Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis.
Readout-segmented multi-shot diffusion-weighted MRI of the knee joint in patients with juvenile idiopathic arthritis.
复制标题
DOI：
10.1186/s12969-017-0203-z
复制
发表时间：
2017-10-12
期刊：
影响因子：
--
通讯作者：
Neubauer H
中科院分区：
文献类型：
--
作者：
Sauer A;Li M;Holl-Wieden A;Pabst T;Neubauer H
弥散加权 MRI 已被提议作为一种无需静脉注射造影剂即可对滑膜炎进行成像的新技术。我们研究了多次读取分段扩散加权 MRI（多次 DWI）对幼年特发性关节炎 (JIA) 患者膝关节滑膜成像的诊断效用。连续 32 名确诊或疑似 JIA 的患者（21 名女孩，中位年龄 13 岁）接受了常规 1.5 T MRI 与对比增强 T1w 成像（对比增强 MRI）和多次 DWI（RESOLVE，b 值 0-50 和 800 s/mm2）。代表诊断标准的对比增强 MRI 和 b = 800 s/mm2 的弥散加权图像由三名不同专业水平的独立盲读员分别评估滑膜炎的存在和滑膜炎的程度（改良的 5 项李克特量表）以及主观诊断置信度水平。 14 名 (44%) 患者患有活动性滑膜炎和关节积液，9 名 (28%) 患者表现出轻度滑膜强化，不符合关节炎的条件，另外 9 名 (28%) 患者在对比增强成像中没有滑膜信号改变。第一个读者对对比增强 MRI 和 DWI 的评分显示出基本一致 (κ = 0.74)。在对比增强 MRI 和 DWI 上诊断或排除活动性膝关节关节炎方面，观察者间的一致性很高，显示第 1 和第 2 读者之间完全一致，而第 1 和第 3 读者之间有一个病例 (3%) 存在分歧。相比之下，DWI 上无滑膜炎症和很少滑膜炎症的评分明显不一致。与对比增强成像相比，DWI 的诊断置信度较低。膝关节多次 DWI 在常规成像中是可行的，并且可以可靠地诊断或排除儿科患者的活动性膝关节关节炎，而无需基于钆的静脉注射。造影剂注射。可能由于“T2w 透光”伪影，DWI 无法可靠地区分未发炎的关节与具有轻度滑膜刺激的膝关节。
Diffusion-weighted MRI has been proposed as a new technique for imaging synovitis without intravenous contrast application. We investigated diagnostic utility of multi-shot readout-segmented diffusion-weighted MRI (multi-shot DWI) for synovial imaging of the knee joint in patients with juvenile idiopathic arthritis (JIA). Thirty-two consecutive patients with confirmed or suspected JIA (21 girls, median age 13 years) underwent routine 1.5 T MRI with contrast-enhanced T1w imaging (contrast-enhanced MRI) and with multi-shot DWI (RESOLVE, b-values 0–50 and 800 s/mm2). Contrast-enhanced MRI, representing the diagnostic standard, and diffusion-weighted images at b = 800 s/mm2 were separately rated by three independent blinded readers at different levels of expertise for the presence and the degree of synovitis on a modified 5-item Likert scale along with the level of subjective diagnostic confidence. Fourteen (44%) patients had active synovitis and joint effusion, nine (28%) patients showed mild synovial enhancement not qualifying for arthritis and another nine (28%) patients had no synovial signal alterations on contrast-enhanced imaging. Ratings by the 1st reader on contrast-enhanced MRI and on DWI showed substantial agreement (κ = 0.74). Inter-observer-agreement was high for diagnosing, or ruling out, active arthritis of the knee joint on contrast-enhanced MRI and on DWI, showing full agreement between 1st and 2nd reader and disagreement in one case (3%) between 1st and 3rd reader. In contrast, ratings in cases of absent vs. little synovial inflammation were markedly inconsistent on DWI. Diagnostic confidence was lower on DWI, compared to contrast-enhanced imaging. Multi-shot DWI of the knee joint is feasible in routine imaging and reliably diagnoses, or rules out, active arthritis of the knee joint in paediatric patients without the need of gadolinium-based i.v. contrast injection. Possibly due to “T2w shine-through” artifacts, DWI does not reliably differentiate non-inflamed joints from knee joints with mild synovial irritation.
登录
查看更多内容
影响因子：
2.3
作者：
Hilbert, Fabian;Holl-Wieden, Annette;Neubauer, Henning
通讯作者：
Neubauer, Henning
影响因子：
19.7
作者：
LEBIHAN, D;BRETON, E;LAVALJEANTET, M
通讯作者：
LAVALJEANTET, M
影响因子：
5.9
作者：
Hemke, Robert;Maas, Mario;Kuijpers, Taco W.
通讯作者：
Kuijpers, Taco W.
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
影响因子：
2.3
作者：
Damasio, Maria Beatrice;Malattia, Clara;Toma, Paolo
通讯作者：
Toma, Paolo