Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Front Endocrinol (Lausanne). 2023 May 29;14:1167334. doi: 10.3389/fendo.2023.1167334. eCollection 2023.
T1-weighted spoiled 3D Gradient Recalled Echo pulse sequences, exemplified by Liver Acquisition with Volume Acceleration-flexible MRI (LAVA-Flex), are currently the preferred MR sequence for detecting erosions of the sacroiliac joint (SIJ). However, zero echo time MRI (ZTE) is recently reported to provide excellent visualization of the cortical bone.
To directly compare the diagnostic accuracy of ZTE and LAVA-Flex in the detection of structural lesions of the SIJ, including erosions, sclerosis and joint space changes.
Two readers independently reviewed the ldCT, ZTE and LAVA-Flex images of 53 patients diagnosed as axSpA and scored the erosions, sclerosis and joint space changes. Sensitivity, specificity and Cohen's kappa (κ) of ZTE and LAVA-Flex were calculated, while McNemar's test was employed to compare the two sequences for the positivity of detecting the structural lesions.
Analysis of diagnostic accuracy showed a higher sensitivity of ZTE in comparison with LAVA-Flex in the depiction of erosions (92.5% vs 81.5%, p<0.001), especially first-degree erosions (p<0.001) and second-degree erosions (p<0.001), as well as sclerosis (90.6% vs 71.2%, p<0.001), but not joint space changes (95.2% vs 93.8%, p=0.332). Agreement with ldCT was also higher in ZTE in the detection of erosions than LAVA-Flex as indicated by the κ values (0.73 vs 0.47), as well as in the detection of sclerosis (0.92 vs 0.22).
With ldCT as the reference standard, ZTE could improve diagnostic accuracy of erosions and sclerosis of the SIJ in patients suspected of axSpA, in comparison with LAVA-Flex.
T1 加权扰相 3D 梯度回波脉冲序列，以 Liver Acquisition with Volume Acceleration-flexible MRI（LAVA-Flex）为例，是目前检测骶髂关节（SIJ）侵蚀的首选磁共振序列。然而，零回波时间 MRI（ZTE）最近被报道可以提供出色的皮质骨可视化效果。
直接比较 ZTE 和 LAVA-Flex 在检测 SIJ 结构病变（包括侵蚀、硬化和关节间隙变化）方面的诊断准确性。
两位读者独立评估了 53 例被诊断为 axSpA 的患者的 ldCT、ZTE 和 LAVA-Flex 图像，并对侵蚀、硬化和关节间隙变化进行评分。计算了 ZTE 和 LAVA-Flex 的敏感度、特异度和 Cohen's kappa（κ），并采用 McNemar 检验比较两种序列检测结构病变的阳性率。
诊断准确性分析显示，ZTE 在显示侵蚀方面的敏感度高于 LAVA-Flex（92.5%比 81.5%，p<0.001），尤其是一级侵蚀（p<0.001）和二级侵蚀（p<0.001），以及硬化（90.6%比 71.2%，p<0.001），但关节间隙变化无差异（95.2%比 93.8%，p=0.332）。ZTE 在检测侵蚀和硬化方面与 ldCT 的一致性也高于 LAVA-Flex，κ 值分别为 0.73 和 0.92，而 LAVA-Flex 的κ 值分别为 0.47 和 0.22。
与 LAVA-Flex 相比，以 ldCT 为参考标准，ZTE 可以提高疑似 axSpA 患者 SIJ 侵蚀和硬化的诊断准确性。
