Guangzhou University of Chinese Medicine, Guangzhou, China.
Department of Ultrasound, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China.
Ultrasound Med Biol. 2023 Feb;49(2):635-644. doi: 10.1016/j.ultrasmedbio.2022.10.004. Epub 2022 Nov 3.
The aim of this study was to quantitatively assess subchondral bone microcirculation perfusion in adults with early osteonecrosis of the femoral head (ONFH) using contrast-enhanced ultrasound (CEUS) and to evaluate its correlation with the Association Research Circulation Osseous (ARCO) stage. We investigated 97 adult patients with definite ONFH by imaging a total of 155 hips, performing CEUS, storing images of CEUS processes at different ARCO stages and generating CEUS time-intensity curves (TICs) to obtain perfusion parameters. Differences in CEUS parameters at different ARCO stages were analyzed, and correlations were explored. A logistic regression model was constructed by incorporating the meaningful CEUS indicators. The CEUS parameters time to peak (TTP), peak intensity (PI), enhanced intensity (EI), ascending slope (AS), descending slope (DS) and area under the receiver operating characteristic curve (AUC) were significantly different in ARCO stage Ⅰ compared with stage ⅢA, and the same results were obtained in stage Ⅱ compared with stage ⅢA. However, there were no significant differences between stages Ⅰ and Ⅱ. The MTT (mean transit time) assay was not significantly different between the different stages. The receiver operating characteristic curve analysis of TTP, PI, EI, AS, DS and AUC in stages Ⅰ and ⅢA had a certain diagnostic efficacy, similar to the results in stages Ⅱ and ⅢA. The diagnostic performance of DS was less accurate in stages Ⅰ and ⅢA, while the diagnostic performance of TTP was less accurate in stages Ⅱ and ⅢA. ARCO stage was independently and negatively correlated with TTP and DS and independently and positively correlated with PI, EI, AS and AUC. The MTT assay was not correlated with ARCO stage. Logistic regression models containing statistically significant TTP, EI and AUC values were constructed, and all three values were closely related to the ARCO stage. In patients with different ARCO stages of ONFH, CEUS can effectively assess subchondral bone perfusion of the femoral head and is expected to become an effective imaging method for the diagnosis of early ONFH.
本研究旨在使用对比增强超声（CEUS）定量评估成人早期股骨头坏死（ONFH）患者的软骨下骨微循环灌注，并评估其与 Association Research Circulation Osseous（ARCO）分期的相关性。我们对 97 例成人确诊 ONFH 患者进行影像学检查，共 155 髋，进行 CEUS，存储不同 ARCO 分期的 CEUS 过程图像，并生成 CEUS 时间-强度曲线（TIC）以获得灌注参数。分析不同 ARCO 分期的 CEUS 参数差异，并探讨相关性。通过纳入有意义的 CEUS 指标构建逻辑回归模型。与 ARCO ⅢA 相比，Ⅰ期的 CEUS 参数达峰时间（TTP）、峰值强度（PI）、增强强度（EI）、上升斜率（AS）、下降斜率（DS）和曲线下面积（AUC）差异有统计学意义，Ⅱ期与 ARCO ⅢA 比较也有同样的结果，但Ⅰ期和Ⅱ期之间差异无统计学意义。MTT（平均通过时间）测定在不同分期之间差异无统计学意义。TTP、PI、EI、AS、DS 和 AUC 在 ARCO Ⅰ期和ⅢA 期的受试者工作特征曲线分析具有一定的诊断效能，与Ⅱ期和ⅢA 期相似。DS 在 ARCO Ⅰ期和ⅢA 期的诊断性能不太准确，而 TTP 在 ARCO Ⅱ期和ⅢA 期的诊断性能不太准确。ARCO 分期与 TTP 和 DS 独立呈负相关，与 PI、EI、AS 和 AUC 独立呈正相关。MTT 测定与 ARCO 分期无相关性。构建包含统计学意义的 TTP、EI 和 AUC 值的逻辑回归模型，所有三个值均与 ARCO 分期密切相关。在不同 ARCO 分期的 ONFH 患者中，CEUS 可有效评估股骨头软骨下骨灌注，有望成为早期 ONFH 的有效影像学诊断方法。
