ablation area of uterine adenomyoma were significantly lower than those in the non-ablation area,and there was statistical difference between the two(P<0.05).The areas under receiver operating characteristic(ROC)curve of D,D*and f values in the ablation area of uterine adenomyoma were 0.854,0.898 and 0.924,respectively;the optimal thresholds for the diagnosis of ablation area of uterine adenomyoma were 0.81×10−3 mm2/s,4.99×10−3 mm2/s and 0.24,respectively;the diagnostic sensitivity was 80.6%,72.2%and 94.4%,respectively;and the specificity was 91.7%,97.2%and 94.4%,respectively.IVIM-DWI has a certain clinical value in the evaluation on early efficacy of MRgFUS ablation of uterine adenomyosis.

IVIM-DWI和IDEAL-IQ技术预测子宫内膜癌p53基因突变

目的:探讨体素不相干运动DWI(IVIM-DWI)和多点非对称回波采集与迭代最小二乘法水脂分离(IDEAL-IQ)成像在鉴别p53基因突变型与野生型子宫内膜癌(EC)中的价值。方法:回顾性分析2021年11月-2022年6月在本院经病理证实的18例p53突变型和28例p53野生型EC患者的IVIM-DWI和IDEAL-IQ成像资料。比较两组间ADC_(slow)、ADC_(fast)、f、FF和R_(2)^(*)值的差异。分别采用受试者工作特征曲线(ROC)、Logistic回归分析和DeLong检验评估各参数的诊断效能、构建多参数联合模型和比较AUC的差异。结果:p53基因突变组的ADC_(slow)和f值均显著小于野生组[(0.66±0.26) vs.(1.11±0.45),P<0.001;1.78 (1.49,2.15) vs. 2.29 (1.51,3.35),P=0.048],R_(2)^(*)值显著大于野生组[(23.98±12.46) vs.(15.10±3.69),P=0.001];两组间ADC_(fast)和FF值的差异无统计学意义(P=0.173、0.184)。ADC_(slow)、f和R_(2)^(*)值预测突变型EC的AUC分别为0.817、0.675和0.718;三者构建的联合模型的AUC为0.984,敏感度为96.43%,特异度为94.44%。DeLong分析结果显示,联合模型与单项参数(ADC_(slow)、f、R_(2)^(*))比较,AUC的差异均有统计学意义(Z=2.659,P=0.008;Z=3.876,P<0.001;Z=3.318,P=0.001)。结论:IVIM-DWI和IDEAL-IQ成像的定量参数可用于评估EC患者的p53基因突变情况,且两种技术多参数联合诊断能够显著提升预测效能。

IVIM序列诊断前列腺癌和前列腺增生价值的研究

目的探讨体素内不相干运动弥散加权(IVIM)序列各参数鉴别诊断前列腺癌和前列腺增生的价值。方法病理证实的前列腺癌57例和前列腺增生45例患者分别行磁共振IVIM序列和DWI序列检查,比较前列腺癌和前列腺增生患者的的ADC值、纯弥散系数(Dslow)、伪弥散系数(Dfast)以及灌注分数(f)值的差异。前列腺癌和前列腺增生各参数的数据建立ROC曲线,分析ROC曲线下的面积(AUC),比较各参数的诊断效能。结果前列腺癌的ADC值、Dslow值明显低于前列腺增生,f值高于前列腺增生,以P≤0. 05为差异有统计学意义,Dfast值差异无统计学意义。ROC曲线下方Dslow的AUC最大,Dslow的诊断效能最高。结论 ADC值、Dslow、f都可以鉴别诊断前列腺癌和前列腺增生,但是Dslow具有最高的诊断效能。

体素内不相干运动成像序列联合双参数MRI对前列腺癌的诊断价值

目的探讨体素内不相干运动(IVIM)成像序列联合双参数MRI对前列腺癌的诊断价值。方法将52例良性前列腺增生(BPH)患者设为对照组,54例前列腺癌患者设为观察组,两组患者均行IVIM序列联合双参数MRI检查,比较两组患者的速率常数(K_(ep))、容量转移常数(K^(trans))、血管容量百分数(V_(p))、血管外细胞外间隙容积比(V_(e)),纯扩散系数(D)、伪扩散系数(D^(*))、灌注分数(f),采用受试者工作特征(ROC)曲线进行诊断价值分析,计算ROC曲线下面积(AUC)、灵敏度及特异度。结果观察组患者K^(trans)、Kep值均明显高于对照组,D、D^(*)、V_(e)、f值均明显低于对照组,差异均有统计学意义(P﹤0.01)。高分化前列腺癌患者D^(*)值高于中分化、低分化患者,中分化前列腺癌患者D^(*)值高于低分化患者,差异均有统计学意义(P﹤0.05)。高分化前列腺癌患者f值均低于中分化、低分化患者,中分化前列腺癌患者f值低于低分化患者,差异均有统计学意义(P﹤0.05)。高分化前列腺癌患者K_(ep)值低于中分化患者,而中分化前列腺癌患者K_(ep)值高于低分化患者,差异均有统计学意义(P﹤0.05)。不同分化程度前列腺癌患者D、Ve、K^(trans)值比较,差异均无统计学意义(P﹥0.05)。D、D^(*)、f、K_(ep)、Ve、K^(trans)值诊断前列腺癌的AUC均在0.6以上,且D值最高。结论IVIM联合双参数MRI对前列腺癌的诊断效能较高,对鉴别前列腺癌及前列腺增生有重要参考价值。

磁共振IDEAL-IQ和体素内不相干运动预测子宫内膜癌细胞增殖状态

目的:探索磁共振成像多点非对称回波采集与迭代最小二乘法水脂分离(iterative decomposition of water and fat with echo asymmetry and the least squares estimation quantification sequence,IDEAL-IQ)和体素内不相干运动(intravoxel incoherent motion,IVIM)在子宫内膜癌(endometrial carcinoma,EC)细胞增殖状态评估中的价值。方法:回顾并分析24例Ki-67增殖指数低(≤50%)和19例Ki-67增殖指数高(>50%)的EC患者的资料,分别测量病灶IDEAL-IQ成像的脂肪分数(fat fraction,FF)、R_(2)^(*)弛豫率(R_(2)^(*))值和IVIM成像的慢速表观弥散系数(slow apparent diffusion coefficient,ADCslow)、快速表观弥散系数(fast apparent diffusion coefficient,ADC-fast)和灌注分数(perfusion fraction,f)并进行对比。受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积(area under curve,AUC)被用于确定各参数的诊断效能,logistic回归和DeLong检验分别被用于多参数联合诊断和不同AUC间的差异分析。Spearman相关被用于评估各参数值与Ki-67增殖指数的相关性。结果:Ki-67增殖指数高的组ADC-slow、ADC-fast和R_(2)^(*)值均显著低于Ki-67增殖指数低的组(P分别为<0.001、0.004、<0.001)。ADC-slow、ADC-fast、R_(2)^(*)以及三者联合鉴别Ki-67增殖指数高、低组EC的AUC分别为0.860、0.748、0.862和0.978。DeLong分析显示,ADC-slow+ADC-fast+R_(2)^(*)与ADC-slow、ADC-fast及R_(2)^(*)之间的AUC差异均有统计学意义(Z分别为2.109、3.134、2.227;P分别为0.035、0.002、0.023)。ADC-slow和R_(2)^(*)值均与Ki-67增殖指数呈中度负相关(r分别为-0.547、-0.711,P<0.001),ADC-fast与Ki-67增殖指数呈轻度负相关(r分别为-0.324,P=0.034)。结论:ADC-slow、ADC-fast和R_(2)^(*)均有助于评估EC患者的细胞增殖状态,且三者联合能够对Ki-67增殖指数高、低组EC进行更有效的鉴别。

Advanced imaging techniques in the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is one of the major causes of morbidity and mortality in patients with chronic liver disease. Transarterial chemoembolization(TACE) can significantly improve the survival rate of patients with HCC and is the first treatment choice for patients who are not suitable for surgical resections. The evaluation of the response to TACE treatment affects not only the assessment of the therapy efficacy but also the development of the next step in the treatment plan. The use of imaging to examine changes in tumor volume to assess the response of solid tumors to treatment has been controversial. In recent years, the emergence of new imaging technology has made it possible to observe the response of tumors to treatment prior to any morphological changes. In this article, the advances in studies reporting the use of computed tomography perfusion imaging, diffusionweighted magnetic resonance imaging(MRI), intravoxel incoherent motion, diffusion kurtosis imaging, magnetic resonance spectroscopy, magnetic resonance perfusionweighted imaging, blood oxygen level-dependent MRI, positron emission tomography(PET)/computed tomography and PET/MRI to assess the TACE treatment response are reviewed.

磁共振IVIM-DWI及IDEAL-IQ序列在肝细胞肝癌病理分级中的应用价值

目的 目前最小二乘估算法迭代水脂分离序列(IDEAL-IQ)在肝细胞肝癌(HCC)病理分级中的应用较少。文中旨在比较磁共振体素内不相干运动扩散加权成像序列(IVIM-DWI)和IDEAL-IQ序列在HCC术前病理分级中的价值。方法 回顾性收集2019年7月至2021年5月中国科学技术大学附属第一医院安徽省立医院南区影像中心100例行常规MR扫描及IVIM-DWI、IDEAL-IQ扫描高度怀疑HCC患者的临床资料,最终61例HCC患者纳入研究。HCC的分级方法采用Edmondson-Steiner病理分级法,高分化组14例、中分化组30例、低分化组17例。所有患者均行磁共振扫描,包括IVIM-DWI和IDEAL-IQ序列,数据传输至ADW 4.6工作站,测量病灶ADC、D值、D*值、f值、FF值、R2*弛豫率值。采用ROC分析比较ADC、D及FF、R2*检验效能;采用Spearman秩相关ADC、D、FF、R2*与HCC分化程度相关性。结果 高、中、低分化组ADC值、D值、FF值及R2*弛豫率值差异均有统计学意义(P<0.05)。ADC值、D值、FF值、R2*弛豫率与HCC病理分级均呈正相关,分化程度越高,ADC值、D值、FF值、R2*弛豫率值越高(P<0.05)。R2*弛豫率值对高、中分化鉴别诊断效能最高(AUC=0.914),D值对中-低分化的鉴别诊断效能最高(AUC=0.869)。结论 ADC值、D值、FF值、R2*弛豫率值对评估HCC分化程度具有重要参考价值,D值、R2*弛豫率值较ADC值、FF值可以更准确地预测HCC病理学分化程度。

IVIM-DWI参数在乳腺癌诊断中的应用及其与免疫组织化学指标表达的关系

目的:研究体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion-weighted imaging,IVIM-DWI)参数在乳腺癌诊断中的应用及其与免疫组织化学指标表达的关系。方法:回顾性分析2019年12月至2020年12月徐州医科大学附属连云港医院收治的70例疑似乳腺癌患者,采用Philips Ingenia 3.0 T超导型磁共振扫描仪和乳腺专用相控线圈进行检测,通过影像学序列设定,分别测定表观扩散系数(apparent diffusion coefficient,ADC)值、慢扩散系数(slow diffusion coefficient,D)值、快扩散系数(fast diffusion coefficient,D^(*))值、灌注分数(perfusion fraction,f)值,同时进行免疫生化指标雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)、人类表皮生长因子受体2(human epidermal growth factor receptor 2,HER-2)及细胞增殖抗原标志物Ki-67的测定。结果:病理检查诊断良性肿瘤2 2例,恶性肿瘤4 8例;E R阳性5 4例,阴性1 6例;P R阳性5 0例,阴性2 0例;K i-6 7高表达5 5例,低表达1 5例;H E R-2阳性2 7例,阴性4 3例。恶性肿瘤患者ADC值、D值、D^(*)值低于良性肿瘤患者,f值高于恶性肿瘤患者,差异有统计学意义(P<0.0 5)。E R阴性与阳性患者、P R阴性与阳性患者、H E R-2阴性与阳性患者的A D C值、D值、D^(*)值、f值差异均无统计学意义(P>0.05),Ki-67高表达与低表达患者的D^(*)值、f值差异无统计学意义(P>0.05)。Ki-67高表达患者的ADC值与D值均低于低表达者,差异有统计学意义(P<0.05)。ER、PR、H ER-2分别与A D C值、D值、D^(*)值、f值无相关性(P>0.05),Ki-67与D^(*)值、f值无相关性(P>0.05),与ADC值和D值呈正相关性(P<0.05)。结论:IVIM-DWI定量参数ADC值、D值、D^(*)值、f值可以为乳腺癌定性诊断提供有价值的依据,其中参数ADC值与D值在乳腺癌Ki-67高表达与低表达患者中存在统计学差异,可以为预测Ki-67表达提供参考。

基于快速自旋回波序列的全病灶体素内不相干运动成像鉴别诊断甲状腺良恶性结节的价值

目的探讨基于快速自旋回波序列(TSE)的全病灶体素内不相干运动成像(IVIM)在鉴别甲状腺良恶性结节中的诊断价值。方法前瞻性收集2019年3月至12月于徐州医科大学附属连云港医院经手术病理证实的57例甲状腺结节患者,共纳入62个结节进行分析,良性结节27个,恶性35个。术前均行常规MRI扫描及基于TSE序列的IVIM检查。在多个连续层面上沿病灶边缘绘制感兴趣区以覆盖整个结节,测量结节的表观扩散系数(ADC)、真扩散系数(D)、伪扩散系数(D*)和微循环灌注分数(f)值,取多层测量值的均值为结果。采用独立样本t检验(正态分布)或Mann-Whitney U检验(非正态分布)比较甲状腺良恶性结节组间差异。对差异有统计学意义的参数采用受试者操作特征(ROC)曲线评估其诊断效能。结果甲状腺恶性结节组ADC和D值均低于良性结节组,差异有统计学意义(t=3.821,P=0.001;t=2.034,P=0.046),D*和f值差异无统计学意义(t=-1.170,P=0.247;Z=-0.559,P=0.577)。ADC及D值诊断甲状腺良恶性结节的最佳诊断阈值分别为1.90×10-3mm2/s、1.10×10-3mm2/s,灵敏度均为81.5%,特异度分别为73.5%、61.8%,曲线下面积分别为0.782、0.688,两者曲线下面积比较差异有统计学意义(Z=2.098,P=0.040)。结论基于TSE序列的全病灶IVIM参数ADC及D值可为术前鉴别甲状腺良恶性结节提供影像学诊断依据。

磁共振评估关节微循环灌注及脂肪含量对早期活动性中轴型脊柱关节炎患者骶髂关节病变的诊断价值

目的应用磁共振体素内不相干运动(intravoxel incoherent motion,IVIM)-扩散加权成像(diffusion-weighted imaging,DWI)序列联合定量非对称回波的最小二乘估算法迭代水脂分离序列(iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence,IDEAL-IQ)测量早期活动性中轴型脊柱关节炎患者骶髂关节微循环灌注及脂肪含量变化,探讨其对早期活动性中轴型脊柱关节炎患者骶髂关节病变的临床诊断价值。方法37例早期活动性中轴型脊柱关节炎患者,均行磁共振常规T_(1)WI、T_(2)WI FSPD序列扫描,其中常规序列显示骶髂关节骨髓水肿为强直性脊柱炎阳性者29例为阳性组,强直性脊柱炎阴性者8例为阴性组,同期体检健康者20例为对照组;应用磁共振IVIM-DWI、IDEAL-IQ序列分别测量3组骶髂关节标准表观扩散系数(apparent diffusion coefficient,D_(stand))、慢速表观扩散系数(slow apparent diffusion coefficient,D_(slow))、快速表观扩散系数(fast apparent diffusion coefficient,D_(fast))、灌注分数(pseudo-diffusion coefficient,f)、骨髓脂肪分数(fat fraction,FF);绘制ROC曲线,评估磁共振IVIM-DWI、IDEAL-IQ序列D_(stand)、D_(slow)、D_(fast)、f、FF对早期活动性中轴型脊柱关节炎患者骶髂关节病变的诊断效能。结果IVIM-DWI序列显示,阳性组D_(stand)[(0.89±0.35)×10^(-3)mm^(2)/s]、D;[(0.95±0.27)×10^(-3)mm^(2)/s]、f(0.28±0.03)均高于阴性组[(0.61±0.12)×10^(-3)mm^(2)/s、(0.87±0.22)×10^(-3)mm^(2)/s、0.26±0.04]、对照组[(0.59±0.04)×10^(-3)mm^(2)/s、(0.73±0.17)×10^(-3)mm^(2)/s、0.25±0.02](P<0.05),阴性组均高于对照组(P<0.05);阳性组D;[(98.86±26.94)×10^(-3)mm^(2)/s]低于阴性组[(122.92±12.47)×10^(-3)mm^(2)/s]、对照组[(133.28±5.69)×10^(-3)mm^(2)/s](P<0.05),阴性组低于对照组(P<0.05);IDEAL-IQ序列显示,阳性组FF(38.38±13.99)低于阴性组(67.15±8.51)、对照组(62.38±8.44)(P<0.05),阴性组高于对照组(P<0.05)。D_(stand)、D_(slow)、D_(fast)、f、FF的最佳截断值分别为0.74×10^(-3)mm^(2)/s、0.67×10^(-3)mm^(2)/s、103.71×10^(-3)mm^(2)/s、0.27、57.71时,预测早期活动性中轴型脊柱关节炎患者骶髂关节病变的AUC分别为0.77(95%CI:0.65~0.86,P<0.001)、0.81(95%CI:0.70~0.89,P<0.001)、0.78(95%CI:0.67~0.87,P<0.001)、0.64(95%CI:0.52~0.75,P=0.037)、0.98(95%CI:0.91~0.99,P<0.001),灵敏度分别为65.52%、93.10%、55.17%、37.39%、96.55%,特异度分别为90.48%、61.90%、90.48%、88.10%、88.10%。结论磁共振IVIM-DWI、IDEAL-IQ序列可定量分析早期活动性中轴型脊柱关节炎患者骶髂关节微循环灌注及脂肪含量的变化,D_(stand)、D_(slow)、D_(fast)、FF对早期活动性中轴型脊柱关节炎患者骶髂关节病变有较高诊断价值。