多模态MRI在骶髂关节炎的应用研究

发布时间：2018-04-06 06:30

本文选题：骶髂关节炎　切入点：多模态磁共振成像　出处：《青岛大学》2017年硕士论文

【摘要】：第一部分：3D-MEDIC-WE序列在SIS关节软骨病变的应用研究目的：探讨3D-MEDIC-WE序列显示SIJ软骨的能力及对SIS关节软骨病变的诊断价值。方法：收集具有典型AS临床症状的患者60例,另选取20名志愿者作为对照组。对双侧骶髂关节采用斜冠状位扫描,序列包括T1WI、T2WI、TIRM-T2WI及3D-MEDIC-WE。对对照组骶髂关节软骨各序列表现进行主观评价并在3D-MEDIC-WE上测量SIJ软骨厚度、骶侧及髂侧的软骨厚度;对患者组关节软骨在各序列上改变进行主观评价并按照边缘光整程度等建立分值标准(0~4分);在TIRM-T2WI、3D-MEDIC-WE上分别进行SIJ软骨分级评分。结果：对照组T1WI、T2WI序列不能显示骶髂关节软骨;TIRM-T2WI上软骨呈稍高信号,与关节面下骨质区分度差;3D-MEDIC-WE序列可以清晰显示骶髂关节软骨,能分辨骶侧、髂侧软骨及两者间的间隙。正常骶髂关节软骨厚约(2.70±0.41)mm,骶侧软骨厚约(1.21±0.22)mm,髂侧软骨厚约(0.72±0.31)mm,骶侧软骨比髂侧软骨明显厚(t=10.90,P0.01)。患者组SIJ软骨在3D-MEDIC-WE序列上软骨表现为信号均匀,边缘光滑20侧;软骨边缘不光整19侧;信号不均匀,边缘毛糙50侧;有不同程度增厚或变窄、扭曲,边缘呈锯齿状27侧;中断甚至未显示4侧。患者组在3D-MEDIC-WE序列上的软骨侵蚀分数高于TIRM-T2WI序列(c2=176.644,P0.01)。结论：3D-MEDIC-WE序列可以清晰显示骶髂关节软骨,包括髂侧、骶侧软骨及两者间的间隙;3D-MEDIC-WE序列对骶髂关节炎关节软骨病变的显示优于其他序列。第二部分：DWI、DCE-MRI诊断骶髂关节急性炎症的价值目的：探讨DWI、DCE-MRI评估骶髂关节急性炎症的价值。方法：收集具有典型AS临床症状的可疑患者42例,另选取18名志愿者作为对照组。对双侧骶髂关节进行MR平扫、动态增强扫描及扩散加权成像(DWI)。根据TIRM-T2WI序列上骨髓信号是否增高将患者分为急性炎症组和非急性炎症组。对急性炎症组进行SPARCC评分。制作时间-信号曲线(TIC)并对其分型;计算、测量各组骨髓区的增强因子(Fenh)、增强斜率(Senh)及表观扩散系数(ADC)。并对急性炎症组SPARCC评分、ADC及Fenh三者间进行相关性分析。结果：TIRM-T2WI、DWI、DCE-MRI分别检出35侧、34侧、36侧关节面下急性炎症;差异无统计学意义(c2=2.06,P0.05)。急性炎症组SPARCC评分为21.06±3.15。急性炎症组病变区ADC值、Fenh及Senh均高于非急性炎症组及对照组,差异有统计学意义(F分别为381.591、62.080、11.097,P均0.01);非炎症组和对照组上述三个参数差异无统计学意义(P均0.05)。急性炎症组TIC表现为快速上升平台型(72.22%)、持续快速上升型(27.78%);非急性炎症组及对照TIC均表现为速升缓降型。急性炎症组的SPARCC评分与ADC、SPARCC评分与Fenh以及ADC与Fenh均呈正相关(r分别为0.874、0.673、0.723,P均0.05)。结论：DWI、DCE-MRI均可敏感显示SIJ急性炎症,通过测量ADC值,计算Fenh、Senh可量化评价炎性病变程度,对SIJ急性炎症的诊断具有价值。
[Abstract]:Part 1: application of 3D-MEDIC-WE sequence in SIS articular cartilage objective: to investigate the ability of 3D-MEDIC-WE sequence to display SIJ cartilage and its diagnostic value in SIS articular cartilage lesions.Methods: 60 patients with typical as symptoms were collected and 20 volunteers were selected as control group.The bilateral sacroiliac joints were scanned with oblique coronal position. The sequences included T1WIT2WIT TIRM-T2WI and 3D-MEDIC-WE.The thickness of SIJ cartilage, the thickness of sacral side and iliac side were measured on 3D-MEDIC-WE by subjective evaluation of each sequence of sacroiliac articular cartilage in control group.The changes of articular cartilage in each sequence of patients were evaluated subjectively, and the score standard was established according to the degree of edge smoothing, and the SIJ cartilage grading score was carried out on TIRM-T2WI3D-MEDIC-WE.Results: the T1WII-T2WI sequence of the control group could not display the superior cartilage of sacroiliac articular cartilage on TIRM-T2WI, but the 3D-MEDIC-WE sequence could clearly display the sacroiliac articular cartilage and distinguish the sacroiliac articular cartilage from the sacroiliac articular cartilage and the interspace between the sacroiliac articular cartilage and the sacroiliac articular cartilage.The thickness of normal sacroiliac articular cartilage was about 2.70 卤0.41mm. the thickness of sacral cartilage was about 1.21 卤0.22mm. the thickness of iliac cartilage was 0.72 卤0.31mm. the thickness of sacroiliac cartilage was significantly thicker than that of iliac cartilage.The SIJ cartilage in the patient group showed homogeneous signal intensity on 3D-MEDIC-WE sequence, smooth edge in 20 sides, not only 19 sides of cartilage margin, but also uneven signal intensity, rough edge in 50 sides, thickening or narrowing in varying degrees, distortion and serrated edge in 27 sides.The interruption did not even show 4 sides.The cartilage erosion score on 3D-MEDIC-WE sequence was higher in the patient group than that in the TIRM-T2WI sequence.Conclusion the 3D-MEDIC-WE sequence can clearly display the sacroiliac articular cartilage, including iliac side, sacral cartilage and the interspace between them. The 3D-MEDIC-WE sequence is superior to other sequences in displaying the articular cartilage lesions of sacroiliac arthritis.Part II: the value of DCE-MRI in the diagnosis of acute sacroiliac joint inflammation objective: to evaluate the value of DWII-DCE-MRI in the assessment of acute sacroiliac joint inflammation.Methods: 42 suspicious patients with typical as clinical symptoms were collected and 18 volunteers were selected as control group.The bilateral sacroiliac joints were examined by Mr scan, dynamic contrast enhancement and diffusion weighted imaging.Patients were divided into acute inflammation group and non-acute inflammation group according to whether the bone marrow signal on TIRM-T2WI sequence was elevated.SPARCC score was used in acute inflammation group.The time-signal curve (TIC) was made and classified, and the enhancement factor (Fenhan), enhanced slope (Senhan) and apparent diffusion coefficient (ADCA) of bone marrow area in each group were measured.The correlation between SPARCC score and Fenh in acute inflammation group was analyzed.Results the acute subarticular inflammation was detected on DWCE-MRI in 35 sides and 34 sides in 36 sides of articular surface, but there was no significant difference between the two groups (P 0.05).The SPARCC score of acute inflammation group was 21.06 卤3.15.The values of ADC and Senh in the lesion area of acute inflammation group were higher than those in non-acute inflammation group and control group, the difference was statistically significant (F = 381.591D, 62.080 / 11.097g, P < 0.01), but there was no significant difference between non-inflammatory group and control group (P < 0.05).The TIC of acute inflammation group was 72.22%, and that of continuous rapid rising type was 27.78%, and that of non-acute inflammation group and control group was rapid ascending and slowly descending type.In acute inflammation group, there was a positive correlation between SPARCC score, Fenh score, ADC score and Fenh score (P < 0.05).ConclusionDCE-MRI can sensitively display the acute inflammation of SIJ. By measuring the value of ADC, the degree of inflammation can be quantitatively evaluated by calculating the value of Fenh-Senh, which is valuable in the diagnosis of acute inflammation of SIJ.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R593.23

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