超高分辨率 3D MRI 检测膝关节软骨钙质沉着症：一项比较 7T 和 3T MRI 与 CT 的前瞻性诊断准确性研究。
Ultra-high resolution 3D MRI for chondrocalcinosis detection in the knee-a prospective diagnostic accuracy study comparing 7-tesla and 3-tesla MRI with CT.
机构信息
Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
出版信息
Eur Radiol. 2021 Dec;31(12):9436-9445. doi: 10.1007/s00330-021-08062-x. Epub 2021 May 28.
OBJECTIVES
To test the diagnostic accuracy of a 3D dual-echo steady-state (DESS) sequence at 7-T MRI regarding the detection of chondral calcific deposits of the knee in comparison to 3-T MRI, using CT as cross-sectional imaging reference standard.
METHODS
CT and 7-T MRI (DESS) of knee joints in 42 patients with radiographically known chondrocalcinosis (13 of 42 bilateral) were prospectively acquired for all included patients (n = 55 knee joints). Additionally, 3-T MRI (DESS) was performed for 20 of these 55 knee joints. Two fellowship-trained musculoskeletal radiologists scored eight cartilage regions of each knee joint separately regarding presence of cartilage calcification, diagnostic confidence level, and sharpness of calcific deposits. In an explorative subanalysis, micro-CT of the menisci was evaluated after knee arthroplasty in one patient. Diagnostic performance metrics and nonparametric tests were used to compare between modalities. p values < 0.05 were considered to represent statistical significance.
RESULTS
Sensitivity for chondrocalcinosis detection was significantly higher for 7-T MRI (100%) compared to 3-T MRI (reader 1: 95.9%, p = 0.03; reader 2: 93.2%, p = 0.002). The diagnostic confidence was significantly higher for both readers at 7 T compared to both 3-T MRI (p < 0.001) and to CT (p = 0.03). The delineation of chondral calcifications was significantly sharper for 7-T compared to both 3-T MRI and CT (p < 0.001, both readers). Micro-CT in one patient suggested that 7-T MRI may potentially outperform standard CT in diagnosing chondral calcifications.
CONCLUSION
3D-DESS imaging at 7-T MRI offers a significantly higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI.
KEY POINTS
• 3D dual-echo steady-state (DESS) MRI at 7 T has a higher sensitivity in detection of chondral calcific deposits compared to 3-T MRI (p ≤ 0.03). • 3D DESS MRI at 7 T yields no false-negative cases regarding presence of chondral calcific deposits. • 3D DESS MRI at 7 T offers better delineation and higher diagnostic confidence in detection of chondral calcific deposits compared to 3-T MRI (p < 0.001).
目的
在 7-T MRI 上使用 3D 双回波稳态（DESS）序列检测膝关节软骨钙化沉积的诊断准确性，并与 CT 作为横断面成像参考标准进行比较。
方法
前瞻性采集 42 例影像学已知软骨钙质沉着症（42 例中有 13 例双侧）患者膝关节 CT 和 7-T MRI（DESS）（共 55 个膝关节）。此外，对其中 20 个膝关节进行了 3-T MRI（DESS）检查。两名关节肌肉骨骼放射科医师分别对每个膝关节的 8 个软骨区域进行评分，评估软骨钙化的存在、诊断信心水平和钙化沉积的清晰度。在一项探索性亚分析中，在一名膝关节置换术后的半月板中进行了微 CT 评估。使用非参数检验比较不同模态之间的诊断性能指标。p 值<0.05 表示具有统计学意义。
结果
7-T MRI 检测软骨钙质沉着症的敏感性明显高于 3-T MRI（读者 1：100%，p=0.03；读者 2：93.2%，p=0.002）。与 3-T MRI 相比，两位读者在 7-T 时的诊断信心明显更高（p<0.001），与 CT 相比也更高（p=0.03）。与 3-T MRI 和 CT 相比，7-T 时软骨钙化的边界更清晰（p<0.001，两位读者）。一名患者的微 CT 提示，7-T MRI 可能在诊断软骨钙化方面优于标准 CT。
结论
与 3-T MRI 相比，7-T MRI 的 3D-DESS 成像在检测软骨钙化沉积方面具有更高的敏感性。
关键点
与 3-T MRI 相比，7-T MRI 的 3D 双回波稳态（DESS）MRI 在检测软骨钙化沉积方面具有更高的敏感性（p≤0.03）。
3D DESS MRI 在 7-T 时没有关于软骨钙化沉积的假阴性病例。
与 3-T MRI 相比，3D DESS MRI 在检测软骨钙化沉积方面具有更好的清晰度和更高的诊断信心（p<0.001）。
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