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磁共振T2-mapping评估Graves眼病活动性的价值

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目的 探讨磁共振T2-mapping在Graves眼病(GO)活动性评估方面的价值。方法 收集2019年7月-2021年1月于重庆医科大学附属第一医院内分泌科就诊的GO患者64例,使用计算机对其进行简单随机分组,其中49例作为观察研究对象,另外15例进行诊断试验评价。按照临床活动性评分(CAS)将49例GO患者分为活动组(CAS≥3分,48只患眼)与非活动组(CAS<3分,50只患眼)。同期招募31名健康志愿者作为正常对照组,共62只眼。所有人均行3。0T眼眶磁共振T2-mapping成像。在T2-mapping冠状位图像上测量上直肌、下直肌、内直肌、外直肌眼球后5个层面的T2 弛豫时间(T2RT),每块眼外肌分别取眼球后5个层面的T2RT最大值来代表该眼外肌的T2RT,最后取4块眼外肌T2RT中的最大值,以眼外肌最大T2RT表示。比较活动组、非活动组与正常对照组间上述5个指标(上直肌T2RT、下直肌T2RT、内直肌T2RT、外直肌T2RT、眼外肌最大T2RT)的差异;采用受试者工作特征(ROC)曲线分析上述5个指标对GO活动性评估的诊断价值,得出诊断阈值,然后利用另外15例GO患者进行诊断试验评价,确定诊断效能较高的指标及其诊断活动性的阈值。结果 活动组所有眼外肌的T2RT均明显高于非活动组及正常对照组,差异有统计学意义(P<0。001)。ROC曲线分析显示,上直肌、下直肌、内直肌、外直肌、眼外肌的最大T2RT判断活动性的截断值分别为 80。200 ms、97。045 ms、94。355 ms、85。750 ms、101。385 ms。利用另外15例GO患者进行诊断试验评价,综合评估敏感度、特异度、阳性预测值、阴性预测值较高的指标为下直肌T2RT、眼外肌最大T2RT,其判断活动性的截断值分别为97。045 ms、101。385 ms;敏感度分别为91。7%、93。8%;特异度均为80。0%。结论 磁共振T2-mapping序列对评估GO的活动性具有良好价值。临床上可选择测量下直肌T2RT或眼外肌最大T2RT协助评估GO的活动性。
Value of evaluating Graves ophthalmopathy motiliny by MRI T2-mapping
Objective To investigate the value of magnetic resonance imaging(MRI)T2-mapping in evaluating the activity of Graves ophthalmopathy(GO).Methods A total of 64 patients with GO in the Department of Endocrinology,the First Affiliated Hospital of Chongqing Medical University from July 2019 to January 2021 were collected.Simple random grouping was performed by computer,with 49 cases as observation subjects,and 15 patients for diagnostic test.According to clinical activity score(CAS),49 GO patients were divided into active group(CAS≥3 points,48 eyes)and inactive group(CAS<3 points,50 eyes).Normal control group(NC group)included 31 patients(62 eyes).All subjects underwent 3.0T orbital MRI T2-mapping.Measuring the T2 relaxation time(T2RT)of superior rectus,inferior rectus,medial rectus,and lateral rectus on five layers behind the eyeball on T2-mapping coronal images,and select the maximum value of T2RT in the five layers for each extraocular muscle to represent the T2RT of this extraocular muscle.Finally,select the maximum T2RT values of the four extraocular muscles,expressed as extraocular muscle maximum T2RT.Compare the differences of the above 5 indicators(superior rectus T2RT,inferior rectus T2RT,medial rectus T2RT,lateral rectus T2RT,extraocular muscle maximum T2RT)between active group,inactive group and NC group.ROC curve was used to analyze the diagnostic value of the above 5 indicators for GO activity assessment,and the diagnostic threshold was obtained.Then,another 15 GO patients were performed for diagnostic tests evaluation to determine the indicators of high diagnostic efficacy and the threshold of diagnostic activity.Results The T2RT of all extraocular muscles in active group were significantly higher than those in inactive group and NC group,the difference was statistically significant(P<0.001).The threshold value of the five indicators were obtained by ROC curve analysis.The maximum T2RT cut-off values of superior rectus muscle,inferior rectus muscle,medial rectus muscle,lateral rectus muscle and extraocular muscles for judging activity were 80.200 ms,97.045 ms,94.355 ms,85.750 ms and 101.385 ms respectively.Another 15 GO patients were performed for diagnostic tests,the indexes with relatively high sensitivity,specificity,positive predictive value and negative predictive value were inferior rectus T2RT and extraocular muscle maximum T2RT,the cut-off values of GO activity were 97.045 ms and 101.385 ms,respectively;the sensitivity were 91.7%and 93.8%,respectively;the specificity all were 80.0%.Conclusions MRI T2-mapping sequence has a good value in assessment of GO activity.The inferior rectus T2RT and extraocular muscle maximum T2RT can be choosed to evaluate the activity of GO.

Graves ophthalmopathymagnetic resonance imaging T2-mappingactivity assessment

王璐、樊瑶、龙健、张明巧、刘纯

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重庆医科大学附属第一医院内分泌科,重庆 400016

Graves眼病 磁共振T2-mapping 活动性评估

重庆市科卫联合医学科研项目

2020MSXM119

2024

解放军医学杂志
人民军医出版社

解放军医学杂志

CSTPCD北大核心
影响因子:1.644
ISSN:0577-7402
年,卷(期):2024.49(1)
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