目的 分析3.0T磁共振成像(MRI)的多种影像学征象对股骨头缺血性坏死(ANFH)诊断及其预后评估的价值。方法 自解放军总医院第四医学中心择取82例ANFH患者,行3.0T MRI扫描检查前均进行电子计算机断层扫描(CT)检查,统计两种检查方法检查ANFH的具体表现。术后进行随访,随访时间6个月,记录患者预后情况,比较不同预后患者的MRI影像组学征象,分析其与预后的关系。结果 82例ANFH患者,单侧股骨头坏死45例,双侧股骨头坏死37例,共计119个股骨头坏死。根据ARCO分期标准:Ⅰ期38个股骨头坏死,Ⅱ期48个,Ⅲ期23个,Ⅳ期10个。MRI股骨头坏死检出率明显高于CT检出率,对比差异有统计学意义(P＜0.05)。ANFH预后良好组骨髓水肿、关节腔积液、双线征、股骨头形态、T1WI低信号、T2WI低信号占比低于预后不良组(P＜0.05)。结论 ANFH患者的特异性MRI征象为骨髓水肿、双线征,可根据以上征象指导疾病分期,并进行有针对性的治疗。
Abstract
Objective To analyze the value of various imaging features of 3.0T magnetic resonance imaging (MRI) in the diagnosis and prognostic evaluation of avascular necrosis of the femoral head (ANFH). Methods A total of 82 patients with ANFH were selected from the Fourth Medical Center of PLA General Hospital. Before 3.0T MRI examination, electronic computed tomography (CT) examination was performed to statistically analyze the specific manifestations of avascular necrosis of the femoral head. Postoperative follow-up was conducted for 6 months to record the prognosis, and compare the MRI radiomics signs of the patients with different prognoses were compared to analyze their relationship with prognosis. Results Out of 82 patients with ANFH, 45 had unilateral femoral head necrosis and 37 had bilateral femoral head necrosis, resulting in a total of 119 cases of femoral head necrosis. According to the ARCO staging criteria: 38 cases of femoral head necrosis in stage I, 48 cases in stage Ⅱ, 23 cases in stage Ⅲ, and 10 cases in stage Ⅳ. The detection rate of femoral head necrosis on MRI was significantly higher than that on CT, and the difference was statistically significant (P<0.05). In the ANFH patients with good prognosis, the proportion of bone marrow edema, joint effusion, double line sign, femoral head morphology, T1WI low signal, and T2WI low signal was lower than that in the poor prognosis group(P＜0.05). Conclusions The specific MRI features of ANFH patients are bone marrow edema and double line sign, which can be used to guide the staging of the disease and provide targeted treatment.
关键词
3.0T核磁共振成像 /
股骨头缺血性坏死 /
电子计算机断层扫描检查 /
预后评估
Key words
3.0T magnetic resonance imaging /
avascular necrosis of the femoral head /
computed tomography examination /
prognostic evaluation
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