Department of Radiology, Research Institute of Radiological Science, YUHS-KRIBB Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Eur Radiol. 2019 May;29(5):2573-2580. doi: 10.1007/s00330-018-5800-9. Epub 2018 Nov 28.
To investigate the agreement between double-inversion recovery (DIR) with synthetic magnetic resonance imaging (MRI) and T1-weighted contrast-enhanced (CE)-MRI for the assessment of knee synovitis.
T1-weighted CE-MRI and synthetic MRI of 30 patients were compared. Synthetic DIR image reconstruction was performed with two inversion times (280-330 ms and 2800-2900 ms). Subjective image quality, visibility of synovium, detection of synovitis, and total synovitis score in the knee joint were evaluated on both MR images. The relative signal intensity (SI) and relative contrast of synovium, joint effusion, and bone marrow for two imaging were assessed. Differences in data between two imaging were assessed by using Wilcoxon's signed-rank test and chi-square test/Fisher's exact test. Interobserver agreement was expressed as weighted kappa value. Accuracy of synthetic DIR image was calculated by using CE-MRI as reference standard.
T1-weighted CE-MRI yielded better image quality than synthetic DIR imaging (p < 0.001). Interobserver agreements for detecting synovitis diagnosis/sum of the synovitis score were moderate to almost perfect (κ = 0.58/0.44, synthetic DIR; κ = 0.83/0.65, T1-weighted CE-MRI). There were no statistical differences in visibility of synovium (p = 0.058-0.190), detection of synovitis (p < 0.001), and relative SI of structures between two imaging (p = 0.086-0.360). Synovium-to-effusion contrast was higher in synthetic DIR (p = 0.003) and synovium-to-bone marrow contrast was higher in CE-MRI (p < 0.001).
Synthetic DIR imaging showed a moderate degree of interobserver agreement and good accuracy for detecting synovitis. Though it has limitations, it may play a role in imaging of degenerative joint disease or larger cohort scientific studies where gadolinium application is not feasible.
• Synthetic double-inversion recovery (DIR) imaging avoids the use of contrast agent. • There was no significant difference between T1-weighted CE-MRI and synthetic DIR imaging in evaluating presence of synovitis in knee joint. • Synthetic DIR imaging showed moderate degree of interobserver agreement and good accuracy for detecting synovitis compared to CE-MRI, and it may facilitate evaluation of some regions of peripatellar synovitis.
探讨双反转恢复（DIR）与合成磁共振成像（MRI）在膝关节滑膜炎评估中的一致性，比较 T1 加权对比增强（CE）-MRI 和合成 MRI。
对 30 例患者的 T1WI-CE-MRI 和合成 MRI 进行对比。合成 DIR 图像重建采用两种反转时间（280-330ms 和 2800-2900ms）。在两种 MR 图像上评估膝关节的主观图像质量、滑膜可见性、滑膜炎检测和总滑膜炎评分。评估两种成像的滑膜、关节积液和骨髓的相对信号强度（SI）和相对对比度。使用 Wilcoxon 符号秩检验和卡方检验/ Fisher 精确检验评估两种成像之间的数据差异。采用加权 Kappa 值表示观察者间的一致性。以 CE-MRI 为参考标准，计算合成 DIR 图像的准确性。
T1WI-CE-MRI 的图像质量优于合成 DIR 成像（p<0.001）。检测滑膜炎诊断/滑膜炎评分总和的观察者间一致性为中等至几乎完美（κ=0.58/0.44，合成 DIR；κ=0.83/0.65，T1WI-CE-MRI）。两种成像的滑膜可见性（p=0.058-0.190）、滑膜炎检测（p<0.001）和结构的相对 SI（p=0.086-0.360）差异无统计学意义。合成 DIR 中滑膜与积液的对比度较高（p=0.003），CE-MRI 中滑膜与骨髓的对比度较高（p<0.001）。
合成 DIR 成像在检测滑膜炎方面具有中等程度的观察者间一致性和良好的准确性。尽管存在局限性，但在评估退行性关节疾病或较大队列的科学研究中，在不能应用钆对比剂的情况下，它可能发挥作用。
合成双反转恢复（DIR）成像避免了使用造影剂。
T1WI-CE-MRI 和合成 DIR 成像在评估膝关节滑膜炎的存在方面无显著差异。
与 CE-MRI 相比，合成 DIR 成像在检测滑膜炎方面具有中等程度的观察者间一致性和良好的准确性，并且可能有助于评估髌旁滑膜的某些区域。
