人体长骨的体内发育：胎儿股骨远端骺软骨的磁共振成像分析。
Human long bone development in vivo: analysis of the distal femoral epimetaphysis on MR images of fetuses.
机构信息
Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
出版信息
Radiology. 2013 May;267(2):570-80. doi: 10.1148/radiol.13112441. Epub 2013 Feb 7.
PURPOSE
To investigate human long bone development in vivo by analyzing distal femoral epimetaphyseal structures and bone morphometrics on magnetic resonance (MR) images of fetuses.
MATERIALS AND METHODS
An institutional review board approved this retrospective study, and informed consent was waived. Included were 272 MR imaging examinations (April 2004-July 2011) in 253 fetuses with a mean gestational age (GA) of 26 weeks 6 days (range, 19 weeks 2 days to 35 weeks 6 days) without known musculoskeletal abnormalities. Two independent readers qualitatively analyzed epiphyseal and metaphyseal shape, secondary ossification, and the perichondrium on 1.5-T echo-planar MR images and correlated the results with the GA that was derived from previous fetal ultrasonography (US). Diaphyseal and epiphyseal morphometric measurements were correlated with GA by means of the Pearson correlation and linear regression. MR imaging measurements of diaphyseal length and US normative values were compared graphically. Interreader agreement analysis was performed with weighted κ statistics and the intraclass correlation coefficient.
RESULTS
With advancing GA, the epiphyseal shape changed from spherical (r(2) = 0.664) to hemispherical with a notch (r(2) = 0.804), and the metaphyseal shape changed from flat (r(2) = 0.766) to clearly undulated (r(2) = 0.669). Secondary ossification (r(2) = 0.777) was not observed until 25 weeks 3 days. The perichondrium decreased (r(2) = 0.684) from 20 weeks onward. Correlation coefficients were 0.897 for diaphyseal length, 0.738 for epiphyseal length, and 0.801 for epiphyseal width with respect to GA. The range of measurements of diaphyseal length was larger than that of the reported US normative values. Interreader agreement was good for bone morphometrics (intraclass correlation coefficient, 0.906-0.976), and moderate for bone characteristics (weighted κ, 0.448-0.848).
CONCLUSION
Prenatal MR imaging allows visualization of human bone development in vivo by means of epimetaphyseal characteristics and bone morphometrics.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112441/-/DC1.
目的
通过分析胎儿磁共振（MR）图像中远端股骨骺软骨下结构和骨形态计量学来研究人体长骨的体内发育。
材料与方法
本回顾性研究经机构审查委员会批准，且豁免了知情同意。共纳入 253 例胎儿的 272 次 MR 成像检查（2004 年 4 月至 2011 年 7 月），这些胎儿的平均胎龄（GA）为 26 周 6 天（范围为 19 周 2 天至 35 周 6 天），无明显的肌肉骨骼异常。两位独立的读者对骺软骨和骺软骨下的形状、次级骨化和软骨膜进行定性分析，并在 1.5-T 回波平面 MR 图像上对其进行相关性分析，结果与之前的胎儿超声（US）获得的 GA 相关联。通过 Pearson 相关和线性回归分析，将骨干和骺干的形态计量学测量值与 GA 进行相关性分析。MR 成像的骨干长度测量值与 US 正常值的比较以图形方式进行。采用加权 κ 统计和组内相关系数进行读者间一致性分析。
结果
随着 GA 的增加，骺软骨的形状从球形（r²=0.664）变为半球形伴切迹（r²=0.804），骺软骨下的形状从扁平（r²=0.766）变为明显的波浪形（r²=0.669）。直到 25 周 3 天，才出现次级骨化（r²=0.777）。软骨膜从 20 周开始减少（r²=0.684）。GA 与骨干长度的相关系数为 0.897，与骺干长度的相关系数为 0.738，与骺干宽度的相关系数为 0.801。骨干长度的测量范围大于报告的 US 正常值。骨形态计量学的读者间一致性较好（组内相关系数为 0.906-0.976），骨特征的读者间一致性为中等（加权 κ 值为 0.448-0.848）。
结论
产前 MR 成像可以通过骺软骨下特征和骨形态计量学来可视化人体骨骼的体内发育。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112441/-/DC1.
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