切换至 "中华医学电子期刊资源库"
高级检索
中华损伤与修复杂志(电子版)

中华损伤与修复杂志(电子版) ›› 2020, Vol. 15 ›› Issue (02) : 122 -127. doi: 10.3877/cma.j.issn.1673-9450.2020.02.008

所属专题： 文献；

论著

多模态MRI技术在激素性股骨头坏死微循环及脂肪含量病理机制研究中的应用
韩晓蕊1, 洪郭驹2, 魏秋实3, 庞凤祥4, 杨鹏4, 郑越生5, 董庸伟5, 何炜5, 何伟3,†()   
  1. 1. 510405　广州，华南理工大学医学院
    2. T6G 2R3　埃德蒙顿，阿尔伯塔大学医学院外科部
    3. 510378　广州中医药大学第三附属医院骨科
    4. 510405　广州中医药大学第一附属医院五骨科
    5. 510000　广州中医药大学金沙洲医院骨科
  • 收稿日期:2020-02-02 出版日期:2020-04-01
  • 通信作者: 何伟
  • 基金资助:
    国家自然科学基金面上项目(81573996，81873327，81473696); 广东省科技厅－广东省中医药科学院联合科研专项项目(2016A020226028); 广东省自然科学基金资助项目(2017A030313698)

Application of multimodal magnetic resonance imaging in the study of pathological mechanism of microcirculation and fat content in steroid-induced osteonecrosis of the femoral head

Xiaorui Han1, Guoju Hong2, Qiushi Wei3, Fengxiang Pang4, Peng Yang4, Yuesheng Zheng5, Yongwei Dong5, Wei He5, Wei He3,†()   

  1. 1. School of Medicine, South China University of Technology, Guangzhou 510405, China
    2. Department of Surgery, the University of Alberta, Edmonton T6G 2R3, Canada
    3. Department of Orthopaedics, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, China
    4. Department of Orthopaedics(Fifth), First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
    5. Department of Orthopaedics, JinShaZhou Hospital of Guangzhou University of Chinese Medicine, GuangZhou 510000, China
  • Received:2020-02-02 Published:2020-04-01
  • Corresponding author: Wei He
  • About author:
    Corresponding author: He Wei, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

韩晓蕊, 洪郭驹, 魏秋实, 庞凤祥, 杨鹏, 郑越生, 董庸伟, 何炜, 何伟. 多模态MRI技术在激素性股骨头坏死微循环及脂肪含量病理机制研究中的应用[J]. 中华损伤与修复杂志(电子版), 2020, 15(02): 122-127.

Xiaorui Han, Guoju Hong, Qiushi Wei, Fengxiang Pang, Peng Yang, Yuesheng Zheng, Yongwei Dong, Wei He, Wei He. Application of multimodal magnetic resonance imaging in the study of pathological mechanism of microcirculation and fat content in steroid-induced osteonecrosis of the femoral head[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2020, 15(02): 122-127.

目的

利用多模态MRI技术检测塌陷前期激素性股骨头坏死(SIONFH)患者的股骨头骨组织微循环障碍及脂肪化的情况，并探讨二者与SIONFH疾病发展的相关性。

方法

纳入在广州中医药大学第一附属医院骨科确诊的SIONFH塌陷前期患者(即ARCO I期～Ⅲ期早期)，运用多模态MRI技术[包括功能性磁共振非对称回波的最小二乘估算法迭代水脂分离序列(IDEAL－IQ)、体素内不相干运动磁共振扩散加权成像(IVIM-DWI)、T1WI和T2WI/fs]进行诊断研究。具体流程包括在采用T1WI和T2WI/fs实现原发灶结构定位的基础上，运用IVIM-DWI和IDEAL-IQ分别测量不同区域(坏死区、硬化区、正常区)的局部微循环(f)和脂肪含量(FF)。重点分析股骨头骨组织微循环障碍及组织脂肪化情况与ARCO分期的相关性，同时对2种病理机制之间相关性进行探讨研究。数据比较采用单因素方差分析、LSD-t检验、Pearson相关性分析。

结果

SIONFH不同区域的局部微循环和脂肪含量比较，差异均有统计学意义(P值均小于0.05)。其中，在IDEAL-IQ序列中，坏死区FF值最高，硬化区FF值最低。在IVIM-DWI中，坏死区f值最低，硬化区其次，正常区最高。部微循环和脂肪含量呈负相关(r＝－0.37，P值均小于0.05)。ARCO Ⅲ期早期的f值最小，而FF值最小(P值均小于0.05)，并且FF值与ARCO分期呈正相关(r＝0.72，P值均小于0.01)，但f值与ARCO分期之间无明显相关性。

结论

多模态MRI技术(IDEAL-IQ、IVIM-DWI、T1WI和T2WI/fs)定量测量得出，SIONFH在塌陷前期中局部微循环进行性障碍和组织脂肪化增加会关联性出现，并随ARCO分期的进展而逐步加重。

关键词: 骨股头坏死, 磁共振成像, 脂肪组织, 微循环
Objectives

To investigate the fat content and microcirculation in the steroid-induced osteonecrosis of the femoral head (SIONFH) and their relationship with the development of SIONFH by multimodal magnetic resonance imaging.

Methods

SIONFH patients in pre-collapse stage (ARCO I to early ARCO Ⅲ stage) diagnosed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were involved in our research. Multimodal magnetic resonance imaging [including sequences as iterative decomposition of water andfat with echo asymmetry and least squares estimation(IDEAL-IQ)、intravoxel incoherent motion diffusion-weightedimaging(IVIM-DWI), T1WI and T2WI/fs] were taken to measure the values in the research. The specific procedure was as follow: sequence of IVIM-DWI and IDEAL-IQ were utilized in the evaluation of fat fraction (FF) and microcirculation (f) in necrosis area, penumbra area and normal area, according to location of primary lesion assessed by sequence of T1WI and T2WI/fs. The correlations among the fat content, microcirculation and ARCO stage were explored in order to investigate the relationship between these two pathological mechanisms. The data were processed with one-way analysis of variance, least significant difference t test, and Pearson correlation analysis.

Results

There were significant differences in fat content and microcirculation in different regions of SIONFH (P<0.05). In IDEAL-IQ, the FF value was highest in necrosis area and lowest in penumbra area. In IVIM-DWI, the f value was lowest in necrosis area, and then penumbra area, and highest in normal area. The FF value was negatively correlated with the F value (r=-0.37, P<0.05). In the early stage of ARCO Ⅲ, the FF value was highest while the f value was lowest (P<0.05), and the FF value was positively correlated with the ARCO staging (r=0.72, P<0.01), but not in that of f value.

Conclusion

Quantitative analysis of multimodal magnetic resonance imaging (IDEAL-IQ, IVIM-DWI, T1WI and T2WI/fs) showed that there was a correlation between the fat content and microcirculation in the pre-collapse stage of SIONFH and both the pathological mechanism developed with the progress of SIONFH.

Key words: Femur head necrosis, Magnetic Resonance Imaging, Adipose Tissue, Microcirculation
图1 激素性股骨头坏死的股骨头依据不同影像学征象分区。A示分成3个区域：坏死区(白色圈)、硬化区(橙色圈)、正常区(绿色圈)；B示各不同区域取值点依据，即将股骨头人为地分成12等份，每个区域分别测量±30°及正中持重线3处的值，最后取其平均值
图2 脂肪含量FF值对应的伪彩图。A示正常股骨头色阶均匀，股骨头形态如常；B、C、D示色阶不均，硬化带区均见明显蓝色伪彩，其中B股骨头关节面光整，C关节面欠光整，D内见新月征处亦见蓝色伪彩填充，股骨头关节面欠光整，局部见小破口；FF为脂肪分数
图3 局部微循环f值对应的伪彩图。A～D分别为正常股骨头，激素性股骨头坏死ARCO I期、ARCO II期、ARCO Ⅲ早期。A示正常股骨头色阶均匀，股骨头形态如常；B～D色阶不均，其内可见异常伪彩填充，且随着ARCO分期的增长，异常伪彩填充增多；B、C股骨头关节面光整，D关节面欠光整，局部见小裂隙；f为灌注分数；ARCO为国际骨循环研究会
图4 脂肪含量FF值、局部微循环f值与ARCO分期的相关性
图5 FF值与f值的相关性
表1 激素性股骨头坏死股骨头3个区域的FF值及f值单因素方差统计分析结果(±s)
参数 坏死区 硬化区 正常区 F值 P值
FF值 102.42±36.67 38.56±13.04 75.24±14.55 51.76 <0.05
f值 0.30±0.07 0.34±0.08 0.40±0.08 12.36 <0.05
表2 激素性股骨头坏死股骨头3个区域的FF值及f值LSD-t检验统计分析结果(±s)
分区 分区 FF值 f值
坏死区 硬化区 63.856±4.522 －0.040±0.020
正常区 27.180±5.121 －0.097±0.011
硬化区 坏死区 －63.856±4.522 0.040±0.020
正常区 －36.676±6.299 －0.057±0.023
正常区 坏死区 －27.180±5.121 0.097±0.011
硬化区 36.676±6.299 0.057±0.023
t1 ? 10.137 －2.046
P1 ? <0.05 0.044
t2 ? 4.315 －4.968
P2 ? <0.05 <0.05
t3 ? －10.137 2.046
P3 ? <0.05 0.044
t4 ? 5.822 －2.901
P4 ? <0.05 0.005
t5 ? －4.315 4.968
P5 ? <0.05 <0.05
t6 ? 5.822 2.901
P6 ? <0.05 0.005
[1]
费腾，阎作勤. 激素性股骨头坏死发病机制的研究进展[J/CD]. 中华关节外科杂志(电子版), 2011, 5(4): 504-508.
[2]
Trikha V, Goyal T, Jha RK. Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture[J]. Chin J Traumatol, 2011, 14(2): 104-106.
[3]
Tatara AM, Mikos AG. Tissue engineering in orthopaedics[J]. J Bone Joint Surg Am, 2016, 98(13): 1132-1139.
[4]
Guerado E, Caso E. The physiopathology of avascular necrosis of the femoral head: an update[J]. Injury, 2016, 47 Suppl 6: S16-S26.
[5]
Zhang YZ, Cao XY, Li XC, et al. Accuracy of MRI diagnosis of early osteonecrosis of the femoral head: a meta-analysis and systematic review[J]. J Orthop Surg Res, 2018, 13(1): 167.
[6]
李子荣. 股骨头坏死临床诊疗规范(2015年版)[J/CD]. 中华关节外科杂志(电子版), 2015, 9(1): 133-138.
[7]
Gontero RP, Bedoya ME, Benavente E, et al. Osteonecrosis in systemic lupus erythematosus[J]. Reumatol Clin, 2015, 11(3): 151-155.
[8]
Hong GJ, Lin N, Chen LL, et al. Association between vascular endothelial growth factor gene polymorphisms and the risk of osteonecrosis of the femoral head: Systematic review[J]. Biomed Rep, 2016, 4(1): 92-96.
[9]
Pansini V, Monnet A, Salleron J, et al. 3 Tesla (1) H MR spectroscopy of hip bone marrow in a healthy population, assessment of normal fat content values and influence of age and sex[J]. J Magn Reson Imaging, 2014, 39(2): 369-376.
[10]
Kawai M, de Paula FJA, Rosen CJ. New insights into osteoporosis: the bone－fat connection[J]. J Intern Med, 2012, 272(4): 317-329.
[11]
Van Alphen NA, Morsy M, Laungani AT, et al. A Three-Dimensional Micro－Computed Tomographic Study of the Intraosseous Lunate Vasculature: Implications for Surgical Intervention and the Development of Avascular Necrosis[J]. Plast and Reconstr Surg, 2016, 138(5): 869e-878e.
[12]
Krings A, Rahman S, Huang S, et al. Bone marrow fat has brown adipose tissue characteristics, which are attenuated with aging and diabetes[J]. Bone, 2012, 50(2): 546-552.
[13]
Aoki T, Yamashita Y, Oki H, et al. Iterative decomposition of water and fat with echo asymmetry and least－squares estimation (IDEAL) of the wrist and finger at 3T: Comparison with chemical shift selective fat suppression images[J]. J Magn Reson Imaging, 2013, 37(3): 733-738.
[14]
Karampinos DC, Melkus G, Baum T, et al. Bone marrow fat quantification in the presence of trabecular bone: initial comparison between water-fat imaging and single-voxel MRS[J]. Magn Reson Med, 2014, 71(3): 1158-1165.
[15]
Döpfert J, Lemke A, Weidner A, et al. Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging[J]. Magn Reson Imaging, 2011, 29(8): 1053-1058.
[16]
Jones LC, Aaron R. Circulatory pathology in osteonecrosis[M]//Srivastava RN. Skeletal Circulation in Clinical Practice. Singapore: World Scientific, 2016: 141-164.
[17]
Yamamoto S, Watanabe A, Nakamura J, et al. Quantitative T2 mapping of femoral head cartilage in systemic lupus erythematosus patients with noncollapsed osteonecrosis of the femoral head associated with corticosteroid therapy[J]. J Magn Reson Imaging, 2011, 34(5): 1151-1158.
[1] 丁建民, 秦正义, 张翔, 周燕, 周洪雨, 王彦冬, 经翔. 超声造影与普美显磁共振成像对具有高危因素的≤3 cm肝结节进行LI-RADS分类诊断的前瞻性研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 930-938.
[2] 张莲莲, 惠品晶, 丁亚芳. 颈部血管超声在粥样硬化斑块易损性评估中的应用价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 816-821.
[3] 刘冰茹, 刘皓希, 陈莹, 赖世伟, 陈蓉. 疑似乳腺癌的韧带样纤维瘤病一例[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 314-317.
[4] 叶艳娜, 叶瑞婷, 陈艳玲, 彭雯, 刘乐, 肖文秋, 黄辉, 李明深, 钟慕仪, 叶娴. 基于影像学表现和临床病理特征预测良性与交界性乳腺叶状肿瘤复发的列线图模型[J]. 中华乳腺病杂志(电子版), 2023, 17(04): 229-237.
[5] 方心俞, 黄昌瑜, 胡洪新, 林溢铭, 陈旸, 张楠心, 张文明. 膝关节软骨下不全骨折的治疗选择与疗效分析[J]. 中华关节外科杂志(电子版), 2023, 17(04): 583-587.
[6] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[7] 张雯, 张彦春, 刘凯波, 徐宏燕. 北京市胎儿先天性脑积水的产前MRI诊断及围产期转归[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 345-349.
[8] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[9] 雷漫诗, 邓锶锶, 汪昕蓉, 黄锦彬, 向青, 熊安妮, 孟占鳌. 人工智能辅助压缩感知技术在上腹部T2WI压脂序列中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 551-556.
[10] 钟广俊, 刘春华, 朱万森, 徐晓雷, 王兆军. MRI联合不同扫描序列在胃癌术前分期诊断及化疗效果和预后的评估[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 378-382.
[11] 吴钰娴, 冯亚园, 霍雷, 贾宁阳, 张娟. 原发性肝脏淋巴瘤的影像学诊断价值研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 349-353.
[12] 冯海涛, 徐涛, 刘文阳, 孙晨, 曹尚超. 三维动脉自旋标记联合动态对比增强MRI对脑胶质瘤术后复发及放射性脑坏死诊断的研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 262-265.
[13] 王志文, 郑雪梅, 张庆坤, 王海江. 自发性低颅压综合征75例临床分析[J]. 中华临床医师杂志(电子版), 2023, 17(04): 398-401.
[14] 李锦亮, 曾茂娟, 钟金宝, 何伟强, 林文新. 司美格鲁肽对肥胖2型糖尿病患者皮肤微循环功能的影响[J]. 中华肥胖与代谢病电子杂志, 2023, 09(03): 192-196.
[15] 赵暾, 徐霁华, 何有娣, 鲁明. 误诊为脑梗死且险些溶栓的急性自发微量脑出血一例[J]. 中华脑血管病杂志(电子版), 2023, 17(04): 369-372.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号