【摘要】 目的 探索磁共振水脂分离成像（IDEAL-IQ）和体素内不相干运动（IVIM）成像在鉴别脊柱转移瘤和脊柱结核中的价值。资料与方法 回顾性选取2021年1月—2022年8月在新乡医学院第一附属医院接受IDEAL-IQ和IVIM扫描的43例脊柱结核和50例脊柱转移瘤患者,分别测量并对比病变部位的脂肪分数（FF）、横向弛豫率（R₂^*）、标准表观扩散系数(ADC_stand)、真性扩散系数（D）、假性扩散系数（D^*）、灌注分数（f）、分布扩散系数（DDC）和扩散异质性指数（α）值。使用Logistic回归分析寻找独立预测因子,采用受试者工作特征曲线下面积（AUC）评价诊断效能,采用Delong分析评估AUC的差异。结果脊柱转移瘤组的FF、R₂^*、ADC_stand、D、D^*和DDC值均低于脊柱结核组（t/Z值=-5.444、2.035、-3.564、-4.323、-3.984、-2.023,P均<0.05）。IDEAL-IQ （FF+R₂^*）、IVIM (ADC_stand+D+D^*+DDC)以及上述各参数的AUC分别为0.835、0.791、0.829、0.622、0.715、0.761、0.740和0.622。FF、ADC_stand和D^*是鉴别脊柱转移瘤和脊柱结核的独立预测因子,三者联合诊断的AUC为0.920,敏感度为72.00%,特异度为95.35%。Delong分析显示,AUC (FF+ADC_stand+D^*)与AUC （IDEAL-IQ）、AUC （IVIM）、AUC （FF）、AUC (ADC_stand)、AUC （R₂^*）、AUC （D）、AUC （D^*）、AUC （DDC）差异均有统计学意义（Z=2.842、3.112、2.810、4.827、3.975、3.450、3.506和5.143,P均<0.05）。结论 IDEAL-IQ和IVIM均可用于鉴别脊柱转移瘤与脊柱结核,其中FF、ADC_stand和D^*结合可能是有效的影像学标记物。更多还原

【Abstract】 Purpose To explore the value of iterative decomposition of water and fat with echo asymmetry and the least square s estimation quantification sequence（IDEAL-IQ） and multiple models intravoxel incoherent motion（IVIM） in the differentiation of spinal metastases and spinal tuberculosis.Materials and Methods From January 2021 to August 2022,a total of 43 patients with spinal tuberculosis and 50 patients with spinal metastases underwent IDEAL-IQ and IVIM scans at the First Affiliated Hospital of Xinxiang Medical University were enrolled retrospectively.The fat fraction（FF）,transverse relaxation rate（R₂^*）,stand average diffusion coefficient（ADCstand）,diffusion coefficient（D）,pseudo diffusion coefficient（D^*）,perfusion fraction（f）, distributed diffusion coefficient（DDC） and diffusion heterogeneity index（α） values of the lesions were calculated and compared,respectively.Logistic regression analysis was used to find the independent predictors.The area under the curve（AUC） of receiver operating characteristic（ROC） curve was used to evaluate diagnostic efficacy,and Delong analysis was used to assess differences of ROC.Results The FF,R₂^*,ADC_stand,D,D^* and DDC in the metastases group were significantly lower than those in the tuberculosis group（t/Z=-5.444,2.035,-3.564,-4.323,-3.984,-2.023,all P<0.05）.The AUCs of IDEAL-IQ（FF+R₂^*）,IVIM(ADC_stand+D+D^*+DDC),and each of the above parameters were 0.835,0.791,0.829,0.622,0.715,0.761,0.740 and 0.622,respectively.The FF,ADCstand and D^* were the independent predictors for the differentiation of spinal metastases from spinal tuberculosis,and the combination of the three factors had an AUC of 0.920,a sensitivity of 72.00% and a specificity of 95.35%,respectively.Delong analysis showed that the differences among AUC of(FF+ADC_stand+D^*) and AUC of IDEAL-IQ,AUC of IVIM,AUC of FF,AUC of ADC_stand,AUC of R₂^*,AUC of D,AUC of D^*,AUC of DDC were all significant（Z=2.842,3.112,2.810,4.827,3.975,3.450,3.506 and 5.143,respectively;all P<0.05）.Conclusion Both IDEAL-IQ and IVIM can be used to differentiate spinal metastases from spinal tuberculosis,and the combination of FF,ADC_stand and D^* may be the effective imaging markers.更多还原