儿科全身磁共振成像：STIR 和 T2 Dixon 序列在检测和分级高信号骨髓变化中的比较。
Pediatric whole-body magnetic resonance imaging: comparison of STIR and T2 Dixon sequences in the detection and grading of high signal bone marrow changes.
机构信息
Department of Radiology, University Hospital of North-Norway, Tromsø, Norway.
Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
出版信息
Eur Radiol. 2023 Jul;33(7):5045-5053. doi: 10.1007/s00330-023-09413-6. Epub 2023 Jan 26.
OBJECTIVES
To compare short time inversion recovery (STIR) and T2 Dixon in the detection and grading of high signal intensity areas in bone marrow on whole-body MRI in healthy children.
METHODS
Prospective study, including whole-body 1.5-T MRIs from 77 healthy children. Two experienced radiologists in consensus identified and graded areas of high bone marrow signal on STIR and T2-weighted (T2W) turbo spin echo (TSE) Dixon images (presence, extension) in two different sessions at an interval of at least 3 weeks. In a third session, a third observer joined the two readers for an additional consensus reading with all sequences available (substitute gold standard).
RESULTS
Four hundred ninety of 545 (89.9%) high signal areas were visible on both sequences, while 27 (5.0%) were visible on STIR only and 28 (5.1%) on T2W Dixon only. Twenty-four of 27 (89%) lesions seen on STIR only, and 25/28 (89%) seen on T2W Dixon only, were graded as mildly increased signal intensity. The proportion of true positive high signal lesions was higher for the T2W Dixon images as compared to STIR (74.2% vs. 68.2%) (p = 0.029), while the proportion of false negatives was lower (25.9% vs. 31.7% (p = 0.035) for T2W Dixon and STIR, respectively). There was a moderate agreement between the T2W Dixon and STIR-based extension scores on a 0-4 scale, with a kappa of 0.45 (95% CI = 0.34-0.56).
CONCLUSIONS
Most high signal bone marrow changes identified on a 1.5-T whole-body MRI were seen on both STIR and water-only T2W Dixon, underscoring the importance of using identical protocols when following bone-marrow signal changes over time.
KEY POINTS
• Whole-body MRI is increasingly being used to diagnose and monitor diseases in children, such as chronic non-bacterial osteomyelitis, malignant/metastatic disease, and histiocytosis. • Standardized and validated imaging protocols, as well as reference standards by age for the growing skeleton are lacking. • Prospective single-center study showed that 90% of high signal bone marrow areas identified on a 1.5-T whole-body MRI in healthy children is seen on both STIR and water-only T2W Dixon, while 5% is seen on STIR only and 5% on T2W Dixon only.
目的
比较短反转时间恢复（STIR）和 T2 双反转 Dixon 序列在健康儿童全身 MRI 中骨髓高信号区的检测和分级中的作用。
方法
前瞻性研究，纳入 77 例健康儿童的全身 1.5-T MRI。两位有经验的放射科医生在至少 3 周的间隔内，分别在两次不同的会议上对 STIR 和 T2 加权（T2W）涡轮自旋回波（TSE） Dixon 图像上的高骨髓信号区（存在、范围）进行共识识别和分级。在第三次会议上，第三位观察者加入了两位读者，对所有序列进行了额外的共识阅读（替代金标准）。
结果
490/545（89.9%）个高信号区在两种序列上均可见，27/545（5.0%）仅在 STIR 上可见，28/545（5.1%）仅在 T2W Dixon 上可见。27/27（89%）个仅在 STIR 上可见的病变和 28/28（89%）个仅在 T2W Dixon 上可见的病变被评为轻度信号增高。与 STIR 相比，T2W Dixon 图像的高信号病变的真阳性比例更高（74.2%比 68.2%）（p=0.029），而假阴性比例更低（25.9%比 31.7%）（p=0.035）。T2W Dixon 和 STIR 的扩展评分之间存在中度一致性，kappa 值为 0.45（95%可信区间：0.34-0.56）。
结论
1.5-T 全身 MRI 上大多数高信号骨髓改变在 STIR 和水激发 T2W Dixon 上均可见，这强调了在随时间观察骨髓信号变化时使用相同协议的重要性。
关键点
全身 MRI 越来越多地用于诊断和监测儿童疾病，如慢性非细菌性骨髓炎、恶性/转移性疾病和组织细胞增多症。
标准化和验证的成像协议，以及针对生长骨骼的年龄参考标准均缺乏。
前瞻性单中心研究表明，在健康儿童的 1.5-T 全身 MRI 上，90%的高信号骨髓区在 STIR 和水激发 T2W Dixon 上均可见，5%仅在 STIR 上可见，5%仅在 T2W Dixon 上可见。
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