IDEAL-IQ联合IVIM-DWI对激素性股骨头坏死脂肪含量及局部微循环的相关性研究

发布时间：2018-01-14 13:46

本文关键词：IDEAL-IQ联合IVIM-DWI对激素性股骨头坏死脂肪含量及局部微循环的相关性研究　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:利用磁共振定量技术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 quantitation sequence,IDEAL-IQ)和体素内不相干运动磁共振扩散加权成像(Intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)分别无创性地测量激素性股骨头坏死塌陷前,即ARCOⅠ期、Ⅱ期及Ⅲ早期患者的脂肪含量及局部微循环指标,分析各定量指标与ARCO分期的相关性,并探讨股骨头坏死脂肪含量与局部微循环的相关性。利用IDEAL-IQ和IVIM-DWI定量技术无创性地分析单髋激素性股骨头坏死患者正常侧股骨头的脂肪含量及局部微循环指标,并探讨该定量指标与健康对照组之间有无差异,以期对股骨头坏死进行超早期诊断。材料与方法:1.IDEAL-IQ联合IVIM-DWI定量技术对激素性股骨头坏死脂肪含量及局部微循环的相关性研究本研究前瞻性地研究了 2015年10月至2017年03月,在广州中医药大学第一附属影像科经X线、MRI及临床证实的53例激素性股骨头坏死病例,其中ARCO Ⅰ期3例,ARCOⅡ期 12 例,ARCOⅢ早期 14 例,ARCOⅢ 晚期 13 例,ARCOⅣ 期 11 例,共78个股骨头受累,符合条件者共39个,受试者年龄范围为16—58岁,中位年龄为42岁,在治疗前均行X线、MRI检查及ARCO分期,所有患者均为初治患者。股骨头坏死患者均选取塌陷前期,即ARCOⅠ期、ARCOⅡ期及ARCO Ⅲ期早期。该研究通过了我院伦理委员会审查,所有受试者均签署了检查知情同意书。磁共振扫描序列包括普通序列(轴位及冠状位T2WI/fs、矢状位T1WI、冠状位LAVAFLEX)及生理序列(轴位IVIM-DWI及IDEAL-IQ序列),其中IVIM-DWI采用9个b 值(10、20、30、50、80、100、200、400、1000)。扫描结束后将 IDEAL-IQ 及 IVIM-DWI图像分别上传至工作站进行后处理,同时将坏死股骨头分为三个不同区域,即坏死区、硬化区及正常区,分别测量不同区域的脂肪含量——FF(fat fraction)值及局部微循环f值。采用SPSS 22.0进行统计学计算与分析。首先采用方差分析(analysis of variance,ANOVA)比较坏死股骨头不同区域的FF值与f值有无差异,P㩳0.05为差异有统计学意义。如差异有统计学意义,再用Pearson相关分析研究FF值、f值与ARCO分期的相关性,同时用Pearson相关分析对激素性股骨头坏死脂肪含量FF值及局部微循环f值进行相关性分析,P㩳0.05为差异有统计学意义。2.单髋激素性股骨头坏死患者正常侧股骨头脂肪含量及局部微循环研究本研究前瞻性地研究了广州中医药大学第一附属医院确诊的30例单髋激素性股骨头坏死初治患者,选取单髋激素性股骨头坏死患者正常侧股骨头作为对侧正常组,坏死侧为坏死组,同时选取16例健康志愿者作为对照组,所有病例均行X线、CT及MRI检查,其中MRI扫描序列包括:常规序列(轴位及冠状位T2WI/fs、矢状位T1WI、冠状位LAVAFLEX)及生理序列(轴位IDEAL-IQ及IVIM-DWI序列),将生理成像序列扫描所得图像上传至工作站进行后处理,测量出定量参数——脂肪含量FF值及局部微循环f值。采用方差分析分析对侧正常组、坏死组及对照组之间的定量数值是否存在差异,P㩳0.05为差异有统计学意义。结果:1.IDEAL-IQ联合IVIM-DWI定量技术对激素性股骨头坏死脂肪含量及局部微循环的相关性研究激素性股骨头坏死不同区域,即坏死区、硬化带区及正常区的FF值与f值分别为(102.42±36.67、38.56±13.04、75.24±14.55,0.30±0.07、0.34±0.08、0.40±0.08),差异有统计学意义(F=51.76、12.36,P均0.01),坏死区的FF值最大,局部微循环f值最小,P均0.01,差异有统计学意义。ARCO Ⅲ期早期的FF值最大(130.50±34.75,P0.05),f 值最小(0.30±0.67,P0.05),差异有统计学意义。并且FF值与ARCO分期呈正相关(r=0.72,P㩳0.01),差异有统计学意义;f值与ARCO分期没有明显相关性(r=-0.17,P0.05),差异无统计学意义。此外,激素性股骨头坏死内的FF值和f值呈现负性相关(r=-0.37,P㩳0.05),差异有统计学意义。2.单髋激素性股骨头坏死患者正常侧股骨头脂肪含量及局部微循环研究在形态学方面,传统MRI检查发现对侧正常组同对照组并无差异,均未见明显坏死区及硬化带。然而通过定量技术IDEAL-IQ及IVIM-DWI测量组织内的生理参数得出:对侧正常组的FF值及f值分别为92.29±3.74、0.36±0.06,坏死组的FF值及f值分别为 102.20±36.05、0.31±0.67,对照组的 FF 值及 f 值分别为 80.88±4.58、0.37±0.07,FF值及f值比较的统计值F值分别为8.11、8.93,P值分别为0.001、0.000,P均0.01,差异有统计学意义。对照组的FF值小于对侧正常组,P㩳0.05,差异有统计学意义;对照组的FF值小于坏死组,P0.01,差异有统计学意义。坏死组的f值小于对侧正常组,P㩳0.01,差异有统计学意义;坏死组的f值小于对照组,P=0.000,P㩳0.01,差异有统计学意义。结论:1.IDEAL-IQ联合IVIM-DWI定量技术对激素性股骨头坏死脂肪含量及局部微循环的相关性研究磁共振IDEAL-IQ联合IVIM-DWI定量成像技术可分别无创地用于激素性股骨头坏死塌陷前期脂肪含量及局部微循环的测量,股骨头坏死ARCO Ⅲ期早期的脂肪含量最高,而局部微循环最小,且股骨头坏死脂肪含量随着ARCO分期的增长而增长,而局部微循环则随着ARCO分期的增长有减少的趋势。激素性股骨头坏死脂肪含量与局部微循环呈负相关。2.单髓激素性股骨头坏死患者正常侧股骨头脂肪含量及局部微循环研究单髋股骨头坏死对侧正常组经传统MRI检查并未发现异常形态学改变,其影像学表现同正常股骨头没有明显不同。但磁共振生理成像技术IDEAL-IQ及IVIM-DWI却通过定量参数检测出其内的生理指标已发生改变。其脂肪含量FF值较正常人升高,局部微循环较坏死股骨头升高。这就提示股骨头坏死对侧正常股骨头在坏死发生形态学改变之前其内的生理指标(尤指脂肪含量的变化)就已经发生改变,即进入坏死超早期。
[Abstract]:Objective: by using the least square magnetic resonance quantitative technique of asymmetric echo estimation method of iterative water fat separation (iterative decomposition of water and sequence fat with echo asymmetry and least-squares estimation quantitation sequence, IDEAL-IQ) and intravoxel incoherent motion of magnetic resonance diffusion weighted imaging (Intravoxel incoherent motion diffusion weighted imaging, IVIM-DWI) were non invasively measurement of steroid induced necrosis of femoral head collapse before the ARCO stage, the fat content in patients with early phase II and III and the local microcirculation index, analysis of the correlation between the index and the stage of ARCO, and to explore the relationship between the content of fat necrosis of the femoral head and the microcirculation. Using IDEAL-IQ and IVIM-DWI quantitative noninvasive analysis of single the hip of the femoral head necrosis in patients with the normal side of the femoral head microcirculation index and fat content, and to explore the There is no difference between the quantitative index and the healthy control group, with a view to avascular necrosis of super early diagnosis. Materials and methods: To study the correlation of 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and local microcirculation of the fat content of this study prospectively studied from October 2015 to 2017 03, X-ray at the Guangzhou University of Chinese Medicine the first affiliated Department of Radiology, MRI and clinical confirmed 53 cases of steroid induced necrosis of the femoral head cases, including 3 cases of ARCO stage, 12 cases of ARCO II, ARCO III early in 14 cases, 13 cases of advanced ARCO ARCO III, IV in 11 cases, a total of 78 femoral head involvement, in line with the conditions of a total of 39. The subjects aged 16 - 58 years old, the median age was 42 years old, before treatment underwent X-ray, MRI examination and ARCO staging, all patients were newly diagnosed patients. Patients with avascular necrosis of the femoral head were selected before collapse, namely the first stage of ARCO, ARCO II and AR Early CO stage. The research by our hospital ethics review committee and all subjects signed the informed consent. MRI scanning sequences included common sequence (axial and coronal T2WI/fs, sagittal T1WI, coronal LAVAFLEX) and physiological (axial IVIM-DWI sequence and IDEAL-IQ sequence), which IVIM-DWI uses 9 b values (10,20,30,50,801002004001000). After scanning the IDEAL-IQ and IVIM-DWI images were uploaded to the workstation for postprocessing, and necrosis of the femoral head is divided into three different regions, namely the necrosis area, hardening area and normal area were measured, the fat content in different regions of the FF (fat fraction) and local the microcirculation F value. SPSS 22 was used for statistical calculation and analysis. Firstly, by analysis of variance (analysis of, variance, ANOVA) between different regions of bone necrosis of femoral FF values had no difference, and the value of F P 0.05 is the difference? There was a significant correlation. The difference was statistically significant, FF correlation analysis and Pearson value, correlation between F value and ARCO stage, and Pearson correlation analysis of steroid induced necrosis of the femoral head fat content FF value and F value of local microcirculation correlation analysis, P? 0.05 for the difference was statistically significant.2. single hip hormone femoral head necrosis of femoral head in patients with normal fat content and microcirculation in this study prospectively studied diagnosed the First Affiliated Hospital of Guangzhou University of Chinese Medicine, 30 cases of single hip necrosis of the femoral head in untreated patients, the hip of the femoral head necrosis of femoral head in patients with normal contralateral normal group, necrosis necrosis side group, while 16 healthy volunteers were enrolled as control group. All patients underwent X-ray, CT and MRI examination, MRI scanning sequences included conventional sequence (axial and coronal sagittal T2WI /fs. T1WI, coronal LAVAFLEX) and physiological (axial IDEAL-IQ sequence and IVIM-DWI sequence), the physiological imaging sequence scanned image upload to the workstation for postprocessing, measurement of quantitative parameters - fat content FF value and F value of local microcirculation. By analysis of variance analysis of the normal side group, whether there are differences between the quantitative values necrosis group and control group, P? 0.05 for the difference was statistically significant. Results: 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and fat content of local microcirculation correlation study of femoral head necrosis in different regions, namely the necrosis area, hardening area and normal area of the FF and F values respectively (102.42 + 36.67,38.56 + 13.04,75.24 + 14.55,0.30 + 0.07,0.34 + 0.08,0.40 + 0.08), the difference was statistically significant (F=51.76,12.36, P 0.01), the necrosis area of the FF value of local micro circulation f minimum, P 0.01, There was a significant difference between the phase III.ARCO early FF maximum (130.50 + 34.75, P0.05), f (minimum 0.30 + 0.67, P0.05), the difference was statistically significant. And FF was positively correlated with the stage of ARCO (r=0.72, P? 0.01), the difference was statistically significant; the value of F and ARCO stage had no obvious correlation (r=-0.17, P0.05), the difference was not statistically significant. In addition, steroid induced necrosis of the femoral head within the FF and F values showed a negative correlation (r=-0.37, P? 0.05), the difference was statistically significant.2. single hip femoral head necrosis of femoral head in patients with normal fat content and local microcirculation in morphology MRI, the traditional examination showed contralateral normal group with no difference in the control group, there were no obvious necrosis and hardening zone. However the physiological parameters of quantitative techniques IDEAL-IQ and IVIM-DWI measurements within the organization that contralateral normal group of FF and F values were 92.29 + 3.74,0.36 + 0.06, Necrosis group FF value and F value were 102.20 + 36.05,0.31 + 0.67, the control group of the FF and F values were 80.88 + 4.58,0.37 + 0.07, FF value and F value of the statistical value of F-measure respectively 8.11,8.93, P = 0.001,0.000, P was 0.01, there were statistically significant differences in the control group. The FF value is less than the contralateral normal group, P? 0.05, the difference was statistically significant; the control group of the FF value is less than P0.01, necrosis group, the difference was statistically significant. The F value is less than the normal group, P group 0.01, necrosis? The difference was statistically significant; the f value is less than the control group, P=0.000, P necrosis group? 0.01, the difference was statistically significant. Conclusion: 1.IDEAL-IQ combined with IVIM-DWI quantitative technique on the treatment of femoral head necrosis and fat content of local microcirculation correlation study on magnetic resonance imaging quantitative IDEAL-IQ combined with IVIM-DWI can noninvasively for collapse of osteonecrosis of the femoral head in early fat The measurement and microcirculation, avascular necrosis of the femoral head in early stage ARCO the highest fat content, while the local microcirculation and minimal necrosis of the femoral head lipid content increases with the stage of ARCO growth, while the local microcirculation with ARCO stage growth decreased. Necrosis of the femoral head microcirculation and fat content was negative.2. single spinal cord of the femoral head necrosis of femoral head in patients with normal fat content and local microcirculation of single hip avascular necrosis of the contralateral normal group after conventional MRI examination did not find abnormal morphological changes, the imaging appearance with normal femoral head was not significantly different. But the magnetic resonance imaging and physiological IDEAL-IQ IVIM-DWI but by quantitative parameters to detect the physiological indexes in it have changed. The fat content of FF was higher than in normal people, the local microcirculation of femoral head necrosis is increased. This suggests that stocks The physiological index (especially the change of fat content) has been changed before the morphological change of normal femoral head on the contralateral side of the femoral head.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R681.8

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