Research On The Correlation Of MRI Quantitative Techniques Of IDEAL-IQ And IVIM-DWI To Fat Quality And Microcirculation In Osteonecrosis Of Femoral Head

ObjectivesTo prospectively evaluate the efficacy of iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation sequence(IDEAL-IQ)and intra-voxel incoherent motion diffusion weighted imaging(IVIM-DWI)magnetic resonance imaging(MRI)parameters in quantitatively measuring the value of local microcirculation and the rate of the fat tissue in osteonecrosis of femoral head(ONFH)before collapse,which include Association of Research Circulation Osseous(ARCO)stage I、stage II and the early of stage III,also the correlation with both two.And to explore the potential correlation of quantitative parameters with the ARCO stages of osteonecrosis of femoral head.To prospectively evaluate the efficacy of IDEAL-IQ and IVIM-DWI MRI parameters in quantitatively measuring the value of local microcirculation and the rate of the fat tissue of the opposite hip in steroid-induced of single osteonecrosis of femoral head.And to assess whether differences between the two groups of the quantitative indicators.Materials and methods1.Research on the correlation of MRI quantitative techniques of IDEAL-IQ and IVIM-DWI to fat quality and microcirculation in osteonecrosis of femoral head The study through the hospital ethics committee review and all participants signed informed consent.Collected 49 cases patients(total include 78 femoral head involvement)of the osteonecrosis of femoral head,which Confirmed by X-ray,MRI and clinical from the first affiliated hospital of Guangzhou university of traditional Chinese medicine during Jan 2016 to March 2017.Participants age range from 16 to 58 and the median age was 42 years old.All of the patients were performed X-ray and MRI examination before treatment and all of the patients were treated first.The patients of osteonecrosis of femoral head were choose before collapse,which include ARCO stage I、stage II and the early stage Ⅲ.All the osteonecrosis of femoral head patients were underwent conventional MRI and IDEAL-IQ、IVIM-DWI examinations.The conventional MRI sequence including axial and coronal slices using T2WI and sagittal T1WI,coronal LAVAFLEX sequences.IVIM,contrast to traditional MRI,were performed by using 9 b-value(10,20,30,50,80,100.200,400 and 1000s/mm2).Through the post-processing,the images of IDEAL-IQ and IVIM-DWI were processed by the quantitative analysis software,measure f value of micro-vasculation by IVIM-DWI,and the rate of fat tissue(FF fraction)by IDEAL-IQ.The osteonecrosis of femoral head were classified into three zones:can be divided into three different regions at the same time,respectively Zone I was the necrotic area with empty osteocyte lacunas and a few alive at cells in the bone marrow.Zone Ⅱ was the reactive interface("penumbra").In this area,the osteoblasts and osteocytes were still alive,but the density of fat cells was decreased.Zone III,the nonnecrotic zone,contained normal bone trabeculae with intact osteoblasts and osteocytes and a few fat cells.Statistical analysis using SPSS 22.0.The variations of the values of FF and f between different regions of osteonecrosis of femoral head were compared by analysis of variance(ANOVA).P<0.05 was considered to indicate a significant difference.The correlations between the FF、f and the ARCO stage were studied by Pearson correlation analysis,if the difference was statistically significant and then the correlations between the FF and f were also studied by Pearson correlation analysis.P<0.05 was considered to indicate a significant difference.2.Research on fat content and local micro-circulation of the opposite hip in steroid-induced of single osteonecrosis of femoral headCollected 21cases patients(total include 30 femoral head involvement)of the osteonecrosis of femoral head,which Confirmed by the first affiliated hospital of Guangzhou university of traditional Chinese medicine.Select the the opposite hip in steroid-induced of single osteonecrosis of femoral head of the normal group,necrosis side for necrosis group.At the same time choose 16 healthy volunteers as control group.All of the patients were performed X-ray and MRI examination before treatment and all of the patients were treated first.The conventional MRI sequence including axial and coronal slices using T2WI and sagittal T1WI,coronal LAVAFLEX sequences.Through the post-processing,the images of IDEAL-IQ and IVIM-DWI were processed by the quantitative analysis software,measure f value of micro-vasculation by IVIM-DWI,and the rate of fat tissue(FF fraction)by IDEAL-IQ.The variations of the values of FF and f between different groups were compared by analysis of variance(ANOVA),P<0.05 was considered to indicate a significant difference.Results1.Research on the correlation of MRI quantitative techniques of IDEAL-IQ and IVIM-DWI to fat quality and microcirculation in osteonecrosis of femoral head The mean FF and f values in different areas of the osteonecrosis of femoral head which include necrotic,penumbra and the normal area were(102.42±36.67、38.56±13.04、75.24±14.55 and 0.30±0.07、0.34±0.08、0.40±0.08),respectively;they were significantly different(F= 51.76、12.36,respectively,P<0.01).The f value necrotic area was minimum,while the FF rate was maximum(P<0.01).The f value ARCO Ⅲ was minimum(0.30±0.67,P<0.05),while the FF rate was maximum(130.50±34.75,P<0.05).FF rate was positively correlated with ARCO staging(r=0.72,P<0.01),whereas f value was no relevance(r=-0.37,P>0.05),There was no statistically significant difference.2.Research on fat content and focal micro-circulation of the opposite hip in steroid-induced of single osteonecrosis of femoral headThere no difference between two groups in morphology by Conventional MRI,No obvious necrosis area and the reactive interface("penumbra").Through quantitative measuring physiological parameters within the organization by IDEAL-IQ and IVIM-DWI MRI,we can found:The mean FF and f values in the contralateral normal group of femoral head were 92.29±3.74、0.36 ± 0.06,respectively;The mean FF and f values in the Necrosis group of femoral head were 102.20±36.05、0.31 ±0.67,respectively;The mean FF and f values in the control group of femoral head were 80.88±4.58、0.37 ± 0.07,respectively.F=t8.11、8.93,respectively,P=0.001、0.000,respectively.P<0.01.The FF fraction were lower in normal group than in the contralateral normal group(P=0.03,p<0.05).The FF fraction were lower in normal group than in the Necrosis group(P=0.00,p<0.01).The f values were lower in Necrosis group than in the contralateral normal group(P=0.03,p<0.01).The f values were lower in Necrosis group than in the normal group(P=0.000,p<0.01).Conclusions1.Research on the correlation of MRI quantitative techniques of IDEAL-IQ and IVIM-DWI to fat quality and microcirculation in osteonecrosis of femoral headIDEAL-IQ and IVIM-DWI MRI is a promising technique for distinguishing different ARCO stages of microcirculation and fat tissue.The f value ARCO III was minimum,while the FF rate was maximum.The f value ONFH decreased,while the FF rate increased.Under measuring by ARCO stage,the local microcirculation in necrotic area was negatively correlated with the fat content,which may help to treatment decision and prognosis evaluation.2.Research on fat content and focal micro-circulation of the opposite hip in steroid-induced of single osteonecrosis of femoral headThe contralateral normal group in Single osteonecrosis of femoral head found no abnormal morphological changes by conventional MRI examination,the imagings found no significant different with normal femoral head.But the internal physiological indexes have be detected changed by The IDEAL-IQ and IVIM-DWI MRI through quantitative parameters.The FF rate increased in the contralateral normal group,while the f value was decreased.This suggests that the physiological indexes have been changed before the morphology changed before the necrosis of the normal femoral head,which is super early of the necrosis.