Intravoxel incoherent motion magnetic resonance imaging of the knee joint in children with juvenile idiopathic arthritis
Intravoxel incoherent motion magnetic resonance imaging of the knee joint in children with juvenile idiopathic arthritis
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DOI：
10.1007/s00247-017-3800-6
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发表时间：
2017-05-01
影响因子：
2.3
通讯作者：
Neubauer, Henning
中科院分区：
文献类型：
--
作者：
Hilbert, Fabian;Holl-Wieden, Annette;Neubauer, Henning
滑膜炎的MRI依赖于钆基造影剂的使用。弥散加权磁共振成像（DWI）显示增厚的滑膜，但在关节积液的情况下使用有限。为了探讨弥散加权磁共振成像与体素内非相干运动（IVIM）诊断青少年特发性关节炎儿童膝关节滑膜炎的可行性和诊断准确性。12例确诊或疑似青少年特发性关节炎的儿童，（10名女孩，中位年龄11岁）进行了MRI对比增强T1加权成像和1.5 T DWI。在0 s/mm（2）、200 s/mm（2）、400 s/mm（2）和800 s/mm（2）的B值下采集读出分段多次激发DWI。计算IVIM参数灌注分数（f）和组织扩散系数（D）。由两名独立的阅片员使用幼年型关节炎MRI评分系统回顾性评估B=800 s/mm（2）的弥散加权成像、f参数图和增强后T1加权成像是否有滑膜炎。DWI和f图上滑膜炎的诊断等级与对比增强成像完全一致，是诊断参考。两名儿童在DWI上有可疑的低置信度评估。滑膜炎的中位f为6.7 +/- 2.0%，积液为2.1 +/- 1.2%，肌肉为5.0 +/- 1.0%，腘淋巴结为10.6 +/- 5.7%。与DWI相比，三名（25%）儿童的f图诊断置信度较高，一名儿童的诊断置信度较低（8%）。IVIM DWI可可靠地显示膝关节滑膜炎。灌注分数图区分增厚的滑膜和关节积液，从而增加诊断的信心。
MRI of synovitis relies on use of a gadolinium-based contrast agent. Diffusion-weighted MRI (DWI) visualises thickened synovium but is of limited use in the presence of joint effusion.To investigate the feasibility and diagnostic accuracy of diffusion-weighted MRI with intravoxel incoherent motion (IVIM) for diagnosing synovitis in the knee joint of children with juvenile idiopathic arthritis.Twelve consecutive children with confirmed or suspected juvenile idiopathic arthritis (10 girls, median age 11 years) underwent MRI with contrast-enhanced T1-weighted imaging and DWI at 1.5 T. Read-out segmented multi-shot DWI was acquired at b values of 0 s/mm(2), 200 s/mm(2), 400 s/mm(2) and 800 s/mm(2). We calculated the IVIM parameters perfusion fraction (f) and tissue diffusion coefficient (D). Diffusion-weighted images at b=800 s/mm(2), f parameter maps and post-contrast T1-weighted images were retrospectively assessed by two independent readers for synovitis using the Juvenile Arthritis MRI Scoring system.Seven (58%) children showed synovial hypertrophy on contrast-enhanced imaging. Diagnostic ratings for synovitis on DWI and on f maps were fully consistent with contrast-enhanced imaging, the diagnostic reference. Two children had equivocal low-confidence assessments on DWI. Median f was 6.7 +/- 2.0% for synovitis, 2.1 +/- 1.2% for effusion, 5.0 +/- 1.0% for muscle and 10.6 +/- 5.7% for popliteal lymph nodes. Diagnostic confidence was higher based on f maps in three (25%) children and lower in one child (8%), as compared to DWI.DWI with IVIM reliably visualises synovitis of the knee joint. Perfusion fraction maps differentiate thickened synovium from joint effusion and hence increase diagnostic confidence.