CAJ | 학술논문

目的：探讨氢质子磁共振波谱（1 H-MRS）和双回波正反相位（ in-phase and out-phase） MRI成像技术在骨髓脂肪沉积中的价值，并比较两种方法一致性。方法前瞻性选择经我院双能X线骨密度测量仪（ DXA）确诊的38例骨质疏松者及30例骨量正常者分别行MRI常规检查、1 H-MRS及双回波正反相位成像，并收集资料，分别测量L2椎体的反相位和正相位信号比值（ SIR）、水脂比（ LRW）和脂肪分数（ FF）。采用t检验比较两组的SIR、LRW及FF差异；采用ROC曲线分析SIR值、LRW及FF对骨质疏松诊断效能，并初步确定骨质疏松各指标诊断阈值；Kolmogorov-Snimov法进行正态性检验，资料符合正态分布，选择pearson相关分析分别检验SIR与LRW和FF的相关性。结果得到横轴位和矢状位各68幅MRI腰椎正反相位图，得到68幅单体素MRS波谱图，骨质疏松组SIR值、LWR及FF分别为0.498±0.160、3.677±3.093、0.732±0.176，骨量正常组SIR值、LWR及FF分别为0.350±0.971、2.094±1.892、0.573±0.211，两组间SIR、LWR FF差异均有统计学意义（ t值分别为6.404、2.035、2.738，P值均＜0.05）；正反相位所测SIR区分骨质疏松的ROC曲线下面积为0.784， SIR阈值为0.3850，灵敏度78.9％，特异度为66.7％。 MRS中LWR、FF区分骨质疏松的ROC曲线下面积分别为0.706、0.740，阈值分别为2.063、0.674，灵敏度分别为75.0％，79.2％，特异度分别为71.4％、72.4％。 Pearson相关分析SIR与LRW和FF的r值和P值，结果P值均＜0.05。结论1 H-MRS和正反相位MRI两种方法均能提供腰椎骨髓脂肪沉积定量信息，可以无创、快速协助诊断骨质疏松，二者指标间有相关性。
목적：탐토경질자자공진파보（1 H-MRS）화쌍회파정반상위（ in-phase and out-phase） MRI성상기술재골수지방침적중적개치，병비교량충방법일치성。방법전첨성선택경아원쌍능X선골밀도측량의（ DXA）학진적38례골질소송자급30례골량정상자분별행MRI상규검사、1 H-MRS급쌍회파정반상위성상，병수집자료，분별측량L2추체적반상위화정상위신호비치（ SIR）、수지비（ LRW）화지방분수（ FF）。채용t검험비교량조적SIR、LRW급FF차이；채용ROC곡선분석SIR치、LRW급FF대골질소송진단효능，병초보학정골질소송각지표진단역치；Kolmogorov-Snimov법진행정태성검험，자료부합정태분포，선택pearson상관분석분별검험SIR여LRW화FF적상관성。결과득도횡축위화시상위각68폭MRI요추정반상위도，득도68폭단체소MRS파보도，골질소송조SIR치、LWR급FF분별위0.498±0.160、3.677±3.093、0.732±0.176，골량정상조SIR치、LWR급FF분별위0.350±0.971、2.094±1.892、0.573±0.211，량조간SIR、LWR FF차이균유통계학의의（ t치분별위6.404、2.035、2.738，P치균＜0.05）；정반상위소측SIR구분골질소송적ROC곡선하면적위0.784， SIR역치위0.3850，령민도78.9％，특이도위66.7％。 MRS중LWR、FF구분골질소송적ROC곡선하면적분별위0.706、0.740，역치분별위2.063、0.674，령민도분별위75.0％，79.2％，특이도분별위71.4％、72.4％。 Pearson상관분석SIR여LRW화FF적r치화P치，결과P치균＜0.05。결론1 H-MRS화정반상위MRI량충방법균능제공요추골수지방침적정량신식，가이무창、쾌속협조진단골질소송，이자지표간유상관성。
Objective To explore the diagnostic value of 1H proton MRS and in-phase and out-phase MRI for bone marrow fat deposition ( BMFD) , and to compare the consistency of two methods.Methods Thirsty-eight patients who were diagnosed with osteoporosis using DXA and 30 people with normal bone mass were enrolled in this study.All the 68 subjects underwent MRI regular examination, MRS, and in-phase and out-phase MRI.SIR, LRW, and FF of L2 vertebra were measured.SIR, LRW, and FF between the two groups were compared using Student t test.Diagnostic accuracy of SIR, LRW, and FF for osteoporosis were analyzed using ROC curve, and the diagnostic threshold of these indicators for osteoporosis was determined.By the use of Kolmogorov-Snimov normality test, the data were proved to be normally distributed.The correlations among SIR, LRW, and FF were assessed with Pearson analysis.Results Sixty-eight axial and sagittal MRI in-phase and out-phase MR images of the lumbar spine and 68 single voxel MRS images were obtained.SIR, LWR, and FF in osteoporosis group were 0.498 ±0.160, 3.677 ± 3.093, and 0.732 ±0.176, respectively.SIR, LWR, and FF in normal bone mass group were 0.350 ±0.971, 2.094 ±1.892, and 0.573 ±0.211, respectively.There were statistically significant differences in SIR, LWR, and FF between the two groups ( t values were 6.404, 2.035, and 2.738 respectively, P<0.05).The area (measured with the SIR deferential point) under ROC curve was 0.784.Using the SIR value of 0.3850 as the ROC cut off point, the diagnostic sensitivity and specificity were 78.9%and 66.7%, respectively.In MRS, using the value 2.063 of LWR and 0.674 of FF as the cutting off points, the area under ROC curve was 0.706 and 0.740, the diagnostic sensitivity was 75.0% and 79.2%, and the diagnostic specificity was 71.4% and 72.4%, respectively.The result of correlation analysis between SIR, LRW, and FF using Pearson correlation showed P <0.05. Conclusion Both 1H-MRS and in-phase and out-phase MRI can provide information of bone marrow fat deposition in the lumbar spine and help to achieve quick and non-invasive osteoporosis diagnosis.There is correlation between the indicators of the two methods.