Centre for Neuromuscular Diseases, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Support Center for Advanced Neuroimaging (SCAN), Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur Radiol. 2022 Nov;32(11):7910-7917. doi: 10.1007/s00330-022-08862-9. Epub 2022 May 21.
To assess quantitative water T2 relaxometry for the early detection of neuromuscular diseases (NMDs) in comparison to standard qualitative MR imaging in a clinical setting.
This retrospective study included 83 patients with suspected NMD who underwent multiparametric MRI at 3 T with a subsequent muscle biopsy between 2015 and 2019. Qualitative T1-weighted and T2-TIRM images were graded by two neuroradiologists to be either pathological or normal. Mean and median water T2 relaxation times (water T2) were obtained from manually drawn volumes of interests in biopsied muscle from multi-echo sequence. Histopathologic pattern of corresponding muscle biopsies was used as a reference.
In 34 patients, the T1-weighted images showed clear pathological alternations indicating late-stage fatty infiltration in NMDs. In the remaining 49 patients without late-stage changes, T2-TIRM grading achieved a sensitivity of 56.4%, and mean and median water T2 a sensitivity of 87.2% and 97.4% to detect early-stage NMDs. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.682, 0.715, and 0.803 for T2-TIRM, mean water T2, and median water T2, respectively. Median water T2 ranged between 36 and 42 ms depending on histopathologic pattern.
Quantitative water T2 relaxometry had a significantly higher sensitivity in detecting muscle abnormalities than subjective grading of T2-TIRM, prior to late-stage fatty infiltration signal alternations in T1-weighted images. Normal-appearing T2-TIRM does not rule out early-stage NMDs. Our findings suggest considering water T2 relaxometry complementary to T2-TIRM for early detection of NMDs in clinical diagnostic routine.
• Quantitative water T2 relaxometry is more sensitive than subjective assessment of fat-suppressed T2-weighted images for the early detection of neuromuscular diseases, prior to late-stage fatty infiltration signal alternations in T1-weighted images. • Normal-appearing muscles in fat-suppressed T2-weighted images do not rule out early-stage neuromuscular diseases. • Quantitative water T2 relaxometry should be considered complementary to subjectively rated fat-suppressed T2-weighted images in clinical practice.
在临床环境中，与标准定性磁共振成像相比，评估定量水 T2 弛豫时间以早期检测神经肌肉疾病 (NMD)。
本回顾性研究纳入了 2015 年至 2019 年间在 3T 上接受多参数 MRI 检查并随后进行肌肉活检的 83 例疑似 NMD 患者。两名神经放射科医生对 T1 加权和 T2-TIRM 图像进行分级，分为病理性或正常。从多回波序列中手动绘制的感兴趣容积中获得活检肌肉的平均和中位数水 T2 弛豫时间（水 T2）。相应肌肉活检的组织病理学模式用作参考。
在 34 例患者中，T1 加权图像显示出明确的病理性改变，表明 NMD 中晚期脂肪浸润。在其余 49 例无晚期改变的患者中，T2-TIRM 分级的敏感性为 56.4%，平均和中位数水 T2 的敏感性分别为 87.2%和 97.4%，可用于检测早期 NMD。受试者工作特征 (ROC) 分析显示 T2-TIRM、平均水 T2 和中位数水 T2 的曲线下面积 (AUC) 分别为 0.682、0.715 和 0.803。根据组织病理学模式，中位数水 T2 范围在 36 至 42ms 之间。
与 T1 加权图像晚期脂肪浸润信号改变前 T2-TIRM 的主观分级相比，定量水 T2 弛豫时间在检测肌肉异常方面具有更高的敏感性。正常表现的 T2-TIRM 并不能排除早期 NMD。我们的研究结果表明，在临床诊断常规中，考虑将水 T2 弛豫时间作为 T2-TIRM 的补充，以早期检测 NMD。
与 T1 加权图像晚期脂肪浸润信号改变前 T2-TIRM 的主观评估相比，定量水 T2 弛豫时间在检测神经肌肉疾病方面更敏感。
在 T1 加权图像中出现脂肪浸润信号改变之前，脂肪抑制 T2 加权图像中看似正常的肌肉并不能排除早期神经肌肉疾病。
在临床实践中，应将定量水 T2 弛豫时间视为 T2-TIRM 主观评分的补充。
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