Huo R, Zheng L, Li S-L, Wang S-K, Ma C, Shi H-Y, Xie X-P, Wang N-W, Zhang X-M, Liu B, Peng L, He Q-Z, Jiang F
Department of Imaging, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou City, Sichuan Province, China.
Eur Rev Med Pharmacol Sci. 2023 Jul;27(14):6545-6553. doi: 10.26355/eurrev_202307_33125.
The aim of this study is to explore the early diagnostic value of contrast-enhanced ultrasound (CEUS)-related quantitative parameter and its relationship with the micro-perfusion of nontraumatic necrosis of the femoral head.
According to the random and double-blind method, the patients with non-traumatic femoral head necrosis diagnosed and treated in our hospital from July 2019 to January 2022 were selected as the subjects (the research group). According to the staging of the International Society of Bone Circulation for Femoral Head Necrosis, 89 patients with stage Ⅱ and Ⅲ A were included (39 patients with stage Ⅱ and 50 patients with stage Ⅲ A). 25 patients who conducted physical examination in our hospital during the same time were taken as the control group. Quantitative parameters of CEUS were analyzed. The content of serum vascular endothelial growth factor (VEGF) and bone morphogenetic protein-2 (BMP-2) were evaluated. The relationship among the quantitative parameters of CEUS, the expression of VEGF and BMP-2 in serum and the patient's condition, and the value for assisting the early diagnosis of nontraumatic femoral head necrosis were analyzed.
The body mass, body mass index (BMI), blood lipid, and cholesterol levels were much higher in the research group than in the control group (p < 0.05). The research group had a markedly higher slope of ascending branch (AS), strength enhancement index (EI), and VEGF and obviously lower decay slope (DS), mean transit time (MTT), and time to peak (TTP) than the control group (p < 0.05). In the research group, compared to stage Ⅱ, the levels of AS, EI, and VEGF in stage Ⅲ A patients were memorably higher, and the levels of DS, MTT, TTP and BMP-2 were dramatically lower (p < 0.05). Pearson's correlation test showed that AS, EI, and VEGF were positively correlated with the patients' condition, while DS, MTT, TTP and BMP-2 were negatively correlated with the patients' condition (p < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the diagnostic area under the curve (AUC) of quantitative parameters of CEUS was 0.961, with sensitivity and specificity of 88.0% and 97.4%, respectively. The AUC of the combined detection of VEGF and BMP-2 was 0.945 with sensitivity and specificity of 82.3% and 87.5%, respectively, and the combined detection had a high diagnostic value (p < 0.05).
The quantitative parameters of CEUS were of great value in the early diagnosis of nontraumatic necrosis of the femoral head with microvascular perfusion and the patients' condition, and provided a reference for the clinical treatment of non-traumatic necrosis of the femoral head. These parameters were expected to be useful indicators for judging the efficacy before and after treatment.
本研究旨在探讨超声造影（CEUS）相关定量参数的早期诊断价值及其与非创伤性股骨头坏死微灌注的关系。
采用随机双盲法，选取2019年7月至2022年1月在我院诊断并治疗的非创伤性股骨头坏死患者作为研究对象（研究组）。根据国际骨循环学会股骨头坏死分期，纳入89例Ⅱ期和ⅢA期患者（Ⅱ期39例，ⅢA期50例）。同期在我院进行体检的25例患者作为对照组。分析CEUS定量参数。评估血清血管内皮生长因子（VEGF）和骨形态发生蛋白-2（BMP-2）的含量。分析CEUS定量参数、血清VEGF和BMP-2表达与患者病情的关系以及辅助非创伤性股骨头坏死早期诊断的价值。
研究组的体重、体重指数（BMI）、血脂和胆固醇水平均显著高于对照组（p<0.05）。研究组的上升支斜率（AS）、增强强度指数（EI）和VEGF明显高于对照组，而衰减斜率（DS）、平均通过时间（MTT）和达峰时间（TTP）明显低于对照组（p<0.05）。在研究组中，与Ⅱ期相比，ⅢA期患者的AS、EI和VEGF水平显著升高，而DS、MTT、TTP和BMP-2水平显著降低（p<0.05）。Pearson相关性检验显示，AS、EI和VEGF与患者病情呈正相关，而DS、MTT、TTP和BMP-2与患者病情呈负相关（p<0.05）。受试者操作特征（ROC）曲线分析显示，CEUS定量参数的曲线下诊断面积（AUC）为0.961，灵敏度和特异度分别为88.0%和97.4%。VEGF和BMP-2联合检测的AUC为0.945，灵敏度和特异度分别为82.3%和87.5%，联合检测具有较高的诊断价值（p<0.05）。
CEUS定量参数对非创伤性股骨头坏死伴微血管灌注及患者病情的早期诊断具有重要价值，为非创伤性股骨头坏死的临床治疗提供参考。这些参数有望成为判断治疗前后疗效的有用指标。
