中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2013年
6期
529-533
,共5页
雷新玮%展影%屈瑾%刘铁%祁吉
雷新瑋%展影%屈瑾%劉鐵%祁吉
뢰신위%전영%굴근%류철%기길
股骨头坏死%磁共振成像%构造塌陷%预测
股骨頭壞死%磁共振成像%構造塌陷%預測
고골두배사%자공진성상%구조탑함%예측
Femur head necrosis%Magnetic resonance imaging%Structure collapse%Forecasting
目的 探讨预测股骨头缺血性坏死塌陷的MRI诊断标准.方法 经MR检查确诊为股骨头缺血性坏死患者22例(39髋)作为研究对象.对39个坏死股骨头的MRI表现进行评定.内容包括:骨髓水肿、关节腔积液、坏死区信号特点及发病部位,测量并计算出坏死体积比例和坏死表面积比例.患者随访18 ～ 84个月,中位时间25个月.前瞻性对上述评定内容进行Logistic回归分析,得出股骨头塌陷的危险因素；对坏死灶表面积比例及坏死体积比例之间的诊断实验采用ROC曲线.计算ROC曲线下面积；取坏死表面积比例约登指数最大时点,作为预测股骨头塌陷的最佳临界点.确定其敏感度、特异度和准确率.结果 39髋中21髋发生股骨头塌陷,18髋未发生塌陷.5例双侧髋关节塌陷.其中坏死表面积大于25％的25髋中21髋(84.0％)发生塌陷；坏死体积大于30％的8髋全部塌陷；坏死区位于股骨头外上象限的33髋中21髋(63.6％)塌陷；坏死区表现为混杂信号22髋中18髋(81.8％)发生塌陷；出现中等及大量关节腔积液25髋中16髋(64.0％)发生塌陷；18髋骨髓水肿的患者中13髋发生塌陷(72.2％).股骨头塌陷结果的Logistic回归分析结果表明:关节腔积液、信号特点、部位、坏死体积比例(％)、坏死面积比例(％)是危险因素.骨髓水肿的OR值小于1,相对于其他因素为低风险因素(按α =0.10的水准).坏死表面积比例及坏死体积比例的ROC曲线分析:坏死表面积比例ROC曲线下面积(0.987)大于坏死体积比例ROC曲线下面积(0.902).坏死表面积比例的最佳临界点为26.7％,诊断的敏感度为95.2％,特异度为94.4％.约登指数为0.896.结论 股骨头坏死后塌陷是多种因素的综合作用.当坏死范围足够大,具有混杂信号特点、大量关节腔积液、骨髓水肿且坏死部位于股骨头外上象限时易发生股骨头塌陷.坏死表面积比例达26.7％时,是股骨头塌陷的危险临界指标.预测股骨头坏死塌陷时坏死表面积比例较坏死体积比例更准确.
目的 探討預測股骨頭缺血性壞死塌陷的MRI診斷標準.方法 經MR檢查確診為股骨頭缺血性壞死患者22例(39髖)作為研究對象.對39箇壞死股骨頭的MRI錶現進行評定.內容包括:骨髓水腫、關節腔積液、壞死區信號特點及髮病部位,測量併計算齣壞死體積比例和壞死錶麵積比例.患者隨訪18 ～ 84箇月,中位時間25箇月.前瞻性對上述評定內容進行Logistic迴歸分析,得齣股骨頭塌陷的危險因素；對壞死竈錶麵積比例及壞死體積比例之間的診斷實驗採用ROC麯線.計算ROC麯線下麵積；取壞死錶麵積比例約登指數最大時點,作為預測股骨頭塌陷的最佳臨界點.確定其敏感度、特異度和準確率.結果 39髖中21髖髮生股骨頭塌陷,18髖未髮生塌陷.5例雙側髖關節塌陷.其中壞死錶麵積大于25％的25髖中21髖(84.0％)髮生塌陷；壞死體積大于30％的8髖全部塌陷；壞死區位于股骨頭外上象限的33髖中21髖(63.6％)塌陷；壞死區錶現為混雜信號22髖中18髖(81.8％)髮生塌陷；齣現中等及大量關節腔積液25髖中16髖(64.0％)髮生塌陷；18髖骨髓水腫的患者中13髖髮生塌陷(72.2％).股骨頭塌陷結果的Logistic迴歸分析結果錶明:關節腔積液、信號特點、部位、壞死體積比例(％)、壞死麵積比例(％)是危險因素.骨髓水腫的OR值小于1,相對于其他因素為低風險因素(按α =0.10的水準).壞死錶麵積比例及壞死體積比例的ROC麯線分析:壞死錶麵積比例ROC麯線下麵積(0.987)大于壞死體積比例ROC麯線下麵積(0.902).壞死錶麵積比例的最佳臨界點為26.7％,診斷的敏感度為95.2％,特異度為94.4％.約登指數為0.896.結論 股骨頭壞死後塌陷是多種因素的綜閤作用.噹壞死範圍足夠大,具有混雜信號特點、大量關節腔積液、骨髓水腫且壞死部位于股骨頭外上象限時易髮生股骨頭塌陷.壞死錶麵積比例達26.7％時,是股骨頭塌陷的危險臨界指標.預測股骨頭壞死塌陷時壞死錶麵積比例較壞死體積比例更準確.
목적 탐토예측고골두결혈성배사탑함적MRI진단표준.방법 경MR검사학진위고골두결혈성배사환자22례(39관)작위연구대상.대39개배사고골두적MRI표현진행평정.내용포괄:골수수종、관절강적액、배사구신호특점급발병부위,측량병계산출배사체적비례화배사표면적비례.환자수방18 ～ 84개월,중위시간25개월.전첨성대상술평정내용진행Logistic회귀분석,득출고골두탑함적위험인소；대배사조표면적비례급배사체적비례지간적진단실험채용ROC곡선.계산ROC곡선하면적；취배사표면적비례약등지수최대시점,작위예측고골두탑함적최가림계점.학정기민감도、특이도화준학솔.결과 39관중21관발생고골두탑함,18관미발생탑함.5례쌍측관관절탑함.기중배사표면적대우25％적25관중21관(84.0％)발생탑함；배사체적대우30％적8관전부탑함；배사구위우고골두외상상한적33관중21관(63.6％)탑함；배사구표현위혼잡신호22관중18관(81.8％)발생탑함；출현중등급대량관절강적액25관중16관(64.0％)발생탑함；18관골수수종적환자중13관발생탑함(72.2％).고골두탑함결과적Logistic회귀분석결과표명:관절강적액、신호특점、부위、배사체적비례(％)、배사면적비례(％)시위험인소.골수수종적OR치소우1,상대우기타인소위저풍험인소(안α =0.10적수준).배사표면적비례급배사체적비례적ROC곡선분석:배사표면적비례ROC곡선하면적(0.987)대우배사체적비례ROC곡선하면적(0.902).배사표면적비례적최가림계점위26.7％,진단적민감도위95.2％,특이도위94.4％.약등지수위0.896.결론 고골두배사후탑함시다충인소적종합작용.당배사범위족구대,구유혼잡신호특점、대량관절강적액、골수수종차배사부위우고골두외상상한시역발생고골두탑함.배사표면적비례체26.7％시,시고골두탑함적위험림계지표.예측고골두배사탑함시배사표면적비례교배사체적비례경준학.
Objective To study the risk factors of MRI for the prediction of collapse in patients with avascular necrosis of the femoral head.Methods Twenty-two patients (39 hips) diagnosed avascular necrosis of femoral head by MR were enrolled in our study.The following MR appearances were evaluated:bone marrow edema,joint fluids,signal intensity and location of the lesion.The volume and surface area of the necrosis zone were calculated.The time of follow-up was 18-84 months (median,25 months).Logistic regression analysis was used to predict the risk factors by SPSS 13.0.The maximum value of Youden index was selected as the critical point to predict the collapse of femoral head and to define the sensitivity,specificity and accuracy.Results In the 39 hips with femoral head necrosis,21 hips had collapse.Bilateral collapse occurred in 5 cases.In 25 hips with the necrosis surface larger than 25％,collapse occurred in 21 (84％); In 8 hips with the volume of femoral head necrosis larger than 30％,collapse occurred in all cases; 1n 33 hips with the necrosis locating at the superolateral quadrant,collapse occurred in 21 (63.6％); In 22 hips with necrotic areas showing heterogeneous signal intensity,collapse occurred in 18(81.8％) ;In 25 hips with large amount of joint effusion,collapse occurred in 16 (64％) ;in 18 hips with bone marrow edema,collapse occurred in 13 (65％).Joint fluid,heterogeneous signal intensity and lesions in the superolateral quadrant,volume ratio,and area ratio were the high risk factors,while bone marrow edema was a relatively low risk factor.The area under ROC curves for area ratio of NASA was greater than that for volume ratio (0.987 vs 0.902).When the critical value for area ratio was 26.7％,the true positive rate was 95.2％,true negative rate was 94.4％,and Youden's index was 0.896.Conclusions The collapse of necrosis of femoral head may result from many factors.The femoral head was easy to collapse when it had large enough area of necrosis and mixed signal intensity,a large amount of joint effusion,bone marrow edema,and superolateral quadrant location.The critical value for area ratio to predict the collapse of femoral head was about 26.7％.The area ratio is more accurate than volume ratio in predicting the collapse of necrosis of femoral head.
