Quantitative ultrashort echo time magnetization transfer (UTE-MT) for diagnosis of early cartilage degeneration: comparison with UTE-T2* and T2 mapping.
Quantitative ultrashort echo time magnetization transfer (UTE-MT) for diagnosis of early cartilage degeneration: comparison with UTE-T2* and T2 mapping.
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DOI：
10.21037/qims.2019.12.04
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发表时间：
2020-01
影响因子：
2.8
通讯作者：
Jiawei Yang;H. Shao;Yajun Ma;Lidi Wan;Yixuan Zhang;Junjie Jiang;J. Du;G. Tang
中科院分区：
文献类型：
--
作者：
Jiawei Yang;H. Shao;Yajun Ma;Lidi Wan;Yixuan Zhang;Junjie Jiang;J. Du;G. Tang
目的探讨应用定量超短回波时间磁化转移(UTE-MT)技术诊断早期软骨退变的可行性，并与UTE-T2*标测和T2标测进行比较。方法取20例全膝关节置换术(TKA)患者的前外侧髁状突标本，在GE，MR750临床3.0T扫描机上进行磁共振扫描。在标本上手工绘制72个感兴趣区(ROI)，用于UTE-MT、UTE-T2*和T2测量，并根据退变的组织学指标(即Mankin评分)将相应的软骨-骨区进一步分为正常(n=11，Mankin评分0~1)、轻度(n=28，Mankin评分2~5)、中度(n=21，Mankin评分6~9)和重度(n=12，Mankin评分10~14)作为参考标准。用方差分析(ANOVA)、Tamhane-T2、LSD、Kruskal-Wallis检验和Spearman‘s相关系数分析定量MR参数与Mankin评分之间的组间差异和相关性。利用受试者-操作特征(ROC)曲线比较不同定量MR参数对轻度软骨退变的诊断效果。结果正常组UTE磁化转移率与轻度组(P=0.021)、中度组(P<；0.001)、重度组(P<；0.001)比较，差异有统计学意义。T2*值在正常组与中度组(P<；0.032)、正常组与重度组(P<；0.001)之间均有显著差异。T2值在重度组与正常组之间仅有显著差异(P=0.011)。UTE-MTR、UTE-T2*和T2值均与Mankin评分呈显著正相关：UTE-MTR值与Mankin评分呈强相关(r=-0.678，P<；0.001)，UTE-T2*值与Mankin评分呈显著正相关(r=-0.501，P<；0.001)，T2值与Mankin评分呈弱相关(r=0.337，P=0.004)。UTE-MTR对早期软骨退变的诊断效果(AUC=0.828，P=0.002)优于UTE T2*标测(AUC=0.604，P=0.318)和T2标测(AUC=0.644，P=0.165)。结论UTE-MTR值与软骨退变的组织学分级密切相关，UTE-MTR值对早期软骨退变的诊断效果优于UTE T2*标测和T2标测。一旦这项技术的临床潜力得到证实，UTE-MT可能会提供一种很有前途的成像生物标志物，在更全面的软骨退变诊断和监测中具有潜在的应用前景。
Background To investigate the feasibility of using quantitative ultrashort echo time magnetization transfer (UTE-MT) technique in diagnosing early cartilage degeneration and to compare the technique's diagnostic efficacy with UTE-T2* mapping and T2 mapping. Methods Twenty human anterolateral condyle specimens with degeneration were obtained from volunteers undergoing total knee arthroplasty (TKA); they then underwent magnetic resonance (MR) scan on a clinical 3.0T scanner (GE, MR750). Seventy-two regions of interest (ROI) were manually drawn on specimens for UTE-MT, UTE-T2*, and T2 measurement, and the corresponding cartilage-bone regions were further divided into degeneration classifications of normal (n=11, Mankin scores 0-1), mild (n=28, Mankin scores 2-5), moderate (n=21, Mankin scores 6-9), and severe (n=12, Mankin scores 10-14) based on histological measures of degeneration (i.e., Mankin scores) as a reference standard. Differences among groups and correlations between quantitative MR parameters and Mankin scores were assessed using analysis of variance (ANOVA), Tamhane-T2, LSD, Kruskal-Wallis tests, and Spearman's correlation coefficient. The receiver-operating characteristic (ROC) curve was used to compare the diagnostic efficacy of different quantitative MR parameters for the detection of mild cartilage degeneration. Results The UTE magnetization transfer ratio (UTE-MTR) in the normal group was significantly different from the mild group (P=0.021), moderate group (P<0.001), and severe group (P<0.001). Significant differences were observed in the T2* values between both the normal group and the moderate group (P<0.032), and between the normal group and the severe group (P<0.001). For T2 values, the only significant difference was observed between the severe group and the normal group (P=0.011). The UTE-MTR, UTE-T2*, and T2 values were all significantly correlated with Mankin scores: UTE-MTR values were strongly (r=-0.678, P<0.001) correlated, UTE-T2* values were markedly correlated (r=-0.501, P<0.001), and T2 values were weakly correlated (r=0.337, P=0.004) correlated with Mankin scores. The diagnostic efficacy of UTE-MTR (AUC =0.828, P=0.002) was better than UTE T2* mapping and T2 mapping (AUC =0.604, P=0.318; AUC =0.644, P=0.165, respectively) for the diagnosis of early cartilage degeneration. Conclusions UTE-MTR values were strongly correlated with histological grades of cartilage degeneration, and its diagnostic efficacy was better than both UTE T2* mapping and T2 mapping in detecting early cartilage degeneration. Once the clinical potential of the technique has been confirmed, UTE-MT may provide a promising imaging biomarker with potential application in a more comprehensive diagnosis and monitoring of cartilage degeneration.