5 分钟膝关节 MRI 同时评估软骨和半月板的形态学和 T2 弛豫率，并使用 3T 下稳态双回波进行半定量放射学评估。
Five-minute knee MRI for simultaneous morphometry and T relaxometry of cartilage and meniscus and for semiquantitative radiological assessment using double-echo in steady-state at 3T.
机构信息
Department of Radiology, Stanford University, Stanford, California, USA.
Department of Bioengineering, Stanford University, Stanford, California, USA.
出版信息
J Magn Reson Imaging. 2018 May;47(5):1328-1341. doi: 10.1002/jmri.25883. Epub 2017 Nov 1.
BACKGROUND
Biomarkers for assessing osteoarthritis activity necessitate multiple MRI sequences with long acquisition times.
PURPOSE
To perform 5-minute simultaneous morphometry (thickness/volume measurements) and T relaxometry of both cartilage and meniscus, and semiquantitative MRI Osteoarthritis Knee Scoring (MOAKS).
STUDY TYPE
Prospective.
SUBJECTS
Fifteen healthy volunteers for morphometry and T measurements, and 15 patients (five each Kellgren-Lawrence grades 0/2/3) for MOAKS assessment.
FIELD STRENGTH/SEQUENCE: A 5-minute double-echo steady-state (DESS) sequence was evaluated for generating quantitative and semiquantitative osteoarthritis biomarkers at 3T.
ASSESSMENT
Flip angle simulations evaluated tissue signals and sensitivity of T measurements. Morphometry and T reproducibility was compared against morphometry-optimized and relaxometry-optimized sequences. Repeatability was assessed by scanning five volunteers twice. MOAKS reproducibility was compared to MOAKS derived from a clinical knee MRI protocol by two readers.
STATISTICAL TESTS
Coefficients of variation (CVs), concordance confidence intervals (CCI), and Wilcoxon signed-rank tests compared morphometry and relaxometry measurements with their reference standards. DESS MOAKS positive percent agreement (PPA), negative percentage agreement (NPA), and interreader agreement was calculated using the clinical protocol as a reference. Biomarker variations between Kellgren-Lawrence groups were evaluated using Wilcoxon rank-sum tests.
RESULTS
Cartilage thickness (P = 0.65), cartilage T (P = 0.69), and meniscus T (P = 0.06) did not significantly differ from their reference standard (with a 20° DESS flip angle). DESS slightly overestimated meniscus volume (P < 0.001). Accuracy and repeatability CVs were <3.3%, except the meniscus T accuracy (7.6%). DESS MOAKS had substantial interreader agreement and high PPA/NPA values of 87%/90%. Bone marrow lesions and menisci had slightly lower PPAs. Cartilage and meniscus T , and MOAKS (cartilage surface area, osteophytes, cysts, and total score) was higher in Kellgren-Lawrence groups 2 and 3 than group 0 (P < 0.05).
DATA CONCLUSION
The 5-minute DESS sequence permits MOAKS assessment for a majority of tissues, along with repeatable and reproducible simultaneous cartilage and meniscus T relaxometry and morphometry measurements.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:1328-1341.
背景
评估骨关节炎活动的生物标志物需要多次 MRI 序列和长时间采集。
目的
进行 5 分钟的同时形态测量（厚度/体积测量）和软骨及半月板 T 弛豫度测量，以及半定量的膝关节骨关节炎磁共振评分（MOAKS）。
研究类型
前瞻性。
受试者
15 名健康志愿者进行形态学和 T 测量，15 名患者（每个 Kellgren-Lawrence 等级 0/2/3 各 5 名）进行 MOAKS 评估。
磁场强度/序列：在 3T 下评估了 5 分钟的双回波稳态（DESS）序列，以生成定量和半定量的骨关节炎生物标志物。
评估
翻转角模拟评估组织信号和 T 测量的灵敏度。比较了形态学和 T 重复性与形态学优化和弛豫度优化序列。通过对 5 名志愿者进行两次扫描来评估可重复性。通过两位读者比较了 MOAKS 与临床膝关节 MRI 方案得出的 MOAKS 的重复性。
统计学检验
变异系数（CVs）、一致性置信区间（CCI）和 Wilcoxon 符号秩检验比较了形态学和弛豫度测量与其参考标准的关系。使用临床方案作为参考，计算了 DESS MOAKS 的阳性百分比一致率（PPA）、阴性百分比一致率（NPA）和两位读者的一致性。使用 Wilcoxon 秩和检验评估 Kellgren-Lawrence 组之间的生物标志物变化。
结果
软骨厚度（P=0.65）、软骨 T（P=0.69）和半月板 T（P=0.06）与参考标准（20° DESS 翻转角）无显著差异。DESS 略微高估了半月板体积（P<0.001）。准确性和重复性 CVs 均<3.3%，除了半月板 T 的准确性（7.6%）。DESS MOAKS 具有较高的读者间一致性和较高的 PPA/NPA 值（87%/90%）。骨髓病变和半月板的 PPA 略低。Kellgren-Lawrence 等级 2 和 3 组的软骨和半月板 T、MOAKS（软骨表面积、骨赘、囊肿和总分）高于等级 0 组（P<0.05）。
数据结论
5 分钟 DESS 序列允许对大多数组织进行 MOAKS 评估，同时还可以进行可重复和可重复的同时软骨和半月板 T 弛豫度和形态测量。
证据水平
2 技术功效：第 1 阶段 J. Magn. Reson. Imaging 2018;47:1328-1341.
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