| Research background and purpose:To study the normal range of some metabolites detected by ~1H-MRS in each anatomical area of normal human femoral head.Using multiple imaging methods(CT,DXA,magnetic resonance mapping and ~1H-MRS)to observe and measure Imaging changes at different time points of the femoral head in patients with using small-medium dose glucocorticoid treatment,explore the meaning of various imaging manifestations and compare the techniques.Materials and Methods:The first part:28 healthy volunteers were collected,14 males and 14 females,aged25-32 years old,with an average age of 27.6±1.8 years old,who underwent ~1H-MRS examination of the left hip joint.Part II:A total of 16 patients with non-femoral head ischemic necrosis who were treated in our hospital for long-term small-medium dose glucocorticoid treatment were collected,8 males and 8 females,aged 30-67 years,mean age 47.6±12.5.CT,DXA,magnetic resonance(conventional sequence,T2map,T2*map,T1map)examinations were performed on bilateral hip joints of each patient,and~1H-MRS was performed on the left hip joint.All of the above examinations were performed on the day before the patient received glucocorticoids,magnetic resonance examinations were performed on the 7th day of glucocorticoids,and all the above examinations were performed on the 30th day of glucocorticoids.Statistical analysis of each imaging image and measured value.Result:1.Part 1:Healthy Human Femoral Head ~1H-MRS(1)The apparent peak height of the MRS spectrum line of the normal femoral head appears at Lip1;Cho and Cr metabolites are larger in the central region of the greater trochanter of the femoral head,and gradually decrease to the marginal region.The distribution of Lip1 and Lip2 metabolites in the femoral head differs greatly from each other,mainly in the central area.(2)Metabolite content is related to anatomical area:Lip2,Cho,Cr:area 2>area 3>area 1;Lip1,Lip1/Cho+Cr:area 1>area 2>area 3;Cho/Cr:area3>area 1>area 2.Lip2 was significantly higher in area 2 than in area 1(P<0.05).(3)Normal femoral head metabolite content is related to gender:at Lip1,Cho/Cr,Lip1/Cho+Cr,women are greater than men;Lip2,Cho,and Cr men are greater than women.The maximum difference between Lip1 and Lip1/(Cho+Cr)and the measured gender in the third zone are statistically significant(P<0.05),and women are greater than men.2.Part 2:Observation on the imaging changes of femoral head in the early stage of glucocorticoid use(1)The T,Z and CT values of the two measured bone mineral density were significantly correlated,but there were no significant differences before and after(P>0.05);there was no significant difference in CT values in each area of bilateral femoral head(P>0.05).(2)Comparison of the differences between the measured values of the mapping technique:(1)T2 value:in the first and second measurements,there are significant differences in the area1 and 3、area 2 and 3 on the right;in the second measurement,there are significant differences between the area2 and 3 on the left.(2)T2*value:in the first and third measurements there was a significant difference between the area 1and 3 on the left;in the second and third measurements there are significant differences between area 1 and 3 on the right.(3)R2*value:in the first and third measurements there are significant differences between the area 1 and 3 on both sides.(3)Comparison of mapping values at different time points of glucocorticoid use:R2*value in the left area 1 and right area 2 have significant differences between the first and third measurements.and T1 value in the right area 2 have significant differences between the first and third measurements.(4)Comparison of regional differences in femoral head metabolite content detected by ~1H-MRS:in the first measurement Cho and Lip2 have significant differences between area 1 and 2、area 1 and 3;Cr has significant difference in area 1 and 3.In the second measurement,Lip2 have significant differences between area 1 and 2、area 1&3;Cho and Cr have significant differences in area 1 and 3.The difference of Lip2,Cho,and Cr between area 1&3 in the third measurement have significant differences.(5)Comparison the integral of these metabolites in the same area at different times of hormone use:Area 1:Lip1/Cho+Cr in 1st and 3rd,2nd and 3rd;Lip2/Cho+Cr in2nd and 3rd have significant differences.Area 2:No statistical difference.Area 3:Lip1in 1st and 2nd,1st and 3rd;Lip1/Cho+Cr in 1st&2nd have significant differences.(6)Correlation of measured values of different magnetic resonance sequences:Correlation analysis was performed for a total of 9 groups of data in 3 times and 3 areas.It was found that except for groups with direct mathematical relationship,In the first measurement on the left area 1 and 3,Lip2 and Cho/Cr of the two groups showed a moderate negative correlation;in the second measurement on the left area 1 and 2,Lip2/Cho+Cr and T1 have a medium-strong positive correlation;Lip1/Cho+Cr and Lip2/Cho+Cr in the first time on the left area 1、Lip1 and Lip2 in the first time on the left area 2、Lip1 and Lip2/Cho+Cr in the second time on the left area 1 have moderate positive correlations.Lip1 and T2*in the third time on the left area 2 have a medium-intensity negative correlation;Lip2/Cho+Cr and T2*in the first time on the left area 3 have a medium positive correlation,and have a medium negative correlation with R2*.(7)Correlation between the two stages of the average change rate of different magnetic resonance sequences:In addition to the direct mathematical operation relationship(such as R2*=1/T2*)pairing,in the first stage(day0-day7):T1 and R2*,Cho and T2*,Cr and T1 have a moderately strong positive correlation;Lip1 and T2,Cho/Cr and T1,T2*and Lip1/Cho+Cr,T2*and Lip2/Cho+Cr are weak negative correlation;Lip1/Cho+Cr and Lip2/Cho+Cr has a weak positive correlation.In the second stage(day7-day30)Lip1/Cho+Cr and Lip2 have a moderate positive correlation;Lip2 and T2*、R2*、Cr have weak positive correlations;Lip2/Cho+Cr and T2*has a weak negative correlation;Lip2/Cho+Cr and R2*has a weak positive correlation.In both stages,only Lip2/Cho+Cr and T2*showed the same weak negative correlation.3.Conclusion(1)The content of metabolites in the femoral head varies in different regions and genders.(2)DXA and CT tests are not sensitive to ultra-early femoral head changes in glucocorticoid use.(3)MR mapping technology and ~1H-MRS can detect obvious changes in the early use of glucocorticoid and some of the changes have a certain correlation.The observation window may be about 7 days. |
PDF Full Text Request