添加 3D 软骨成像序列对常规膝关节磁共振成像方案的临床应用价值。
Clinical usefulness of adding 3D cartilage imaging sequences to a routine knee MR protocol.
机构信息
Department of Radiology, University of Wisconsin, Clinical Science Center, 600 Highland Ave., E3/311, Madison, WI 53792-3252, USA.
出版信息
AJR Am J Roentgenol. 2011 Jan;196(1):159-67. doi: 10.2214/AJR.09.4095.
OBJECTIVE
The objective of our study was to determine whether 3D sequences can improve the diagnostic performance of a routine MR protocol for detecting cartilage lesions within the knee joint at 3 T.
SUBJECTS AND METHODS
An iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) spoiled gradient-recalled echo (SPGR) sequence (n = 75 patients) or an IDEAL gradient-recalled acquisition in a steady state (GRASS) sequence (n = 75 patients) was added to routine 3-T knee MR protocol to examine 150 patients who subsequently underwent arthroscopic knee surgery. Each articular surface of the knee joint was graded at arthroscopy. All MR examinations were independently reviewed twice by two musculoskeletal radiologists. During the first review, the routine MR protocol was used alone to grade each articular surface of the knee joint; during the second review, the routine MR protocol was used with IDEAL-SPGR or IDEAL-GRASS. Using arthroscopy as the reference standard, the sensitivity and specificity for detecting cartilage lesions and the proportion of correctly graded cartilage lesions were determined for the routine MR protocol alone and for the routine MR protocol with IDEAL-SPGR or IDEAL-GRASS. The McNemar test was used to compare sensitivity, specificity, and accuracy values and proportions of correctly graded cartilage lesions.
RESULTS
There was a statistically significant improvement in the specificity (p < 0.05) but not the sensitivity (p = 0.08-0.32) for detecting cartilage lesions when using the routine MR protocol with IDEAL-SPGR or IDEAL-GRASS. There was also a statistically significant (p < 0.05) improvement in the proportion of correctly graded cartilage lesions when using the routine MR protocol with IDEAL-SPGR or with IDEAL-GRASS.
CONCLUSION
Adding 3D sequences to a routine MR protocol improves the diagnostic performance for detecting cartilage lesions within the knee joint at 3 T.
目的
本研究旨在确定在 3T 磁共振（MR）检查中，三维（3D）序列是否可以提高常规 MR 协议检测膝关节软骨病变的诊断性能。
材料与方法
对 150 例接受关节镜膝关节手术的患者，在常规 3T 膝关节 MR 检查中分别加入迭代水脂分离反演恢复（IDEAL）扰相梯度回波（SPGR）序列（n=75 例）或 IDEAL 稳态梯度回波采集（GRASS）序列（n=75 例），对其膝关节进行检查。每位患者的膝关节关节面在关节镜下进行分级。所有 MR 检查均由 2 位肌肉骨骼放射科医生独立进行两次复查。第一次复查时仅使用常规 MR 协议对膝关节各关节面进行分级；第二次复查时，同时使用常规 MR 协议和 IDEAL-SPGR 或 IDEAL-GRASS 协议。以关节镜检查为参考标准，确定单独使用常规 MR 协议以及联合 IDEAL-SPGR 或 IDEAL-GRASS 协议时检测软骨病变的敏感性、特异性和正确分级软骨病变的比例。采用 McNemar 检验比较单独使用常规 MR 协议以及联合 IDEAL-SPGR 或 IDEAL-GRASS 协议时的敏感性、特异性和准确性值以及正确分级软骨病变的比例。
结果
单独使用常规 MR 协议联合 IDEAL-SPGR 或 IDEAL-GRASS 协议检测软骨病变的特异性（p＜0.05）较单独使用常规 MR 协议时提高（p=0.080.32），但敏感性差异无统计学意义（p=0.080.32）。单独使用常规 MR 协议联合 IDEAL-SPGR 或 IDEAL-GRASS 协议时，正确分级软骨病变的比例也明显提高（p＜0.05）。
结论
在常规 MR 协议中加入 3D 序列可提高 3T 膝关节软骨病变的诊断性能。
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