Radiology:对于骶髂关节炎患者骨骼病变的显示,我们又有了新的手段!

2021-07-26 shaosai MedSci原创

骶髂(SI)关节MRI扫描是诊断脊柱关节炎患者骶髂关节炎的影像学标准。SI关节的骨髓水肿在诊断中起关键作用,但敏感性和特异性有限。

骶髂(SI)关节MRI扫描是诊断脊柱关节炎患者骶髂关节炎的影像学标准。SI关节的骨髓水肿在诊断中起关键作用,但敏感性和特异性有限。然而SI关节的侵蚀在脊椎关节炎中虽不常见且其敏感性较低,但特异性极高(95%),可显著提高脊柱关节炎诊断的准确性。然而,应用常规的T1加权MRI序列评价SI关节的如侵蚀等结构性病变能力有限。

CT在显示骨骼结构性病变上有明显的优势。现阶段,MRI和CT的联合应用已用于放射治疗、骨科手术等各个领域。然而,同时进行CT和MRI扫描不仅增加了病人的负担,同时还使工作流程复杂化,因此我们已引入了合成CT (sCT)这一概念。基于MRI的sCT是一种基于深度学习的影像学技术,该技术执行三维(3D) MRI到CT映射、从轴位3D T1MGE序列生成类CT图像,已在颈椎和骨盆的病变显示上得到了临床验证。

近日,发表在Radiology杂志的一项研究以CT为参考标准并对比常规T1加权MRI图像,评价了基于MRI的sCT在显示SI关节的侵蚀、硬化和强直方面的诊断性能,为临床提供了一种兼有CT及MRI优势的评价骨骼病变的影像学手段。

本项前瞻性研究(临床试验注册号:B670201837885)于2019年2月至2019年11月执行。所纳入的患者均为从三级医院风湿病门诊转诊的临床怀疑炎症性骶髂炎的患者。同一天对患者SI关节进行MRI和CT检查。使用一种基于商业深度学习的图像合成方法由MRI扫描生成SCT图像。两名阅读者独立记录不同阶段的T1加权MRI、sCT和CT图像是否存在结构性病变(侵蚀、硬化和强直),阅读者对临床信息和其他图像不知情。以CT一致性结果为参考标准,采用广义估计方程模型分析sCT和T1加权MRI扫描的诊断性能。

本研究共纳入30名参与者(16名男性,14名女性;平均年龄:40±10 [标准差])。sCT对侵蚀(94% vs 86%,P = 0.003)、硬化(97% vs 81%,P < .001)和强直(92% vs 84%,P = 0.04)的诊断准确性高于T1加权MRI

图 28岁男性,骶髂关节炎。(a, d) T1加权MRI图像, (b, e) CT图像, (c, f)合成CT图像。骶髂关节的广泛侵蚀(粗箭头)在合成CT图像上比T1加权MRI上显示更为清晰,甚至比CT图像更清楚。软骨下硬化(细箭头)在合成CT图像的显示也优于T1加权MRI。

表 基于广义评估模型并以CT为参考标准评估合成CT和T1加权MRI的诊断性能。如表所示,应用sCT后,检测侵蚀的特异性(96% [95%置信区间:90、98]vs89% [95%置信区间:81、94],P = . 01]和检测硬化[94% [95%置信区间:87、97]vs20% [95%可信区间:10,35],P <.001)和关节强直的敏感性(93% [95%置信区间:78、98]vs70% [95%置信区间CI: 87], P =.001)均得到了改善。

总之,我们发现由轴向三维t1加权射频破坏多重梯度回声序列重建的合成CT扫描比t1加权MRI。

本研究表明以CT为参考标准,骶髂关节的合成CT(sCT)图像对疑似骶髂炎患者骨骼的结构性病变的检测及显示均优于常规T1加权MRI。sCT具有更高的诊断准确性,且可靠性与CT相当,为临床提供了可操作性更强的影像学手段,为脊柱关节炎的准确诊断提供了新的思路

原文出处:

Lennart B O Jans,Min Chen,Dirk Elewaut,et al.MRI-based Synthetic CT in the Detection of Structural Lesions in Patients with Suspected Sacroiliitis: Comparison with MRI.DOI:10.1148/radiol.2020201537

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    2021-07-27 lmm397
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    2021-07-26 ms3000000193651015

    👍

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    2021-07-26 学医无涯

    好技术~期待用于基层

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