新型多对比 1 分钟全脑检查（EPIMix）在神经放射学中的诊断性能：一项前瞻性研究。

Diagnostic performance of a new multicontrast one-minute full brain exam (EPIMix) in neuroradiology: A prospective study.

机构信息

Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.

出版信息

J Magn Reson Imaging. 2019 Dec;50(6):1824-1833. doi: 10.1002/jmri.26742. Epub 2019 Apr 1.

DOI:10.1002/jmri.26742

PMID:30932287

Abstract

BACKGROUND

Clinical MRI protocols are time-consuming; hence, new faster techniques are needed. One new fast multicontrast MRI technique, called echo planar image mix (EPIMix) (including contrasts T -FLAIR, T -weighted, diffusion-weighted images [DWI], apparent diffusion coefficient [ADC], T *-weighted, and T -FLAIR images) needs to be tested.

PURPOSE

To assess if EPIMix has comparable diagnostic performance as routine clinical brain MRI.

STUDY TYPE

Prospective.

POPULATION

A consecutive series of 103 patients' brain MRI (January 2018 to May 2018).

FIELD STRENGTH/SEQUENCE: 1.5 T or 3T. EPIMix and routine clinical protocol (clinical MRI included all or some of the contrasts T -FLAIR, T -weighted, DWI, T *-weighted, T -FLAIR, 3D-FSE).

ASSESSMENT

Two neuroradiologists assessed EPIMix and clinical scans and categorized the images as abnormal or normal and described diagnosis, artifacts, diagnostic confidence image quality, and comparison of imaging time.

STATISTICAL TESTS

Pivot tables with diagnostic performance calculated by receiver operating characteristics (ROC) and the area under curve (AUC). Disease categorization and image quality measures were evaluated. The study protocol is published at ClinicalTrials.gov NCT03338270.

RESULTS

After exclusion of 21 patients, 82 patients had a routine clinical MRI with comparable contrasts to EPIMix and were evaluated. The diagnostic performance to categorize a full brain MRI investigation as abnormal or normal was comparable between EPIMix (AUC 0.99 (95% confidence interval [CI] 0.97-1.00) and 0.99 (95% CI 0.97-1.00)) and routine clinical MRI (n = 82). Sensitivity was 95% (95% CI 88-95) and 93% (95% CI 86-98), and specificity 100% (95% CI 97-100) and 100% (95% CI 90-100). Disease categorization was congruent between EPIMix and clinical routine MRI in 90% (reader 2) and 93% (reader 1). Image quality was generally rated lower for EPIMix (P < 0.001). Imaging time was 78 seconds for EPIMix and for the same contrasts 12 minutes 29 seconds for conventional 3T MRI.

DATA CONCLUSION

EPIMix has comparable diagnostic performance (disease identification and categorization) for most patients investigated in clinical routine. Level of Evidence 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1824-1833.

摘要

背景

临床 MRI 方案耗时较长；因此，需要新的更快的技术。一种新的快速多对比度 MRI 技术，称为回波平面图像混合（EPIMix）（包括对比 T-FLAIR、T 加权、弥散加权图像 [DWI]、表观弥散系数 [ADC]、T*-加权和 T-FLAIR 图像），需要进行测试。

目的

评估 EPIMix 是否具有与常规临床脑部 MRI 相当的诊断性能。

研究类型

前瞻性。

人群

连续系列的 103 例脑部 MRI（2018 年 1 月至 2018 年 5 月）。

磁场强度/序列：1.5T 或 3T。EPIMix 和常规临床方案（临床 MRI 包括所有或部分对比 T-FLAIR、T 加权、DWI、T*-加权、T-FLAIR、3D-FSE）。

评估

两位神经放射学家评估了 EPIMix 和临床扫描，并将图像分类为异常或正常，并描述了诊断、伪影、诊断置信度、图像质量以及成像时间的比较。

统计检验

通过接收器操作特征（ROC）和曲线下面积（AUC）计算诊断性能的枢轴表。对疾病分类和图像质量指标进行了评估。该研究方案已在 ClinicalTrials.gov 上发布（NCT03338270）。

结果

排除 21 例患者后，82 例患者接受了常规临床 MRI 检查，其对比与 EPIMix 相当，并进行了评估。将全脑 MRI 检查归类为异常或正常的诊断性能在 EPIMix（AUC 0.99（95%置信区间 [CI] 0.97-1.00）和 0.99（95% CI 0.97-1.00））和常规临床 MRI（n=82）之间相当。敏感性分别为 95%（95% CI 88-95）和 93%（95% CI 86-98），特异性分别为 100%（95% CI 97-100）和 100%（95% CI 90-100）。在 EPIMix 和临床常规 MRI 中，疾病分类在 90%（读者 2）和 93%（读者 1）中是一致的。图像质量通常被评为 EPIMix 较低（P<0.001）。成像时间为 EPIMix 的 78 秒，而相同对比的常规 3T MRI 的成像时间为 12 分 29 秒。