The combined application of multiple quantitative values of synthetic magnetic resonance imaging can improve the diagnostic accuracy of sjogren's syndrome
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摘要:
目的 探讨合成磁共振成像（MAGiC）在干燥综合征（SS）诊断中的的可行性及临床应用价值。 方法 前瞻性收集2023年2~10月于扬州大学附属医院就诊的SS患者36例作为SS组，选取同期38例健康志愿者作为对照组（HC组），分别对两组患者双侧腮腺行T1WI、T2WI及MAGiC扫描，对MAGiC图像进行后处理，生成T1、T2及质子密度（PD）mapping 3组定量序列。由2位医师分别测量双侧腮腺的T1、T2及PD值，采用组内相关系数（ICC）评估观察者间及观察者内的一致性。采用Pearson或Spearman检验比较双侧腮腺MAGiC各定量值的相关性。采用独立样本t检验或Wilcoxon秩和检验比较双侧腮腺SS组与HC组间MAGiC各定量值的差异。对MAGiC定量值差异具有统计学意义的计数资料绘制ROC曲线，采用Z检验比较曲线下面积。 结果 一致性分析结果显示双侧腮腺T2、PD值的ICC均 > 0.800，双侧腮腺T1值最低，ICC均 > 0.700。相关性分析结果显示双侧腮腺两组间MAGiC各定量值均具有高度相关性（r > 0.8）。两组T1、T2值差异均有统计学意义（P < 0.001），PD值差异均无统计学意义（P > 0.05）。MAGiC T1与T2值联合诊断的准确率（84.35%）及曲线下面积（0.88）最高，与T1值的差异有统计学意义（P=0.026）。 结论 MAGIC技术可以定量评估SS腮腺病变，MAGiC多定量值联合应用可提高诊断准确率。 Abstract:Objective To explore the feasibility and clinical application value of MAGiC technique in the diagnosis of Sjogren's syndrome (SS). Methods A total of thirty-six SS patients from the Affiliated Hospital of Yangzhou University from February to October 2023 were selected as the SS group, and thirty-eight healthy volunteers from the same period were selected as the control group (HC group). T1WI, T2WI and MAGiC scanning were performed on bilateral parotid glands of the two groups, respectively. After post-processing of MAGiC images, three sets of quantitative sequences T1, T2, proton density (PD) mapping were generated. The obtained T1, T2 and PD values of the bilateral parotid glands were measured by two physicians, and intra-group correlation coefficient (ICC) was used to evaluate inter-observer and intra-observer consistency; the correlation of quan titative values of MAGiC in bilateral parotid glands was compared by Pearson or Spearman test; and the independent samples t test or Wilcoxon rank sum test was used to analysis the differences in quantitative values of MAGiC between the bilateral parotid gland SS group and HC group. ROC curves were plotted for counting data with statistically significant differences in MAGiC quantitative values, and Z- test was used to compare the area under the curve. Results The results of consistency analysis showed that both T2 and PD values of the bilateral parotid gland had ICC > 0.800, while T1 values of the bilateral parotid gland were lower (ICC > 0.700). Correlation analysis showed that the quantitative values of MAGiC were highly correlated between the two groups (r > 0.8). The analysis results between the two groups showed that T1 and T2 values were statistically significant (P < 0.001), while PD values were not statistically significant (P > 0.05). The accuracy (84.35%) and area under the curve (0.88) of the combination of MAGiC T1 and T2 values were the highest, and the difference with T1 values was statistically significant (P=0.026). Conclusion MAGiC technology can quantitatively evaluate SS parotid gland lesions, and the combined application of multiple quantitative values of MAGIC technology can improve the diagnostic accuracy. -
Key words:
- MAGiC /
- parotid /
- quantitative MRI /
- sjogren's syndrome
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图 1 SS组受检者MAGiC定量图
Figure 1. MAGiC quantitative images of subjects in the SS group. A 57-year-old female patient with primary SS. A-C: Pseudo-color images of MAGiC T1, T2, and PD maping, respectively.
图 2 HC组受检者MAGiC定量图
Figure 2. MAGiC quantitative images of subjects in the HC group. Volunteer, male, 67 years old. A-C: Pseudo-color images of MAGiC T1, T2 and PD maping, respectively.
图 3 MAGiC T1值、T2值及二者联合诊断SS腮腺的ROC曲线
Figure 3. ROC curve of MAGiC T1 value, T2 value and their combination in diagnosing SS parotid gland. The ROC curve of MAGiC T1 value, T2 value and their combined diagnosis of SS parotid gland showed that the combined diagnosis had the largest AUC of 0.88.
表 1 观察者测量腮腺T1、T2及PD值的ICC值
Table 1. ICC values of parotid gland T1, T2 and PD measured by observers
Observer T1 T2 PD L R L R L R Observer 1 0.851 0.834 0.923 0.893 0.912 0.889 Observer 2 0.824 0.822 0.917 0.902 0.901 0.904 Between observers 0.721 0.747 0.901 0.870 0.873 0.868 PD: Proton density. 
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表 2 SS组与HC组间MAGiC各定量值相关性分析
Table 2. Correlation analysis of quantitative values of MAGiC between SS group and HC group
Correlation T1 T2 PD SS group HC group SS group HC group SS group HC group r 0.834 0.809 0.893 0.851 0.824 0.863 P ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 SS: Sjogren's syndrome; HC: Healthy control.
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表 3 SS组与HC组间MAGiC各定量值差异比较
Table 3. Comparison of quantitative values of MAGiC between SS group and HC group (Mean±SD)
Group T1 (ms) T2 (ms) PD (pu) SS group(n=36) 625.08±107.77 88.89±7.64 82.62±11.02 HC group(n=38) 803.88±74.82 83.40±3.45 80.11±8.97 t -9.898 4.489 1.327 P ＜0.001 ＜0.001 0.147 pu: Hydrogen proton density per unit voxel (perunit).
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表 4 MAGiC各定量值及联合诊断SS效能
Table 4. MAGiC quantitative values and combined diagnostic efficacy of SS
Diagnostic mode Diagnostic criteria(ms) AUC(95%CI) Sensitivity (%) Specificity (%) Accuracy (%) MAGiC T1 value ＜634 0.81(0.75, 0.88) 66.10(47/71) 95.24(72/76) 80.95(119/147) MAGiC T2 value ＞84 0.85(0.80, 0.91) 61.86(44/71) 97.62(74/76) 80.27(118/147) Combination T1＜632+T2＞84 0.88(0.82, 0.93) 73.73(52/71) 95.24(72/76) 84.35(124/147)
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[1] van Ginkel MS, Glaudemans AWJM, van der Vegt B, et al. Imaging in primary sjögren's syndrome[J]. J Clin Med, 2020, 9(8): 2492. doi: 10.3390/jcm9082492 [2] Fox PC. Autoimmune diseases and Sjogren's syndrome: an autoimmune exocrinopathy[J]. Ann N Y Acad Sci, 2007, 1098: 15-21. doi: 10.1196/annals.1384.003 [3] Fox RI. Sjögren's syndrome[J]. Lancet, 2005, 366(9482): 321-31. doi: 10.1016/S0140-6736(05)66990-5 [4] Rao Y, Xu N, Zhang Y, et al. Value of magnetic resonance imaging and sialography of the parotid gland for diagnosis of primary Sjögren syndrome[J]. Int J Rheum Dis, 2023, 26(3): 454-63. doi: 10.1111/1756-185X.14528 [5] Jousse-Joulin S, Coiffier G. Current status of imaging of Sjogren's syndrome[J]. Best Pract Res Clin Rheumatol, 2020, 34(6): 101592. doi: 10.1016/j.berh.2020.101592 [6] Ding C, Xing X, Guo Q, et al. Diffusion-weighted MRI findings in Sjögren's syndrome: a preliminary study[J]. Acta Radiol, 2016, 57 (6): 691-700. doi: 10.1177/0284185115603245 [7] 韦洁勤, 张静, 陆力坚, 等. 干燥综合征腮腺导管MRS与CT及X线造影对比研究[J]. 中国临床新医学, 2015, 8(3): 193-7. [8] 李方正, 李芹, 郑召龙, 等. 合成MRI临床应用的研究进展[J]. 放射学实践, 2022, 37(3): 402-6. [9] 孙其安, 李郑, 何玲, 等. MAGiC技术在颈椎间盘退行性改变中的应用价值[J]. 放射学实践, 2023, 38(1): 70-5. [10] Shiboski CH, Shiboski SC, Seror R, et al. 2016 American college of rheumatology/european league against rheumatism classification criteria for primary sjögren's syndrome: a consensus and data-driven methodology involving three international patient cohorts[J]. Arthritis Rheumatol, 2017, 69(1): 35-45. doi: 10.1002/art.39859 [11] 崔峰, 王聪, 王娅, 等. MAGiC技术的基本原理及临床研究进展[J]. 临床放射学杂志, 2021, 40(12): 2434-7. doi: 10.3969/j.issn.1001-9324.2021.12.lcfsxzz202112038 [12] 冯倩倩, 储晨, 王凤仙, 等. MR T2* mapping技术评估干燥综合征涎腺病变[J]. 中国医学影像技术, 2019, 35(10): 1467-71. [13] 冯倩倩, 储晨, 王振伟, 等. 体素内不相干运动MR成像在诊断干燥综合征腮腺病变的应用研究[J]. 临床放射学杂志, 2020, 39(6): 1074-9. [14] 纪权书, 丁长伟. 干燥综合征腮腺MRI的研究进展[J]. 磁共振成像, 2020, 11(4): 311-4. [15] Zhou QQ, Zhang W, Yu YS, et al. Comparative study between ZOOMit and conventional intravoxel incoherent motion MRI for assessing parotid gland abnormalities in patients with early-or mid-stage sjögren's syndrome[J]. Korean J Radiol, 2022, 23(4): 455. doi: 10.3348/kjr.2021.0695 [16] 何思慧, 张剑勇, 贾二涛. 原发性干燥综合征炎症发病机制[J]. 中国免疫学杂志, 2023, 39(12): 2679-83. doi: 10.3969/j.issn.1000-484X.2023.12.037 [17] Takagi Y, Sasaki M, Eida S, et al. Comparison of salivary gland MRI and ultrasonography findings among patients with Sjögren's syndrome over a wide age range[J]. Rheumatology, 2022, 61(5): 1986-96. doi: 10.1093/rheumatology/keab560 [18] McCoy SS, Baer AN. Neurological complications of sjögren's syndrome: diagnosis and management[J]. Curr Treatm Opt Rheumatol, 2017, 3(4): 275-88. doi: 10.1007/s40674-017-0076-9 [19] Módis LV, Aradi Z, Horváth IF, et al. Central nervous system involvement in primary sjögren's syndrome: narrative review of MRI findings[J]. Diagnostics, 2022, 13(1): 14. doi: 10.3390/diagnostics13010014 [20] 中华医学会风湿病学分会. 干燥综合征诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(11): 766-8. doi: 10.3760/cma.j.issn.1007-7480.2010.11.011 [21] 贾斯齐, 颜春龙, 金宇华, 等. 磁共振T2 mapping技术在心脏疾病中的应用研究进展[J]. 磁共振成像, 2023, 14(6): 145-50. [22] 曾飘娥, 周延, 刘剑羽. 功能MRI在肌肉损伤中的应用进展[J]. 国际医学放射学杂志, 2019, 42(2): 189-92. [23] 金明丽, 潘志华, 蒋颖, 等. T2值定量评估不同肝纤维化分期大鼠肝脏铁沉积[J]. 中国介入影像与治疗学, 2022, 19(2): 110-4. [24] Muntean DD, Bădărînză M, Stefan PA, et al. The diagnostic value of MRI-based radiomic analysis of lacrimal glands in patients with sjögren's syndrome[J]. Int J Mol Sci, 2022, 23(17): 10051. doi: 10.3390/ijms231710051 [25] 冯倩倩, 储晨, 王凤仙, 等. T2 mapping在干燥综合征腮腺损伤早期评估中的应用[J]. 医学影像学杂志, 2020, 30(1): 27-30. [26] Liu SM, Chen WW, Wang M, et al. Quantitative analysis of parotid gland secretion function in Sjögren's syndrome patients with dynamic magnetic resonance sialography[J]. Korean J Radiol, 2019, 20(3): 498-504. doi: 10.3348/kjr.2018.0508 [27] 张楠, 刘辉, 乔薇, 等. 唾液腺超声评分联合核素显像对干燥综合征具有较高的诊断价值[J]. 分子影像学杂志, 2022, 45(3): 323-9. doi: 10.12122/j.issn.1674-4500.2022.03.03 [28] 邢晓菲, 丁长伟. 酸刺激前后扩散加权成像评价干燥综合征患者腮腺功能[J]. 中国临床医学影像杂志, 2016, 27(10): 706-9. [29] Ogura I, Sasaki Y, Oda T, et al. Magnetic resonance sialography and salivary gland scintigraphy of parotid glands in sjögren's syndrome[J]. Chin J Dent Res, 2018, 21(1): 63-8. [30] Su GY, Xu XQ, Wang YY, et al. Feasibility study of using intravoxel incoherent motion MRI to detect parotid gland abnormalities in early-stage Sjögren syndrome patients[J]. Magn Reson Imaging, 2016, 43(6): 1455-61. doi: 10.1002/jmri.25096 [31] Kami YN, Sumi MS, Takagi Y, et al. Arterial spin labeling imaging for the parotid glands of patients with sjögren's syndrome[J]. PLoS One, 2016, 11(3): e0150680. doi: 10.1371/journal.pone.0150680 [32] Ren YD, Li XR, Zhang J, et al. Conventional MRI techniques combined with MR sialography on T2-3D-DRIVE in Sjögren syndrome[J]. Int J Clin Exp Med, 2015, 8(3): 3974-82. [33] Kojima I, Sakamoto M, Iikubo M, et al. Diagnostic performance of MR imaging of three major salivary glands for Sjögren's syndrome[J]. Oral Dis, 2017, 23(1): 84-90. doi: 10.1111/odi.12577 [34] Niemelä RK, Takalo R, Pääkkö E, et al. Ultrasonography of salivary glands in primary Sjogren's syndrome. A comparison with magnetic resonance imaging and magnetic resonance sialography of parotid glands[J]. Rheumatology, 2004, 43(7): 875-9. doi: 10.1093/rheumatology/keh187 -
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