扩散加权成像ADC值在滑膜炎诊断及分级中的应用

目的探讨磁共振扩散加权成像(DWI)表观扩散系数(ADC)值在滑膜炎的诊断及分级中的应用。方法前瞻性纳入29例确诊或者疑似类风湿关节炎的患者;所有患者均行手腕关节DWI及增强磁共振扫描,分析可疑滑膜炎或积液的平均ADC值及最小ADC值;按照强化程度将病灶分为0、1、2和3分,分别代表积液、轻度滑膜炎、中度滑膜炎和重度滑膜炎。Spearman检验用于相关性分析,受试者工作特征(ROC)曲线用于分析诊断效能。结果评分0组ADC值(包括平均ADC值和最小ADC值)大于评分(1~3)组ADC值,差异均具有统计学意义(P均<0.001);平均ADC值和最小ADC值与滑膜炎强化程度呈显著负相关(r=-0.740,P<0.001;r=-0.549,P<0.001);ROC分析结果显示在鉴别评分0组与评分(1~3)组时,平均ADC值的敏感性、特异性及AUC值分别为84.9%、92.5%和0.939。结论扩散加权成像ADC值在滑膜炎的诊断及分级中具有一定潜力,有望在类风湿关节炎的早期诊断及治疗评估中提供有用信息。

The Application of Apparent Diffusion Coefficient Values Derived from DiffusionWeighted Imaging in the Diagnosis and Grading of Synovitis

Objective To explore the application of apparent diffusion coefficient(ADC)values derived from diffusion-weighted imaging(DWI)for diagnosing and grading synovitis.Methods A total of 29 patients confirmed or suspected rheumatoid a rthritis(RA)were prospectively en rolled.All patients underwent DWI and contrast enhanced magnetic resonance imaging of the wrist joint.Mean ADC values and minimum ADC values of suspected synovitis or joint effusion were analyzed.According to the degree of enhancement,the lesions were divided into score 0,score 1,score 2,and score 3,representing joint effusion,mild synovitis,moderate synovitis and severe synovitis,respectively.The Spearman correlation test was used to evaluate the correlation.The diagnostic performance was analyzed with receiver operating characteristic(ROC)curve analysis.Results The mean and minimum ADC values of score 0 were significantly higher than those of score(1~3)(all P<0.001).The degree of enhancement of synovitis were negatively correlated with the mean ADC values(r=-0.740,P<0.001)and minimum ADC values(r=-0.549,P<0.001)significantly.ROC curve analysis showed that the sensitivity,specificity and AUC of the mean ADC values were 84.9%,92.5%,and 0.939,respectively,for differentiating score(1~3)from score 0.Conclusion ADC values derived from DWI may be potential for diagnosing and grading synovitis,and is expected to provide useful information in the early diagnosis of RA and the evaluation of treatment response.