幼年特发性关节炎：磁共振弥散加权成像在膝关节关节炎评估中的应用。
Juvenile Idiopathic Arthritis: Diffusion-weighted MRI in the Assessment of Arthritis in the Knee.
机构信息
From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.).
出版信息
Radiology. 2020 May;295(2):373-380. doi: 10.1148/radiol.2020191685. Epub 2020 Mar 10.
Background Diffusion-weighted imaging (DWI) can depict the inflamed synovial membrane in arthritis. Purpose To study the diagnostic accuracy of DWI for the detection of arthritis compared with the clinical reference standard and to compare DWI to contrast material-enhanced MRI for the detection of synovial inflammation. Materials and Methods In this institutional review board-approved prospective study, 45 participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA (seven boys, 38 girls; median age, 14 years [interquartile range, 12-16 years]) were included between December 2015 and December 2018. Study participants underwent pre- and postcontrast 3.0-T MRI of the knee with an additional DWI sequence. For the clinical reference standard, a multidisciplinary team determined the presence or absence of arthritis on the basis of clinical, laboratory, and imaging findings (excluding DWI). Two data sets were scored by two radiologists blinded to all clinical data; data set 1 contained pre- and postcontrast sequences (contrast-enhanced MRI), and data set 2 contained precontrast and DWI sequences (DWI). Diagnostic accuracy was determined by comparing the scores of the DWI data set to those of the clinical reference standard. Second, DWI was compared with contrast-enhanced MRI regarding detection of synovial inflammation. Results Sensitivity for detection of arthritis for DWI was 93% (13 of the 14 participants with arthritis were correctly classified with DWI; 95% confidence interval [CI]: 64%, 100%) and specificity was 81% (25 of 31 participants without arthritis were correctly classified with DWI; 95% CI: 62%, 92%). Scores for synovial inflammation at DWI and contrast-enhanced MRI agreed in 37 of 45 participants (82%), resulting in a sensitivity of 92% (12 of 13 participants; 95% CI: 62%, 100%) and specificity of 78% (25 of 32 participants; 95% CI: 60%, 90%) with DWI when contrast-enhanced MRI was considered the reference standard. Conclusion Diffusion-weighted imaging (DWI) was accurate in detecting arthritis in pediatric participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA and showed agreement with contrast-enhanced MRI. The results indicate that DWI could replace contrast-enhanced MRI for imaging of synovial inflammation in this patient group. © RSNA, 2020
背景 弥散加权成像（DWI）可显示关节炎中的炎症滑膜。目的 研究 DWI 检测关节炎的诊断准确性，并与临床参考标准进行比较，比较 DWI 与对比增强 MRI 检测滑膜炎症的效果。材料与方法 本研究经机构审查委员会批准，纳入了 2015 年 12 月至 2018 年 12 月期间的 45 例患有幼年特发性关节炎（JIA）或疑似 JIA 的参与者（7 名男性，38 名女性；中位年龄 14 岁[四分位间距，12~16 岁]）。这些参与者接受了膝关节的 3.0-T 磁共振成像（MRI）检查，包括对比增强和 DWI 序列。对于临床参考标准，多学科团队根据临床、实验室和影像学检查结果（不包括 DWI）确定是否存在关节炎。两位放射科医生对所有临床数据均不知情，分别对两组数据进行评分；数据集 1 包含增强前后的序列（对比增强 MRI），数据集 2 包含增强前和 DWI 序列（DWI）。通过比较 DWI 数据与临床参考标准的评分，确定诊断准确性。其次，将 DWI 与对比增强 MRI 检测滑膜炎症的效果进行比较。结果 DWI 检测关节炎的敏感度为 93%（14 例关节炎患者中有 13 例正确分类；95%置信区间[CI]：64%，100%），特异度为 81%（31 例无关节炎患者中有 25 例正确分类；95%CI：62%，92%）。在 45 例参与者中，DWI 和对比增强 MRI 检测的滑膜炎症评分一致 37 例（82%），因此当以对比增强 MRI 为参考标准时，DWI 的敏感度为 92%（13 例中的 12 例；95%CI：62%，100%），特异度为 78%（32 例中的 25 例；95%CI：60%，90%）。结论 DWI 可准确检测儿科 JIA 或疑似 JIA 患者的关节炎，与对比增强 MRI 结果一致。结果表明，在该患者组中，DWI 可替代对比增强 MRI 用于滑膜炎症成像。
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