CAJ | 학술논문

目的：探讨干燥综合征（ SS）的腮腺MRI表现特点。方法收集因口干于本院就诊的27例患者，根据SS国际分类诊断标准，分为SS组（21例）和非SS组（6例）。另外选取10名健康志愿者作为对照组。所有受试者均行常规腮腺MRI检查和双侧腮腺导管MR成像（ MRS）。观察T1 WI和T2 WI上信号强度的标准差，并进行脂肪信号分级和腮腺导管扩张程度分级。以临床诊断为金标准，评价常规MRI、MRS及二者联合应用对SS的诊断效能。采用单因素方差分析比较3组受试者腮腺信号强度标准差的差异，采用配对四格表χ2检验比较常规MRI和MRS诊断SS的差异，采用一致性检验比较SS组2种分级结果的一致性。结果对照组和非SS组受试者腮腺常规MRI信号均匀；SS组患者均为双侧腮腺病变，表现为腮腺信号不均匀，T1 WI和T2 WI上均见多发弥漫分布的高信号，在抑脂T2 WI上呈低信号；42个腮腺的脂肪信号分级，0级2个、1级10个、2级10个、3级6个、4级14个。 MRS上对照组和非SS组受试者均未见腮腺末梢导管扩张；SS组患者均为双侧腮腺病变，表现为弥漫性腮腺末梢导管扩张；42个腮腺的腮腺导管扩张程度分级，0级12个、1级8个、2级10个、3级5个、4级7个。 SS组、非SS组和对照组腮腺T1 WI 信号强度的标准差分别为124.1±30.0、81.8±27.6和86.3±35.0，T2 WI信号强度的标准差分别为115.1±35.2、69.8±23.5和80.1±31.4， SS组信号强度的标准差均高于非SS组和对照组，差异有统计学意义（ F值分别为13.780和13.301， P值均＜0.01）；而非SS组和对照组腮腺信号强度标准差差异无统计学意义（P＞0.05）。21例SS患者的42个腮腺中，常规MRI和MRS分别检出病变腮腺40和30个，均无假阳性结果，差异有统计学意义（χ2＝13.04，P＝0.013），而2种方法联合应用检出了全部42个病变腺体。脂肪信号分级和腮腺导管扩张程度分级方法诊断SS组患者病变腮腺的一致性较差（Kappa＝0.12，P＝0.092）。结论 SS患者腮腺常规MRI的弥漫性脂肪沉积和MRS的弥漫性末梢导管扩张均为特征性表现。常规MRI作为SS的首选检查手段，联合应用MRS可提高诊断准确性。目的：探討榦燥綜閤徵（ SS）的腮腺MRI錶現特點。方法收集因口榦于本院就診的27例患者，根據SS國際分類診斷標準，分為SS組（21例）和非SS組（6例）。另外選取10名健康誌願者作為對照組。所有受試者均行常規腮腺MRI檢查和雙側腮腺導管MR成像（ MRS）。觀察T1 WI和T2 WI上信號彊度的標準差，併進行脂肪信號分級和腮腺導管擴張程度分級。以臨床診斷為金標準，評價常規MRI、MRS及二者聯閤應用對SS的診斷效能。採用單因素方差分析比較3組受試者腮腺信號彊度標準差的差異，採用配對四格錶χ2檢驗比較常規MRI和MRS診斷SS的差異，採用一緻性檢驗比較SS組2種分級結果的一緻性。結果對照組和非SS組受試者腮腺常規MRI信號均勻；SS組患者均為雙側腮腺病變，錶現為腮腺信號不均勻，T1 WI和T2 WI上均見多髮瀰漫分佈的高信號，在抑脂T2 WI上呈低信號；42箇腮腺的脂肪信號分級，0級2箇、1級10箇、2級10箇、3級6箇、4級14箇。 MRS上對照組和非SS組受試者均未見腮腺末梢導管擴張；SS組患者均為雙側腮腺病變，錶現為瀰漫性腮腺末梢導管擴張；42箇腮腺的腮腺導管擴張程度分級，0級12箇、1級8箇、2級10箇、3級5箇、4級7箇。 SS組、非SS組和對照組腮腺T1 WI 信號彊度的標準差分彆為124.1±30.0、81.8±27.6和86.3±35.0，T2 WI信號彊度的標準差分彆為115.1±35.2、69.8±23.5和80.1±31.4， SS組信號彊度的標準差均高于非SS組和對照組，差異有統計學意義（ F值分彆為13.780和13.301， P值均＜0.01）；而非SS組和對照組腮腺信號彊度標準差差異無統計學意義（P＞0.05）。21例SS患者的42箇腮腺中，常規MRI和MRS分彆檢齣病變腮腺40和30箇，均無假暘性結果，差異有統計學意義（χ2＝13.04，P＝0.013），而2種方法聯閤應用檢齣瞭全部42箇病變腺體。脂肪信號分級和腮腺導管擴張程度分級方法診斷SS組患者病變腮腺的一緻性較差（Kappa＝0.12，P＝0.092）。結論 SS患者腮腺常規MRI的瀰漫性脂肪沉積和MRS的瀰漫性末梢導管擴張均為特徵性錶現。常規MRI作為SS的首選檢查手段，聯閤應用MRS可提高診斷準確性。
목적：탐토간조종합정（ SS）적시선MRI표현특점。방법수집인구간우본원취진적27례환자，근거SS국제분류진단표준，분위SS조（21례）화비SS조（6례）。령외선취10명건강지원자작위대조조。소유수시자균행상규시선MRI검사화쌍측시선도관MR성상（ MRS）。관찰T1 WI화T2 WI상신호강도적표준차，병진행지방신호분급화시선도관확장정도분급。이림상진단위금표준，평개상규MRI、MRS급이자연합응용대SS적진단효능。채용단인소방차분석비교3조수시자시선신호강도표준차적차이，채용배대사격표χ2검험비교상규MRI화MRS진단SS적차이，채용일치성검험비교SS조2충분급결과적일치성。결과대조조화비SS조수시자시선상규MRI신호균균；SS조환자균위쌍측시선병변，표현위시선신호불균균，T1 WI화T2 WI상균견다발미만분포적고신호，재억지T2 WI상정저신호；42개시선적지방신호분급，0급2개、1급10개、2급10개、3급6개、4급14개。 MRS상대조조화비SS조수시자균미견시선말소도관확장；SS조환자균위쌍측시선병변，표현위미만성시선말소도관확장；42개시선적시선도관확장정도분급，0급12개、1급8개、2급10개、3급5개、4급7개。 SS조、비SS조화대조조시선T1 WI 신호강도적표준차분별위124.1±30.0、81.8±27.6화86.3±35.0，T2 WI신호강도적표준차분별위115.1±35.2、69.8±23.5화80.1±31.4， SS조신호강도적표준차균고우비SS조화대조조，차이유통계학의의（ F치분별위13.780화13.301， P치균＜0.01）；이비SS조화대조조시선신호강도표준차차이무통계학의의（P＞0.05）。21례SS환자적42개시선중，상규MRI화MRS분별검출병변시선40화30개，균무가양성결과，차이유통계학의의（χ2＝13.04，P＝0.013），이2충방법연합응용검출료전부42개병변선체。지방신호분급화시선도관확장정도분급방법진단SS조환자병변시선적일치성교차（Kappa＝0.12，P＝0.092）。결론 SS환자시선상규MRI적미만성지방침적화MRS적미만성말소도관확장균위특정성표현。상규MRI작위SS적수선검사수단，연합응용MRS가제고진단준학성。
Objective To investigate MR imaging features of parotid gland in Sj?gren′s syndrome ( SS).Methods Twenty-seven cases of xerostomia patients were collected and divided into SS group ( n=21) and non-SS group (n=6) according to the international classification (diagnosis) criteria for SS.Ten healthy volunteers were recruited as the control group.All the subjects underwent conventional MRI of parotid gland and MR sialography ( MRS).Standard deviation of T 1 WI and T2 WI signal intensity among 3 groups was observed, meanwhile, grading was made according to parotid glands , fat signal and parotid duct expansion degree respectively.With clinical diagnosis as the gold standard , diagnostic value of conventional MRI , MRS and their combination used in SS was compared.One-way ANOVA was used in comparison of standard deviation of parotid gland′s signal intensity among 3 groups , and Chi-square test was applied in comparison of conventional MRI and MRS diagnostic value.Moreover , Kappa value was calculated to assess the consistency of two grading results in SS.Results Signal intensity of parotid glands in control group and non-SS group was homogeneous.However , bilaterally diffused and heterogeneous high signal intensity on both T1WI and T2WI was found in SS patients, which was depressed on T2WI fat suppression sequences.Forty-two parotid glands were graded by fat signal:Grade 0 (n=2 glands), Grade 1 (n=10), Grade 2 (n=10), Grade 3 (n=6) and Grade 4 (n=14).Parotid peripheral ducts of control group and non-SS group were unexpanded , while bilaterally expanded parotid peripheral ducts were shown in SS patients.The grading of 42 parotid glands by expansion degree of parotid duct , Grade 0 was rated in 12, Grade 1 in 8, Grade 2 in 10, Grade 3 in 5, and Grade 4 in 7.Standard deviation of T1WI signal intensity of parotid glands among SS group , non-SS group and control group were 124.1 ±30.0, 81.8 ±27.6, and 86.3 ±35.0 respectively;and standard deviation of T 2 WI signal intensity were 115.1 ±35.2, 69.8 ±23.5, and 80.1 ±31.4 respectively; the standard deviation of T 1 WI and T2 WI signal intensity of SS group was higher than both non-SS group and control group′s ( F value =13.780 and 13.301, respectively, P <0.01), however, the difference of standard deviation of signal intensity of non-SS group and control group had no statistical significance (P>0.05).Among 42 parotid glands with SS, conventional MRI and MRS showed parotid gland lesions in 40 and 30 respectively , and the difference was statistically significant (χ2 =13.04, P=0.013).There was no false positive result.The combination of the two methods detected all 42 lesions.The consistency of detecting parotid abnormalities with SS between conventional MRI and MRS was poor (Kappa=0.12, P=0.092).Conclusions Diffuse fatty infiltration on conventional MRI and diffuse peripheral duct dilatation on MRS in the parotid gland are characteristic features of SS , and conventional MRI could be used as the preferred technique for the SS.combination with MRS may improve diagnostic accuracy.