【摘要】 目的 探索多点非对称回波采集与迭代最小二乘法水脂分离（IDEAL-IQ）和体素不相干运动成像（IVIM）在脊柱转移瘤诊断及来源评估的价值。方法 共40例脊柱转移瘤（40个椎体病变，其中，肺癌转移25个，非肺癌转移15个）和12例脊柱正常者（36个正常椎体）接受了IDEAL-IQ和IVIM扫描，分别测量并对比转移瘤组与对照组以及肺癌转移组和非肺癌转移组间脂肪分数（FF）、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）的差异。采用logistic回归分析寻找独立预测因子，受试者工作特征（ROC）曲线和De Long检验分别被用于评估诊断效能和不同曲线下面积（AUC）间的差异。结果 在脊柱转移瘤诊断方面，转移瘤组的FF、R2^*、ADC_stand、D、D^*、f、DDC和α值均低于对照组（P<0.05）。FF和D是独立预测因子，二者结合的AUC为0.962，敏感度为87.50%，特异度为97.22%。De Long分析显示，AUC（FF+D）与AUC（FF）、AUC（R2^*）、AUC(ADC_stand)、AUC（D）、AUC（D^*）、AUC（f）、AUC（DDC）、AUC（α）之间的差异均有统计学意义（P<0.05）。在转移瘤来源评估方面，肺癌转移组的FF和DDC值均高于非肺癌转移组（P<0.05）,FF是独立预测因子，AUC为0.761，敏感度为72.00%，特异度为73.33%。De Long分析显示，FF和DDC之间AUC的差异无统计学意义（P > 0.05）。结论 IDEAL-IQ和IVIM均能够在脊柱转移诊断及来源评估中发挥作用，且部分定量参数有望成为可靠的影像学标志物。更多还原

【Abstract】 Objective To explore the value of iterative decomposition of water and fat with echo asymmetry and the least squares estimation quantification sequence（ IDEAL-IQ） and intravoxel incoherent motion（ IVIM） in the diagnosis and source evaluation of spinal metastases. Methods A total of 40 spinal metastases（ 40 vertebral lesions,of which,25 were lung cancer metastases and 15 were non-lung cancer metastases） and 12 with normal spines（ 36 normal vertebral bodies）underwent IDEAL-IQ and IVIM scans. Differences in fat fraction（ FF）, R2^*, stand average diffusion coefficient( ADC_stand),diffusion coefficient（ D）,pseudo diffusion coefficient（ D^*）,perfusion fraction（ f）,distributed diffusion coefficient（ DDC） and diffusion heterogeneity index（ α） values were measured and compared between the metastatic tumour and normal groups and between the lung cancer metastatic and non-lung cancer metastatic groups,respectively. Logistic regression analysis was used to search for independent predictors,and the receiver operating characteristic（ ROC） curve and DeLong test were respectively used to evaluate the diagnostic efficacy and the differences among different areas under the curve（ AUC）. Results In the diagnosis of spinal metastases,FF,R2^*,ADC_stand,D,D^*,f,DDC,and α values were lower in the metastasis group than in the normal group（ P < 0. 05）. FF and D were independent predictors,with an AUC of 0. 962 for the combination of the two,a sensitivity of 87. 50% and a specificity of 97. 22%. DeLong analysis showed that AUC（ FF + D） and AUC（ FF）,AUC（ R2^*）,AUC( ADC_stand),AUC（ D）,AUC（ D^*）,AUC（ f）,AUC（ DDC） and AUC（ α） were all statistically significant（ P < 0. 05）. In terms of metastatic tumour source assessment,both FF and DDC values were higher in the lung cancer metastasis group than in the non-lung cancer metastasis group（ P < 0. 05）,with FF being an independent predictor with an AUC of 0. 761, sensitivity of72. 00% and specificity of 73. 33%. DeLong analysis showed that the difference in AUC between FF and DDC was not statistically significant（ P > 0. 05）. Conclusion Both IDEAL-IQ and IVIM have a role to play in the diagnosis and source assessment of spinal metastases,and some of the quantitative parameters are expected to be reliable imaging markers.更多还原