Intravoxel incoherent motion (IVIM) MRI in pediatric patients with synovitis of the knee joint: a prospective pilot study.
Intravoxel incoherent motion (IVIM) MRI in pediatric patients with synovitis of the knee joint: a prospective pilot study.
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DOI：
10.1186/s12969-022-00756-w
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发表时间：
2022-11-16
影响因子：
2.5
通讯作者：
Neubauer, Henning
中科院分区：
文献类型：
--
作者：
Huch, Britta;Stumpf, Kilian;Bracher, Anna-Katinka;Rasche, Volker;Vogele, Daniel;Schuetz, Catharina;Janda, Ales;Beer, Meinrad;Neubauer, Henning
关键词：
通过给予钆基造影剂诊断滑膜炎症受到侵入性和可能的副作用的限制，特别是在儿童和青少年中。我们研究了弥散加权（DWI）MRI与体素内非相干运动（IVIM）成像相比，对比增强MRI在儿科和年轻成人人群中检测膝关节滑膜炎的诊断准确性。此外，我们比较了一组健康志愿者的滑膜扩散和灌注的定量测量。在这项前瞻性研究中，8名患有已知或疑似滑膜炎的10个症状性膝关节（6名女孩和2名男孩，平均年龄13岁）的儿童患者在2016年10月至2019年7月期间接受了膝关节造影前后3.0 T MRI和额外的DWI序列。为了进行比较，我们招募了5名健康的年轻成年人（2名女性和3名男性，中位年龄27岁），对双膝进行了无对比剂MRI。由两名具有不同经验水平的独立和盲法阅片者分别对患者的增强后T1 w图像和B = 1000 s/mm 2的DWI图像及表观扩散系数（ADC）图进行评分，以确定是否存在滑膜炎和滑膜炎的程度以及置信水平沿着。我们测量了患者和志愿者滑膜、关节积液和肌肉感兴趣区域的DWI信号强度，并计算了IVIM参数组织扩散系数（D）和灌注分数（f）。所有患者的滑膜均有不同程度的增强，以增强T1 w为诊断标准，8例（80%）儿童膝关节滑膜炎。第一位和第二位阅片人对ce-T1 w和DWI的评分显示，诊断滑膜炎完全一致（kappa = 1），滑膜增强程度基本一致（k = 0.655）。DWI的观察者间一致性显示两名阅片者之间的一致性相当（k = 0，220）。DWI的诊断置信度较低。患者和志愿者之间肌肉的平均D值和f值相当。与志愿者相比，患者的有效平均D较高，平均f较低，滑膜平均D较低，平均f较高。所有差异均具有统计学显著性（p < 0.001）。在儿科患者中，IVIM成像的弥散加权MRI仍然是一种很有前途的替代静脉造影剂增强成像的阅片者依赖性方法，可以可靠地诊断或排除膝关节滑膜炎。与健康志愿者相比，我们检测到患者的滑膜扩散明显受限，灌注增加。伦理委员会大学医院乌尔姆，Nr。320/16.
Diagnosing synovial inflammation by administration of gadolinium-based contrast agents is limited by invasiveness and possible side effects, especially in children and adolescents. We investigated diagnostic accuracy of diffusion-weighted (DWI) MRI with intravoxel incoherent motion (IVIM) imaging compared to contrast-enhanced MRI for detecting synovitis of the knee in a population of pediatrics and young adults. In addition we compared quantitative measures of synovial diffusion and perfusion to a group of healthy volunteers. In this prospective study, 8 pediatric patients with 10 symptomatic knees (6 girls and 2 boys, mean age 13 years) with known or suspected synovitis underwent pre- and post-contrast 3.0 T MRI of the knee joint and additional DWI sequences between October 2016 and July 2019. For comparison we enrolled 5 healthy young adults (2 women and 3 men, median age 27 years) with contrast-free MRI of both knees. Post-contrast T1w images and DWI images at b = 1000s/mm2 with apparent diffusion coefficient (ADC) maps of patients were separately rated by two independent and blinded readers with different levels of experience for the presence or absence and degree of synovitis along with the level of confidence. We measured signal intensity on DWI of synovium, joint effusion and muscle with regions of interests and calculated the IVIM-parameters tissue diffusion coefficient (D) and perfusion fraction (f) for patients and volunteers. All patients showed at least some synovial contrast enhancement, 8 (80%) children knees were diagnosed with synovitis on contrast-enhanced (= ce)-T1w, the diagnostic standard. Ratings by the first and second reader on ce-T1w and DWI showed full agreement (kappa = 1) in diagnosing synovitis and substantial agreement (k = 0,655) for the degree of synovial enhancement. Interobserver agreement on DWI showed fair agreement (k = 0,220) between both readers. Diagnostic confidence was lower on DWI. Mean D- and f-values of muscle was comparable between patients and volunteers. Effusion mean D was higher, mean f was lower, synovial mean D was lower, mean f higher in patients than in volunteers. All differences were statistically significant (p < 0.001). Diffusion-weighted MRI with IVIM imaging remains a promising, though reader-dependent alternative to i.v. contrast-enhanced imaging in pediatric patients to reliably diagnose, or rule out, synovitis of the knee joint. We detected significantly restricted synovial diffusion and increased perfusion in patients compared to healthy volunteers. Ethical Comitee University Hospital Ulm, Nr. 320/16.
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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：
3.3
作者：
Sigmund EE;Cho GY;Kim S;Finn M;Moccaldi M;Jensen JH;Sodickson DK;Goldberg JD;Formenti S;Moy L
通讯作者：
Moy L
DOI：
10.1186/s12969-017-0203-z
发表时间：
2017-10-12
期刊：
Pediatric rheumatology online journal
影响因子：
--
作者：
Sauer A;Li M;Holl-Wieden A;Pabst T;Neubauer H
通讯作者：
Neubauer H
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