基于MRI影像特征、定量参数构建类风湿性关节炎治疗效果的评估模型

目的 探究基于磁共振成像（magnetic resonance imaging，MRI）影像特征、定量参数构建类风湿性关节炎（rheumatoid arthritis，RA）治疗效果的评估模型。 方法 选取我院RA患者120例作为研究对象，均给予重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白联合甲氨蝶呤治疗，于治疗3个月后评估疗效，根据疗效分为有效组（94例）与无效组（26例）。比较2组治疗前后MRI影像特征（骨侵蚀、骨髓水肿）、定量参数［容积转移常数（volume transfer constant，Ktrans）、血浆容积（fractional plasma volume，Vp）、血流灌注参数（flow，F）、血管表面通透性（permeabilitysurface，PS）］、血清标志物［抗环瓜氨酸肽（cyclic citrullinated peptide，CCP）抗体、类风湿因子（rheumatoid factor，RF）］水平，分析MRI影像特征、定量参数与血清标志物的关系，评价MRI影像特征、定量参数对疗效的评估价值。 结果 治疗3个月后，2组MRI骨侵蚀、骨髓水肿评分、Ktrans、Vp、F、PS低于治疗前，有效组MRI骨侵蚀、骨髓水肿评分、Ktrans、Vp、F、PS低于无效组（P＜0.05）；血清CCP抗体、RF水平低于治疗前，有效组血清CCP抗体、RF水平低于无效组（P＜0.05）；治疗前与治疗3个月后MRI骨侵蚀、骨髓水肿评分、Ktrans、Vp、F、PS差值与血清CCP抗体、RF水平差值呈正相关（P＜0.05）；Logistic回归分析显示，治疗前与治疗3个月后MRI骨侵蚀、骨髓水肿评分、Ktrans、Vp、F、PS差值是RA疗效的独立影响因素（P＜0.05）。Logistic回归模型方程：3.175-1.058×骨侵蚀评分差值-0.842×骨髓水肿评分差值-0.894×Ktrans差值-0.606×Vp差值-0.952×F差值-1.014×PS差值；MRI骨侵蚀、骨髓水肿评分、Ktrans、Vp、F、PS差值单独评估疗效的AUC分别0.816、0.719、0.769、0.803、0.828、0.778，联合评估疗效的AUC为0.924，95%CI：0.862~0.965，敏感度为88.46%，特异度为87.23%，优于各指标单独评估价值。 结论 MRI检查骨侵蚀、骨髓水肿影像特征、Ktrans、Vp、F、PS等定量参数联合构建的评估模型可作为评估RA疗效的重要辅助途径，能为临床准确评估疗效提供更全面、可靠的数据支持。

Construction of an evaluation model for the therapeutic effect of rheumatoid arthritis based on MRI image characteristics and quantitative parameters

Objective To explore an evaluation model for the therapeutic effect of rheumatoid arthritis(RA) based on the image characteristics and quantitative parameters of magnetic resonance imaging(MRI).Methods A total of 120 patients with RA were selected as the research subjects, all of whom were treated with recombinant human tumor necrosis factor receptor antibody fusion protein combined with methotrexate, and the efficacy was evaluated at 3 months after treatment. They were divided into an effective group(n=94) and an ineffective group(n=26) according to the efficacy. MRI imaging characteristics(bone erosion, bone marrow edema), quantitative parameters ［volume transfer constant(Ktrans), fractional plasma volume(Vp), flow perfusion parameters(F), vascular permeability surface(PS)］ and serum markers［cyclic citrullinated peptide(CCP) antibodies, rheumatoid factor(RF)］ levels were compared between two groups before and after treatment. The relationship between MRI image characteristics, quantitative parameters and serum markers was analyzed. The value of MRI imaging characteristics and quantitative parameters on the assessment of efficacy was evaluated.Results At 3 months after treatment, the scores of bone erosion, bone marrow edema, Ktrans, Vp, F and PS on MRI in both groups were lower than those before treatment, and in the effective group were lower than those in the ineffective group(P＜0.05). The levels of serum CCP antibody and RF were lower than those before treatment, and lower in the effective group than in the ineffective group(P＜0.05). Bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS differences on MRI were positively correlated with serum CCP antibody and RF level before and at 3 months after treatment(P＜0.05). Logistic regression analysis showed that MRI bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS difference were independent influencing factors of RA efficacy before and at 3 months after treatment(P＜0.05). Logistic regression model equation was as follows: 3.175-1.058×difference of bone erosion score -0.842×score difference of bone marrow edema -0.894×Ktrans difference value -0.606×Vp difference value -0.952×F difference -1.014×PS difference. The AUC of bone erosion, bone marrow edema score, Ktrans, Vp, F, and PS difference on MRI alone in evaluating efficacy was 0.816, 0.719, 0.769, 0.803, 0.828, and 0.778, respectively; the AUC of combined evaluation was 0.924(95%CI: 0.862-0.965), sensitivity was 88.46%, and specificity was 87.23%, which were superior to the evaluation value of each index alone.Conclusion The evaluation model constructed by imaging characteristics of bone erosion, bone marrow edema, Ktrans, Vp, F, PS and other quantitative parameters on MRI can be used as an important auxiliary way to evaluate the efficacy of RA, which can provide more comprehensive and reliable data support for accurate clinical evaluation of efficacy.