From the Department of Radiology, Seoul National University Hospital, Seoul, South Korea (H.J.Y., S.H.H., H.Y.O., J.Y.C., H.D.C.); Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea (H.J.Y., S.H.H., J.Y.C., H.D.C., J.M.A., H.S.K.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea (S.H.H., H.S.K.); and Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.M.A., H.S.K.).
Radiology. 2017 Jun;283(3):769-778. doi: 10.1148/radiol.2016160155. Epub 2016 Oct 24.
Purpose To determine the agreement of fat-suppressed (FS) fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging and contrast material-enhanced (CE) T1-weighted MR imaging for the assessment of peripatellar synovitis. Materials and Methods The institutional review board approved this retrospective study and waived the requirement for patient informed consent. Thirty-three patients with knee pain underwent 3-T MR imaging. The protocol consisted of routine clinical sequences followed by the FLAIR FS sequence (inversion time, 2200 msec) and CE T1-weighted imaging. Visibility of the synovium, synovial thickness, and severity of synovitis in five peripatellar regions were assessed with both sequences. Hoffa synovitis on unenhanced MR images was also analyzed. Then, correlations and agreements between FLAIR FS and CE T1-weighted imaging were evaluated. Diagnostic performance statistics of FLAIR FS and Hoffa synovitis were calculated by using CE T1-weighted imaging as the reference standard. Results Peripatellar synovitis on FLAIR FS images was found in 14 patients by reader 1 and in 17 patients by reader 2. Strong correlations were found between FLAIR FS and CE T1-weighted imaging in the assessment of peripatellar synovitis by both readers (correlation coefficient, 0.675-0.973). With CE T1-weighted imaging as the reference standard, FLAIR FS showed relatively good diagnostic performance for the detection of synovitis of any severity (accuracy of 92.1%-93.9% at the site level and 90.9% at the patient level), while Hoffa synovitis on unenhanced MR images showed moderate sensitivity (78.9%-87.5%) and low specificity (47.1%-64.3%) for the detection of peripatellar synovitis. There was good agreement between the two readers for the synovial visibility (weighted κ = 0.81-0.88) and synovitis assessments (intraclass correlation coefficient = 0.95, weighted κ = 0.72-0.79) on FLAIR FS and CE T1-weighted images. Conclusion Our preliminary study shows that FLAIR FS imaging can potentially enable evaluation of inflamed synovium with high sensitivity and specificity, without the injection of a contrast agent. RSNA, 2016 Online supplemental material is available for this article.
旨在确定脂肪抑制（FS）液体衰减反转恢复（FLAIR）磁共振（MR）成像与对比增强（CE）T1 加权 MR 成像在评估髌周滑膜炎症中的一致性。
本回顾性研究经机构审查委员会批准，且豁免了患者知情同意书的要求。33 例膝关节疼痛患者接受了 3T MR 成像检查。该方案包括常规临床序列，随后是 FLAIR FS 序列（反转时间，2200msec）和 CE T1 加权成像。使用两种序列评估髌周 5 个部位的滑膜可见性、滑膜厚度和滑膜炎症严重程度。还分析了非增强 MR 图像上的 Hoffa 滑膜炎。然后，评估了 FLAIR FS 和 CE T1 加权成像之间的相关性和一致性。使用 CE T1 加权成像作为参考标准，计算 FLAIR FS 和 Hoffa 滑膜炎的诊断性能统计数据。
由读者 1 在 FLAIR FS 图像上发现 14 例髌周滑膜炎，由读者 2 在 FLAIR FS 图像上发现 17 例。两位读者在评估髌周滑膜炎时，均发现 FLAIR FS 与 CE T1 加权成像之间具有较强的相关性（相关系数为 0.675-0.973）。以 CE T1 加权成像作为参考标准，FLAIR FS 显示出对任何严重程度滑膜炎检测的较好诊断性能（在部位水平的准确率为 92.1%-93.9%，在患者水平的准确率为 90.9%），而未增强 MR 图像上的 Hoffa 滑膜炎对髌周滑膜炎的检测具有中等敏感性（78.9%-87.5%）和较低特异性（47.1%-64.3%）。两位读者在 FLAIR FS 和 CE T1 加权图像上的滑膜可见性（加权 κ=0.81-0.88）和滑膜炎评估（组内相关系数=0.95，加权 κ=0.72-0.79）方面具有较好的一致性。
我们的初步研究表明，FLAIR FS 成像有可能在不注射造影剂的情况下，以较高的灵敏度和特异性来评估炎症滑膜。
RSNA，2016 在线补充材料可在本文中获得。
