动态钆增强 MRI 中的灌注增加与 Kienböck 病患者的骨修复和骨坏死区域相关。
Increased perfusion in dynamic gadolinium-enhanced MRI correlates with areas of bone repair and of bone necrosis in patients with Kienböck's disease.
机构信息
Department of Radiology, Lund University, Malmö, Sweden.
Department of Medical Radiation Physics, Lund University, Malmö, Sweden.
出版信息
J Magn Reson Imaging. 2019 Aug;50(2):481-489. doi: 10.1002/jmri.26573. Epub 2018 Dec 16.
BACKGROUND
Osteonecrosis of the lunate, Kienböck's disease, can lead to fragmentation of the lunate, carpal collapse, and severe osteoarthritis. Since the etiology of Kienböck's disease is impaired circulation, a diagnostic method capable of assessing perfusion would be valuable. Recent studies have suggested that dynamic contrast-enhanced (DCE) MR examinations at 3 T can assess perfusion in healthy carpal bones.
PURPOSE
To evaluate the use of DCE-MR for assessing perfusion in the lunate bone in patients with Kienböck's disease. Furthermore, to compare perfusion with histopathology with a focus on bone viability.
STUDY TYPE
Prospective case-control study.
POPULATION
Fourteen patients with Kienböck's disease and a control group of 19 healthy subjects. Field Strength: 3 T with T -weighted fat-saturated contrast-enhanced gradient echo series.
ASSESSMENT
Features of the enhancement curves from the DCE-MR examinations, time to peak (TTP), maximum slope (MS), and maximum enhancement (ME) assessed by a radiologist. Six of 14 patients were surgerized with lunate excision, allowing comparison between features of the enhancement curves and histopathology.
STATISTICAL TESTS
Mann-Whitney U-test. P < 0.05 was considered a statistically significant difference.
RESULTS
Patients with Kienböck's disease showed significantly higher and faster perfusion parameters compared with the control group, the mean value of the TTP in patients was 126.73 sec, in controls 189.79 sec (P = 0.024), ME in patients 173.55 AU, in controls 28.46 AU (P < 0.001), and MS in patients 5.04 AU, in controls 1.06 AU (P < 0.001). When compared with histopathology, increased perfusion was seen in areas of bone formation but also in necrosis. Areas of normal bone showed low perfusion.
DATA CONCLUSION
DCE-MRI at 3 T can diagnose altered perfusion in patients with Kienböck's disease. Increased perfusion cannot definitely be used as a marker of bone viability.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:481-489.
背景
月骨坏死（Kienböck 病）可导致月骨碎裂、腕骨塌陷和严重的关节炎。由于 Kienböck 病的病因是血液循环受损，因此一种能够评估灌注的诊断方法将是有价值的。最近的研究表明，3T 下的动态对比增强（DCE）MR 检查可以评估健康腕骨的灌注。
目的
评估 DCE-MR 用于评估 Kienböck 病患者月骨灌注的情况。此外，将灌注与重点关注骨活力的组织病理学进行比较。
研究类型
前瞻性病例对照研究。
人群
14 例 Kienböck 病患者和 19 例健康对照组。磁场强度：3T 下 T1 加权脂肪饱和对比增强梯度回波序列。
评估
由放射科医生评估 DCE-MR 检查的增强曲线特征、达峰时间（TTP）、最大斜率（MS）和最大增强（ME）。14 例患者中有 6 例行月骨切除术，允许将增强曲线特征与组织病理学进行比较。
统计检验
Mann-Whitney U 检验。P < 0.05 被认为具有统计学意义。
结果
与对照组相比，Kienböck 病患者的灌注参数明显更高且更快，患者的 TTP 平均值为 126.73 秒，对照组为 189.79 秒（P = 0.024），ME 患者为 173.55AU，对照组为 28.46AU（P < 0.001），MS 患者为 5.04AU，对照组为 1.06AU（P < 0.001）。与组织病理学相比，在骨形成区域和坏死区域观察到灌注增加，但在正常骨区域观察到低灌注。
数据结论
3T 下的 DCE-MRI 可诊断 Kienböck 病患者的灌注改变。增加的灌注不能明确用作骨活力的标志物。
证据水平
1 技术功效：第 3 阶段 J. Magn. Reson. Imaging 2019;50:481-489。
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