分析磁共振成像（MR）征象以鉴别股骨头坏死的ARCO 2期和3A期
Analysis of MR Signs to Distinguish Between ARCO Stages 2 and 3A in Osteonecrosis of the Femoral Head.
作者信息
Shi Shan, Luo Ping, Sun Li, Zhao Yanping, Yang Xuedong, Xie Limin, Yu Tong, Wang Zhenchang
机构信息
Department of Radiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
出版信息
J Magn Reson Imaging. 2022 Feb;55(2):610-617. doi: 10.1002/jmri.27860. Epub 2021 Jul 26.
BACKGROUND
MRI is the most effective diagnostic tool of osteonecrosis of the femoral head (ONFH), especially for early diagnosis, but its detection of subchondral or cortical fractures is less accurate than CT. Therefore, it is difficult to accurately stage ONFH in the peri-collapse period by MRI.
PURPOSE
To improve the accuracy of MR for distinguishing between Association Research Circulation Osseous (ARCO) stages 2 and 3A in ONFH.
STUDY TYPE
Retrospective.
SUBJECTS
One hundred and fifty five cases of ARCO stage 2/3A of ONFH underwent MR examinations, M/F = 72/83. CT was used as reference standard for collapse, which was decided by an orthopedist and a radiologist in consultation.
FIELD STRENGTH/SEQUENCE: 3 T/axial and coronal T -weighted Turbo Spin Echo (T W TSE) sequence, axial T -weighted fat-saturated (T W FS) TSE sequence, and coronal proton density-weighted imaging (PDWI)-FS-Dixon fat/water image.
ASSESSMENT
Five potential MR signs (the maximum width of the necrotic-viable interface, bone marrow edema (BME), irregular articular surface of the femoral head, T heterogeneous high signal, and the absence of a necrotic-viable interface with the morphology of closed loop) were evaluated blindly by five radiologists independently and the total scores of different combinations of MR signs were calculated.
STATISTICAL TESTS
Mann-Whitney U test and Chi-square test were used to evaluate age, gender, and MR signs differences between the two groups. ROC curve was used to access the distinguishing value of MR signs. The consistency of the five radiologists was analyzed by intraclass correlation coefficient.
RESULTS
The area under the curve of the combined MR signs 2 for distinguishing between ARCO stages 2 and 3A was the greatest (0.967), sensitivity and specificity were 100.00% and 88.71% respectively, and greater than 1 was the threshold.
DATA CONCLUSION
Combined MR signs 2 has great values in distinguishing between ARCO stages 2 and 3A in ONFH, thus helping clinical therapy.
LEVEL OF EVIDENCE
4 TECHNICAL EFFICACY: Stage 2.
背景
磁共振成像（MRI）是诊断股骨头缺血性坏死（ONFH）最有效的工具，尤其适用于早期诊断，但其对软骨下或皮质骨折的检测准确性低于CT。因此，在MRI上很难准确判断ONFH塌陷前期的分期。
目的
提高MRI区分ONFH的国际骨循环研究（ARCO）2期和3A期的准确性。
研究类型
回顾性研究。
研究对象
155例ARCO 2/3A期ONFH患者接受了MR检查，男72例，女83例。以CT作为塌陷的参考标准，由骨科医生和放射科医生会诊确定。
场强/序列：3T/轴位和冠状位T加权快速自旋回波（T W TSE）序列、轴位T加权脂肪抑制（T W FS）TSE序列以及冠状位质子密度加权成像（PDWI）-FS-Dixon脂肪/水成像。
评估
5位放射科医生独立盲法评估5个潜在的MR征象（坏死-存活界面的最大宽度、骨髓水肿（BME）、股骨头关节面不规则、T2加权像高信号不均匀以及无呈闭环形态的坏死-存活界面），并计算不同MR征象组合的总分。
统计分析
采用Mann-Whitney U检验和卡方检验评估两组间的年龄、性别及MR征象差异。采用ROC曲线评估MR征象的鉴别价值。通过组内相关系数分析5位放射科医生的一致性。
结果
区分ARCO 2期和3A期的联合MR征象2的曲线下面积最大（0.967），敏感性和特异性分别为100.00%和88.71%，阈值大于1。
数据结论
联合MR征象2在区分ONFH的ARCO 2期和3A期方面具有重要价值，有助于临床治疗。
证据水平
4级 技术疗效：2级
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