發(fā)布時間：2018-04-06 06:30

  本文選題：骶髂關(guān)節(jié)炎　切入點：多模態(tài)磁共振成像　出處：《青島大學(xué)》2017年碩士論文

【摘要】：第一部分：3D-MEDIC-WE序列在SIS關(guān)節(jié)軟骨病變的應(yīng)用研究目的：探討3D-MEDIC-WE序列顯示SIJ軟骨的能力及對SIS關(guān)節(jié)軟骨病變的診斷價值。方法：收集具有典型AS臨床癥狀的患者60例,另選取20名志愿者作為對照組。對雙側(cè)骶髂關(guān)節(jié)采用斜冠狀位掃描,序列包括T1WI、T2WI、TIRM-T2WI及3D-MEDIC-WE。對對照組骶髂關(guān)節(jié)軟骨各序列表現(xiàn)進(jìn)行主觀評價并在3D-MEDIC-WE上測量SIJ軟骨厚度、骶側(cè)及髂側(cè)的軟骨厚度;對患者組關(guān)節(jié)軟骨在各序列上改變進(jìn)行主觀評價并按照邊緣光整程度等建立分值標(biāo)準(zhǔn)(0~4分);在TIRM-T2WI、3D-MEDIC-WE上分別進(jìn)行SIJ軟骨分級評分。結(jié)果：對照組T1WI、T2WI序列不能顯示骶髂關(guān)節(jié)軟骨;TIRM-T2WI上軟骨呈稍高信號,與關(guān)節(jié)面下骨質(zhì)區(qū)分度差;3D-MEDIC-WE序列可以清晰顯示骶髂關(guān)節(jié)軟骨,能分辨骶側(cè)、髂側(cè)軟骨及兩者間的間隙。正常骶髂關(guān)節(jié)軟骨厚約(2.70±0.41)mm,骶側(cè)軟骨厚約(1.21±0.22)mm,髂側(cè)軟骨厚約(0.72±0.31)mm,骶側(cè)軟骨比髂側(cè)軟骨明顯厚(t=10.90,P0.01)�；颊呓MSIJ軟骨在3D-MEDIC-WE序列上軟骨表現(xiàn)為信號均勻,邊緣光滑20側(cè);軟骨邊緣不光整19側(cè);信號不均勻,邊緣毛糙50側(cè);有不同程度增厚或變窄、扭曲,邊緣呈鋸齒狀27側(cè);中斷甚至未顯示4側(cè)。患者組在3D-MEDIC-WE序列上的軟骨侵蝕分?jǐn)?shù)高于TIRM-T2WI序列(c2=176.644,P0.01)。結(jié)論：3D-MEDIC-WE序列可以清晰顯示骶髂關(guān)節(jié)軟骨,包括髂側(cè)、骶側(cè)軟骨及兩者間的間隙;3D-MEDIC-WE序列對骶髂關(guān)節(jié)炎關(guān)節(jié)軟骨病變的顯示優(yōu)于其他序列。第二部分：DWI、DCE-MRI診斷骶髂關(guān)節(jié)急性炎癥的價值目的：探討DWI、DCE-MRI評估骶髂關(guān)節(jié)急性炎癥的價值。方法：收集具有典型AS臨床癥狀的可疑患者42例,另選取18名志愿者作為對照組。對雙側(cè)骶髂關(guān)節(jié)進(jìn)行MR平掃、動態(tài)增強掃描及擴散加權(quán)成像(DWI)。根據(jù)TIRM-T2WI序列上骨髓信號是否增高將患者分為急性炎癥組和非急性炎癥組。對急性炎癥組進(jìn)行SPARCC評分。制作時間-信號曲線(TIC)并對其分型;計算、測量各組骨髓區(qū)的增強因子(Fenh)、增強斜率(Senh)及表觀擴散系數(shù)(ADC)。并對急性炎癥組SPARCC評分、ADC及Fenh三者間進(jìn)行相關(guān)性分析。結(jié)果：TIRM-T2WI、DWI、DCE-MRI分別檢出35側(cè)、34側(cè)、36側(cè)關(guān)節(jié)面下急性炎癥;差異無統(tǒng)計學(xué)意義(c2=2.06,P0.05)。急性炎癥組SPARCC評分為21.06±3.15。急性炎癥組病變區(qū)ADC值、Fenh及Senh均高于非急性炎癥組及對照組,差異有統(tǒng)計學(xué)意義(F分別為381.591、62.080、11.097,P均0.01);非炎癥組和對照組上述三個參數(shù)差異無統(tǒng)計學(xué)意義(P均0.05)。急性炎癥組TIC表現(xiàn)為快速上升平臺型(72.22%)、持續(xù)快速上升型(27.78%);非急性炎癥組及對照TIC均表現(xiàn)為速升緩降型。急性炎癥組的SPARCC評分與ADC、SPARCC評分與Fenh以及ADC與Fenh均呈正相關(guān)(r分別為0.874、0.673、0.723,P均0.05)。結(jié)論：DWI、DCE-MRI均可敏感顯示SIJ急性炎癥,通過測量ADC值,計算Fenh、Senh可量化評價炎性病變程度,對SIJ急性炎癥的診斷具有價值。
[Abstract]:Part 1: application of 3D-MEDIC-WE sequence in SIS articular cartilage objective: to investigate the ability of 3D-MEDIC-WE sequence to display SIJ cartilage and its diagnostic value in SIS articular cartilage lesions.Methods: 60 patients with typical as symptoms were collected and 20 volunteers were selected as control group.The bilateral sacroiliac joints were scanned with oblique coronal position. The sequences included T1WIT2WIT TIRM-T2WI and 3D-MEDIC-WE.The thickness of SIJ cartilage, the thickness of sacral side and iliac side were measured on 3D-MEDIC-WE by subjective evaluation of each sequence of sacroiliac articular cartilage in control group.The changes of articular cartilage in each sequence of patients were evaluated subjectively, and the score standard was established according to the degree of edge smoothing, and the SIJ cartilage grading score was carried out on TIRM-T2WI3D-MEDIC-WE.Results: the T1WII-T2WI sequence of the control group could not display the superior cartilage of sacroiliac articular cartilage on TIRM-T2WI, but the 3D-MEDIC-WE sequence could clearly display the sacroiliac articular cartilage and distinguish the sacroiliac articular cartilage from the sacroiliac articular cartilage and the interspace between the sacroiliac articular cartilage and the sacroiliac articular cartilage.The thickness of normal sacroiliac articular cartilage was about 2.70 鹵0.41mm. the thickness of sacral cartilage was about 1.21 鹵0.22mm. the thickness of iliac cartilage was 0.72 鹵0.31mm. the thickness of sacroiliac cartilage was significantly thicker than that of iliac cartilage.The SIJ cartilage in the patient group showed homogeneous signal intensity on 3D-MEDIC-WE sequence, smooth edge in 20 sides, not only 19 sides of cartilage margin, but also uneven signal intensity, rough edge in 50 sides, thickening or narrowing in varying degrees, distortion and serrated edge in 27 sides.The interruption did not even show 4 sides.The cartilage erosion score on 3D-MEDIC-WE sequence was higher in the patient group than that in the TIRM-T2WI sequence.Conclusion the 3D-MEDIC-WE sequence can clearly display the sacroiliac articular cartilage, including iliac side, sacral cartilage and the interspace between them. The 3D-MEDIC-WE sequence is superior to other sequences in displaying the articular cartilage lesions of sacroiliac arthritis.Part II: the value of DCE-MRI in the diagnosis of acute sacroiliac joint inflammation objective: to evaluate the value of DWII-DCE-MRI in the assessment of acute sacroiliac joint inflammation.Methods: 42 suspicious patients with typical as clinical symptoms were collected and 18 volunteers were selected as control group.The bilateral sacroiliac joints were examined by Mr scan, dynamic contrast enhancement and diffusion weighted imaging.Patients were divided into acute inflammation group and non-acute inflammation group according to whether the bone marrow signal on TIRM-T2WI sequence was elevated.SPARCC score was used in acute inflammation group.The time-signal curve (TIC) was made and classified, and the enhancement factor (Fenhan), enhanced slope (Senhan) and apparent diffusion coefficient (ADCA) of bone marrow area in each group were measured.The correlation between SPARCC score and Fenh in acute inflammation group was analyzed.Results the acute subarticular inflammation was detected on DWCE-MRI in 35 sides and 34 sides in 36 sides of articular surface, but there was no significant difference between the two groups (P 0.05).The SPARCC score of acute inflammation group was 21.06 鹵3.15.The values of ADC and Senh in the lesion area of acute inflammation group were higher than those in non-acute inflammation group and control group, the difference was statistically significant (F = 381.591D, 62.080 / 11.097g, P < 0.01), but there was no significant difference between non-inflammatory group and control group (P < 0.05).The TIC of acute inflammation group was 72.22%, and that of continuous rapid rising type was 27.78%, and that of non-acute inflammation group and control group was rapid ascending and slowly descending type.In acute inflammation group, there was a positive correlation between SPARCC score, Fenh score, ADC score and Fenh score (P < 0.05).ConclusionDCE-MRI can sensitively display the acute inflammation of SIJ. By measuring the value of ADC, the degree of inflammation can be quantitatively evaluated by calculating the value of Fenh-Senh, which is valuable in the diagnosis of acute inflammation of SIJ.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R593.23

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