三點(diǎn)法非對(duì)稱回波水脂分離技術(shù)的基底動(dòng)脈高分辨磁共振成像的可行性研究

張宇，查云飛，2*，陸雪松，李亮，胡磊，楊仁杰，林苑

三點(diǎn)法非對(duì)稱回波水脂分離技術(shù)的基底動(dòng)脈高分辨磁共振成像的可行性研究

張宇1，查云飛1，2*，陸雪松2，3，李亮1，胡磊1，楊仁杰1，林苑1

目的 比較不同頻率編碼方向FSE-T2WI和IDEAL FSE-T2WI技術(shù)的高分辨磁共振成像(high-resolution magnetic resonance imaging，HRMRI)對(duì)于基底動(dòng)脈管壁顯示的效果。材料與方法 選擇30名磁共振顱腦檢查患者，采用不同頻率編碼方向FSE-T2WI (A/P)、FSE-T2WI (R/L)和IDEAL FSE-T2WI (A/P)3組序列行基底動(dòng)脈同斷面掃描，基底動(dòng)脈管壁顯示情況行4分法評(píng)價(jià)，并比較3組序列基底動(dòng)脈的圖像質(zhì)量。結(jié)果 基底動(dòng)脈圖像質(zhì)量評(píng)分FSE-T2WI (A/P)、FSE-T2WI (R/L)、IDEAL FSE-T2WI (A/P)分別為81分、92分、115分。3種序列基底動(dòng)脈圖像質(zhì)量?jī)蓛杀容^，F(xiàn)SE-T2WI (A/P)和FSE-T2WI (R/L)差異具有統(tǒng)計(jì)學(xué)意義(Z=-3.317，P=0.001)。FSE-T2WI (R/L)和IDEAL FSE-T2WI (A/P)差異具有統(tǒng)計(jì)學(xué)意義(Z=-4.600，P=0.000)。FSE-T2WI (A/P)和IDEAL FSE-T2WI (A/P)差異具有統(tǒng)計(jì)學(xué)意義(Z=-4.540，P=0.000)，IDEAL FSE-T2WI (A/P)對(duì)于基底動(dòng)脈管壁結(jié)構(gòu)顯示效果最好。結(jié)論 IDEAL技術(shù)能顯著消除顱底磁敏感偽影，使基底動(dòng)脈管壁更清晰顯示。

三點(diǎn)法非對(duì)稱回波水脂分離；磁共振成像；基底動(dòng)脈；磁敏感偽影

Key words Iterative decomposition of water and fat with echo asymmetric and least-squares estimation; Magnetic resonance imaging; Basal artery; Magnetic susceptibility artifact

顱內(nèi)動(dòng)脈粥樣硬化是導(dǎo)致缺血性腦卒中的主要原因，在亞洲人群中占比約30%～50%[1-2]。其中，椎基底動(dòng)脈是腦動(dòng)脈粥樣硬化的好發(fā)部位。近年來高分辨磁共振成像(high-resolution magnetic resonance imaging，HRMRI)由于其無創(chuàng)性和優(yōu)越的組織對(duì)比度而在顱內(nèi)動(dòng)脈斑塊成像方面應(yīng)用日益廣泛[3-9]。但在臨床實(shí)踐中，隨場(chǎng)強(qiáng)的提高，快速自旋回波(fast spin echo，F(xiàn)SE)序列對(duì)磁敏感偽影(magnetic susceptibility artifact，MSA)更加敏感，MSA常沿頻率編碼方向引起空間位置和信號(hào)的失真，在顱底腦組織與骨氣交界面處引起的信號(hào)丟失可能造成基底動(dòng)脈(basilar artery，BA)管壁信號(hào)缺失，從而影響斑塊顯示，特別是蝶竇氣化程度較高的患者，信號(hào)丟失現(xiàn)象更加明顯。

非對(duì)稱回波的最小二乘估算法迭代水脂分離(iterative decomposition of water and fat with echo asymmetric and least-squares estimation，IDEAL)又稱為三點(diǎn)法非對(duì)稱回波水脂分離技術(shù)。在消除磁化率偽影和改善脂肪抑制效果方面顯示了巨大優(yōu)勢(shì)，目前尚未見基于IDEAL FSE-T2WI技術(shù)的基底動(dòng)脈高分辨MRI相關(guān)研究報(bào)道。本研究旨在比較不同頻率編碼方向FSE-T2WI和IDEAL FSE-T2WI技術(shù)的HRMRI對(duì)于基底動(dòng)脈管壁顯示的效果。

1 材料與方法

1.1 臨床資料

2015年10月至2015年12月，招募我院30名磁共振顱腦檢查患者，其中男17例、女13例，年齡(51.9±16.5)歲。納入標(biāo)準(zhǔn)：蝶竇氣化較好的患者(鞍型蝶竇，與腦干間僅隔以紙樣薄骨板)、無固定金屬假牙或種植牙、無MRI檢查禁忌證。該研究經(jīng)醫(yī)院倫理委員會(huì)嚴(yán)格審批，并詳細(xì)告知試驗(yàn)?zāi)康募斑^程，簽署知情同意書。

1.2 檢查方法及圖像分析

采用GE Discovery MRI 750 plus 3.0 T掃描儀，8通道頭部標(biāo)準(zhǔn)線圈。先完成常規(guī)顱腦平掃，再行顱腦3D-TOF MRA掃描，采用3D-TOF MRA圖像定位做垂直于基底動(dòng)脈的高分辨FSE-T2WI (A/P)橫斷面成像(圖1)，F(xiàn)SE-T2WI (R/L)、IDEAL FSE-T2WI (A/P)的層厚和位置完全拷貝FSE-T2WI (A/P)。3組序列FSE-T2WI (A/P)、FSE-T2WI (R/L)、IDEAL FSE-T2WI (A/P)在成像選項(xiàng)界面(image option)中均選?。翰蔑椛漕l(tailored RF，TRF)、流動(dòng)補(bǔ)償(flow compensation，F(xiàn)C)、擴(kuò)展的動(dòng)態(tài)范圍(extended dynamic range，EDR)、無相位卷褶(no phase wrap，NPW)、零穿插后處理(ZIP 512)。FSE-T2WI (A/P)、IDEAL FSE-T2WI (A/P)頻率編碼方向?yàn)榍昂蠓较颍籉SE-T2WI (R/L)頻率編碼方向?yàn)樽笥曳较?；FSE-T2WI (A/P)、FSE-T2WI (R/L)均采用頻率選擇飽和法脂肪抑制技術(shù)。3組序列具體掃描參數(shù)見表1。

1.3 圖像分析與評(píng)價(jià)

屏蔽患者臨床信息后，由兩名高年資放射診斷醫(yī)師(分別從事MRI診斷21年及25年)對(duì)受試者BA管壁圖像質(zhì)量按優(yōu)、良、中、差4個(gè)等級(jí)目測(cè)評(píng)分[10]，評(píng)分標(biāo)準(zhǔn)如下：全部12個(gè)層面管腔壁清晰顯示，無缺失及偽影干擾者為“優(yōu)”，記4分；8個(gè)層面以上管腔壁顯示清晰，其余層面管腔壁顯示欠清晰者為“良”，記3分；6個(gè)層面以上管腔壁顯示清晰，其余層面管腔壁缺失中斷欠連續(xù)者為“中”，記2分；6個(gè)層面以上管腔壁顯示缺失中斷者為“差”，記1分。

1.4 統(tǒng)計(jì)學(xué)分析

采用Bland-Altman分析兩個(gè)觀察者對(duì)BA管壁圖像質(zhì)量評(píng)分的一致性(95% LOA)，若兩觀察者評(píng)分具有高度一致性，則進(jìn)一步對(duì)不一致的評(píng)分?jǐn)?shù)據(jù)經(jīng)兩者共同協(xié)商取得一組一致評(píng)分?jǐn)?shù)據(jù)，所得數(shù)據(jù)采用SPSS 17.0統(tǒng)計(jì)分析軟件，進(jìn)行非參數(shù)統(tǒng)計(jì)多個(gè)相關(guān)樣本，F(xiàn)riedman檢驗(yàn)比較3種序列的圖像質(zhì)量，如差異有統(tǒng)計(jì)學(xué)意義者，再采用Wilcoxon配對(duì)符號(hào)秩和檢驗(yàn)兩兩比較，以P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

所有患者均順利完成檢查，無明顯頭部運(yùn)動(dòng)偽影。IDEAL FSE-T2WI (A/P)序列較FSE-T2WI序列掃描時(shí)間增加約1 min 30 s。經(jīng)Bland-Altman分析，兩觀察者評(píng)分差值均位于95%的一致性界限區(qū)間內(nèi)，兩觀察者評(píng)分具有較好的一致性(圖2)。3組序列經(jīng)Friedman檢驗(yàn)，P＜0.001，3組序列評(píng)分的差異總體上具有統(tǒng)計(jì)學(xué)意義。

3種序列基底動(dòng)脈圖像質(zhì)量比較：FSE-T2WI (A/P)總分81分，基底動(dòng)脈下端近椎動(dòng)脈分叉處，基底動(dòng)脈及其前方腦脊液常信號(hào)缺失，管壁顯示模糊甚至中斷；FSE-T2WI (R/L)總分92分，較FSET2WI (A/P)在管壁顯示清晰度和連續(xù)性上雖有所提高，但在部分磁敏感偽影較大的情況下也沒有較大改善；IDEAL FSE-T2WI (A/P)總分115分，管壁結(jié)構(gòu)清晰顯示，無中斷，基底動(dòng)脈及其前方腦脊液信號(hào)顯示正常無缺失，圖像質(zhì)量顯著提高。3種序列兩兩比較，F(xiàn)SE-T2WI (A/P)和FSE-T2WI (R/L)差異具有統(tǒng)計(jì)學(xué)意義(Z=-3.317，P=0.001)。FSE-T2WI (R/L)和IDEAL FSE-T2WI (A/P)差異具有統(tǒng)計(jì)學(xué)意義(Z=-4.600，P=0.000)。FSE-T2WI (A/P)和IDEAL FSE-T2WI (A/P)差異具有統(tǒng)計(jì)學(xué)意義(Z=-4.540，P=0.000)，IDEAL FSE-T2WI (A/P)對(duì)于基底動(dòng)脈管壁結(jié)構(gòu)顯示效果最好，可顯著減少磁敏感偽影干擾(表2、圖3)。

表1 基底動(dòng)脈HRMRI掃描序列掃描參數(shù)Tab. 1 HRMRI parameters of basilar artery imaging sequences

圖1 A、B：以MRA的最大密度投影為定位像，做垂直于基底動(dòng)脈長(zhǎng)軸的斷面圖像；C：蝶竇氣化較好患者矢狀位定位像Fig. 1 A, B: Take MIP images of MRA as a localizer, perpendicular to the long axis of the basilar artery, obtain traverse images; C: The sagittal localizer of the patients with better sphenoid sinus gasification, obtain traverse images.

圖2 A～C分別為兩觀察者對(duì)FSE-T2WI (A/P)、FSE-T2WI (R/L)、IDEAL FSE-T2WI (A/P)的Bland-Altman圖，上下虛線為95%一致性界限，中間實(shí)線為平均差。A～C評(píng)分?jǐn)?shù)值均位于一致性界限以內(nèi)，提示兩觀察者之間評(píng)分一致性高Fig. 2 A—C: Bland-Altman diagram of FSE-T2WI (A/P), FSE-T2WI (R/L), IDEAL FSE-T2WI (A/P) for two observers, above and below the dotted line is 95% limits of agreement, the middle line is the mean difference. A—C: The score values were within the limits of agreement, indicating the high consistency of the two observers.

3 討論

動(dòng)脈粥樣硬化性狹窄常累及頭頸部血管，是缺血性腦卒中的主要原因。歐美國(guó)家動(dòng)脈粥樣硬化常累及頸動(dòng)脈，而中國(guó)人則更易累及顱內(nèi)動(dòng)脈[11-13]。目前國(guó)內(nèi)外還未見有關(guān)IDEAL-T2WI技術(shù)在BA高分辨血管壁成像應(yīng)用的文獻(xiàn)報(bào)道。本研究將IDEAL技術(shù)應(yīng)用顱腦BA高分辨掃描，并與常規(guī)FSE-T2WI進(jìn)行比較，結(jié)果顯示IDEAL FSE-T2WI中BA管壁結(jié)構(gòu)清晰顯示，基底動(dòng)脈及其前方腦脊液信號(hào)無缺失，該技術(shù)較FSE-T2WI圖像質(zhì)量顯著提高。

表2 3個(gè)序列對(duì)基底動(dòng)脈HRMRI圖像質(zhì)量評(píng)價(jià)的比較Tab.2 Comparison of image quality evaluation for three imaging sequences

圖3 A～C為同一患者BA管壁圖像。A：FSE-T2WI (A/P)部分層面BA前方管壁連續(xù)性中斷，記2分(短箭)；B：FSE-T2WI (R/L)同一層面管壁連續(xù)，但顯示欠清晰，記3分；C：IDEAL FSE-T2WI (A/P)同一層面BA管壁完整，無磁敏感偽影干擾，信號(hào)無丟失，圖像無變形，4分。D～F為同一患者BA管壁圖像。D、E分別采用FSE-T2WI (A/P)、FSE-T2WI (R/L)圖像無明顯改善，磁敏感偽影較大，BA前方管壁信號(hào)丟失；F：IDEAL FSE-T2WI (A/P)同一層面BA管壁完整，顯示清晰(長(zhǎng)箭)，頸內(nèi)動(dòng)脈海綿竇段管壁亦清晰完整顯示(短箭)。G～I(xiàn)為同一患者BA管壁圖像。G：FSE-T2WI (A/P)BA管壁斑塊，受磁敏感偽影干擾，前方管壁信號(hào)缺失，斑塊范圍未完整顯示(短箭)；H：FSE-T2WI (R/L)頻率方向?yàn)樽笥曳较?，磁敏感偽影干擾影響變小，斑塊顯示完整，BA管壁受信號(hào)缺失干擾，前方管壁顯示似欠清晰(短箭)；I：IDEAL FSE-T2WI (A/P)BA管壁無磁敏感偽影干擾，斑塊形態(tài)、范圍清晰顯示Fig. 3 A—C: Images of the basal artery of the same patient. A: Part of the level of the basilar artery wall discontinuity for FSE-T2WI (A/P), 2 points (short arrow); B: The same level of the basilar artery wall is continuous for FSE-T2WI (R/L), but the display is not clear, 3 points; C: At the same level, the basilar artery wall is complete, no magnetic susceptibility artifact interference, no loss of signal, no distortion of the image for IDEAL FSE-T2WI (A/P), 4 points. D—F: Images of the basal artery of the same patient. D, E: There was no signifcant improvement in the image, and the magnetic susceptibility artifacts were larger, and the basilar artery front wall signal was lost for FSE-T2WI (A/P) and FSE-T2WI (R/L); F: The same level of basilar artery wall is complete and clear display for IDEAL FSE-T2WI (A/P)(long arrow), beside the cavernous segment of internal carotid artery wall is complete and clear display (short arrow). G—I: Images of the basal artery of the same patient. G: The basilar artery wall plaque, which is affected by the magnetic susceptibility artifacts, is missing in front of the wall, and the area of the plaque is not fully displayed for FSE-T2WI (A/P) (short arrow); H: Magnetic susceptibility artifact is small, the plaque display is complete, but basilar artery front wall is not clear display for FSE-T2WI (R/L); I: There is no magnetic susceptibility artifact interference in the basilar artery wall, and the shape and range of the plaque are clearly displaye

目前腦動(dòng)脈高分辨MRI技術(shù)主要選用頻率選擇飽和法脂肪抑制技術(shù)的FSE-T2WI序列[14-15]，該序列在高分辨率參數(shù)下保持了較高的信噪比，而且成像時(shí)間短，能夠較好地顯示管壁結(jié)構(gòu)。但是，在顱底腦組織與骨氣等具有不同磁化率的物質(zhì)交界面處，局部場(chǎng)強(qiáng)差異導(dǎo)致主磁場(chǎng)不均勻，致使該處質(zhì)子自旋失相位，導(dǎo)致局部圖像信號(hào)缺失。由于FSE序列對(duì)B1場(chǎng)不均勻性敏感，在顱底特別是鞍型蝶竇患者行BA高分辨成像時(shí)，信號(hào)丟失更加明顯。IDEAL技術(shù)是一種采用三點(diǎn)法非對(duì)稱回波的水脂分離成像法，一次掃描采集3個(gè)回波，一次激勵(lì)實(shí)際上是3次激勵(lì)，在分離獲得單純水和脂肪圖像同時(shí)保持高的信噪比(signal noise ratio，SNR)，能有效克服磁場(chǎng)不均勻性的影響，脂肪抑制均勻，在高場(chǎng)MR儀上應(yīng)用越來越廣泛[16-17]。基于這一特點(diǎn)，本研究IDEAL FSE-T2WI (A/P)序列采用6次激勵(lì)，圖像SNR顯著提高。IDEAL技術(shù)能在一次掃描內(nèi)，獲得水像、脂像、同相位圖像、反相位圖像4種組織對(duì)比度圖像，能提高顱內(nèi)動(dòng)脈斑塊檢測(cè)和特征的顯示，對(duì)腦動(dòng)脈斑塊的風(fēng)險(xiǎn)評(píng)估具有重要臨床意義。

常用的減小磁敏感偽影的技術(shù)方法有：減小視野、增大矩陣、減小層厚和增加回波鏈長(zhǎng)度[18-19]。另外在FOV和相位編碼一定的情況下，增加帶寬使體素減少，縮短體素間失相位時(shí)間，造成偽影直徑減小。由于FSE-T2WI (A/P)本身就是高分辨成像在參數(shù)設(shè)置上符合小FOV、大矩陣、小層厚的條件，但在BA管壁顯示上還是受顱底MSA的影響，管壁結(jié)構(gòu)顯示并不理想?；诖琶舾惺д?zhèn)斡俺Ｑ仡l率編碼方向這一特點(diǎn)，本研究FSE-T2WI序列在保持高分辨成像參數(shù)的情況下，通過改變頻率編碼的方向，由前后方向變成左右方向，試驗(yàn)結(jié)果得出，雖較FSE-T2WI (A/P)在BA管壁顯示清晰度和連續(xù)性上有所提高，但在部分磁敏感偽影較大的情況下管壁的顯示亦不理想。腦動(dòng)脈HRMRI磁敏感偽影最明顯、造成信號(hào)缺失和失真的位置集中在顱底腦干下緣、斜坡骨質(zhì)和蝶竇氣腔交界處，而此處的基底動(dòng)脈常常顯示欠佳，尤其在基底動(dòng)脈走行于腦干前方較正中位置，與前方斜坡骨質(zhì)和氣化程度高的鞍型蝶竇僅僅隔以紙樣薄骨板時(shí)，受MSA影響最大。本研究采用IDEAL FSE-T2WI序列，較常規(guī)FSE序列能顯著消除顱底MSA干擾，BA管壁及其周圍結(jié)構(gòu)清晰顯示。

本研究存在的不足：首先樣本量偏少，可能削弱統(tǒng)計(jì)結(jié)果的準(zhǔn)確性，未來需加大樣本量進(jìn)一步研究。其次，沒有對(duì)管壁斑塊的檢出率和診斷效能進(jìn)行進(jìn)一步評(píng)價(jià)。IDEALFSE-T2WI掃描時(shí)間較常規(guī)FSE序列延長(zhǎng)，若結(jié)合快速采集技術(shù)時(shí)間能夠顯著縮短。

綜上所述，基于IDEAL FSE-T2WI技術(shù)的基底動(dòng)脈高分辨MRI是可行的，該技術(shù)可以顯著減小顱底磁敏感偽影，改善基底動(dòng)脈管壁的顯示效果。

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High-resolution magnetic resonance imaging of basilar artery with iterative decomposition of water and fat with echo asymmetric and least-squares estimation (IDEAL): A feasibility study

ZHANG Yu1, ZHA Yun-fei1,2*, LU Xue-song2,3, LI Liang1, HU Lei1, YANG Ren-jie1, LIN Yuan11Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
2Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis & Treatment, Wuhan 430074, China
3Department of Biological Engineering, School of Biomedical Engineering, South-Central University for Nationalities, Wuhan 430074, China

Objective: To evaluate the potential for high-resolution MR imaging using IDEAL FSE-T2WI compared with FSE-T2WI in the assessment of the basilar artery wall. Materials and Methods: High-resolution FSE (A/P), FSE (R/L) and IDEAL FSE (A/P) T2W images were acquired from basilar artery of 30 patients using 3.0 T MRI scanner. Imaging studies were evaluated for total image quality and graded using a 4-point Likert Scale (1, nondiagnostic; 4, outstanding). Results: The total scores for FSE-T2WI (A/P), FSE-T2WI (R/L) and IDEAL FSE-T2WI (A/P) images, respectively, were as follows: 81, 92 and 115. FSE-T2WI (A/P) and FSE-T2WI (R/L) difference with statistical signifcance (Z=-3.317, P=0.001). FSE-T2WI (R/L) and IDEAL FSET2WI (A/P) difference with statistical signifcance (Z=-4.600, P=0.000). FSE-T2WI (A/P) and IDEAL FSE-T2WI (A/P) difference with statistical signifcance (Z=-4.540, P=0.000) . IDEAL FSE-T2WI images showed improved image quality compared to FSE-T2WI technique at 3.0 T. Conclusion: IDEAL FSE-T2WI is a feasible technique in the basilar artery for producing high-resolution T2-weighted imaging.

醫(yī)學(xué)信息分析及腫瘤診療湖北省重點(diǎn)實(shí)驗(yàn)室開放課題資助項(xiàng)目(編號(hào)：PJS140011511)

1.武漢大學(xué)人民醫(yī)院放射科，武漢430060

2.醫(yī)學(xué)信息分析及腫瘤診療湖北省重點(diǎn)實(shí)驗(yàn)室，武漢 430074

3.中南民族大學(xué)生物醫(yī)學(xué)工程學(xué)院，武漢 430074

查云飛，E-mail：zhayunfei999@126. com

2016-07-30

接受日期：2016-09-23

R445.2；R743.1

A

10.12015/issn.1674-8034.2016.10.007

張宇, 查云飛, 陸雪松, 等. 三點(diǎn)法非對(duì)稱回波水脂分離技術(shù)的基底動(dòng)脈高分辨磁共振成像的可行性研究. 磁共振成像, 2016, 7(10): 754-758.

*Correspondence to: Zha YF, E-mail: zhayunfei999@126.com

Received 30 Jul 2016, Accepted 23 Sep 2016

ACKNOWLEDGMENTS This work was sponsored by the Opening Foundation of Hubei Key Laboratory of Medical Information Analysis and Tumor Diagnosis & Treatment (No. PJS140011511).