Application value of diffusion-weighted imaging based apparent diffusion coefficient in anatomic distribution and quantitative analysis of sacroiliac joint bone marrow edema in patients with ankylosing spondylitis
Song Lingling, Zhang Ziwei, Wang Jiawei, Zeng Qi, Sui He, li Yu, Liang Chen, Huang Zhaoshu, Zhou Shi
Department of Radiology, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
Abstract：Objective This study aimed to discuss the value of apparent diffusion coefficient (ADC) based on diffusion-weighted imaging (DWI) in the anatomical location and quantitative analysis of bone marrow edema in the sacroiliac joint in ankylosing spondylitis (AS). Methods This was a prospective non-randomized controlled study. A total of 35 AS patients from the Affiliated Hospital of Guizhou Medical University from January to December 2021 were included in the AS group, including 22 males and 13 females, aged 16-44(28.0±7.2) years old. Meanwhile, a total of 30 normal volunteers matching the age of the AS group with a roughly balanced gender composition were recruited as the normal control group, including 14 males and 16 females, aged 20-45(26.9±6.2)years old. All the participants underwent oblique coronal short time inversion recovery (STIR)-T2WI, oblique coronal T1WI, axial STIR-T2WI, axial T1WI, and oblique coronal DWI sequences. The images of patients' sacroiliac joints were analyzed and graded based on the MRI grade system. The AS group was divided into the obvious bone marrow edema group (19 patients) and the insignificant bone marrow edema group (16 patients) depending on if there were high signals on the DWI images. The site of occurrence of bone marrow edema in the obvious bone marrow edema group was statistically analyzed. The ADC values of subchondral bone marrow (bilateral sacral and iliac sides) in AS and normal control groups were measured using the self-contained Functool software equipped on the GE healthcare MR post-processed workstation ADW 4.7. A two-sample t-test was used to compare the ADC values of AS and normal control groups. The paired sample t-test was used to compare ADC values of the sacral and iliac sides of different grades of patients in the AS group. Results No significant difference was observed in gender and age between the two groups(all P values >0.05). The MRI grading of 35 AS patients included 7, 17, 6, and 5 patients of grades Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. In the obvious bone marrow edema group of AS, there were three patients of grade Ⅰ involved only the iliac side, and one patient involved both the sacral and iliac sides. Of the 10 patients of grade Ⅱ, 9 patients involved both sacral and iliac sides. In addition, four patients of grade Ⅲ involved sacral and iliac sides. Moreover, bone marrow edema was obvious in one patient of grade Ⅳ, involving both the sacral and iliac sides. The ADC values of bone marrow in the AS group were as follows: (4.94±1.90)×10-4 mm2/s at the left sacral side, (4.84±2.21)×10-4 mm2/s at the left iliac side, (4.38±1.86)×10-4 mm2/s at the right sacral side, (4.23±1.64)×10-4 mm2/s at the right iliac side. These ADC values were higher than those of the control group: at the left sacral side (3.45±1.44)×10-4 mm2/s, at the left iliac side (3.48±1.25)×10-4 mm2/s, at the right sacral side (3.28±1.35)×10-4 mm2/s, and at the right iliac side (3.08±1.37)×10-4 mm2/s, and significant differences were found (all P values <0.05). The ADC values of bone marrow in the obvious bone marrow edema group (4.85±1.44)×10-4 mm2/s and (4.30±0.64)×10-4 mm2/s in the insignificant bone marrow edema group were higher than those in the control group (3.32±1.36)×10-4mm2/s, and significant differences were observed (F=9.27, P<0.001). Conclusion ADC value of DWI can be used for quantitative analysis of bone marrow edema under the surface of the sacroiliac joint in AS, and can indicate the occurrence location and display the severity of bone marrow edema of the sacroiliac joint in AS patients with different MRI grades and has certain diagnostic value for bone marrow edema without obvious signal changes.
宋玲玲, 张紫微, 王家维, 曾琪, 眭贺, 李语, 梁晨, 黄曌殊, 周石. 基于DWI的ADC值在强直性脊柱炎患者骶髂关节面下骨髓水肿解剖分布及定量分析中的应用[J]. 中华解剖与临床杂志, 2023, 28(8): 512-518.
Song Lingling, Zhang Ziwei, Wang Jiawei, Zeng Qi, Sui He, li Yu, Liang Chen, Huang Zhaoshu, Zhou Shi. Application value of diffusion-weighted imaging based apparent diffusion coefficient in anatomic distribution and quantitative analysis of sacroiliac joint bone marrow edema in patients with ankylosing spondylitis. Chinese Journal of Anatomy and Clinics, 2023, 28(8): 512-518.
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