背景：动态增强MRI 作为一种无创性检测方法，目前在肿瘤领域运用广泛，可进行肿瘤良恶性的鉴别、肿瘤级别的分级以及预后的预测与评估等。近年其在骨关节领域的运用研究逐渐成为热点，可用于骨髓血流灌注的测定、骨组织活性的评估、骨灌注异常的早期发现以及关节炎性病变血运的评估等。

目的：总结动态增强MRI 的技术概况及其目前在骨关节方面的应用进展。

方法：英文检索式为“(bone OR joint) AND (dynamic contrast-enhanced MRI) OR dynamic contrast-enhanced magnetic resonance imaging)”，中文检索式为“(骨OR 关节)AND 动态增强磁共振”“(骨OR 关节)AND 动态增强MRI”“(骨OR 关节)AND DCE-MRI”，由第一作者检索1984 至2019年PubMed、Springerlink 以及中国期刊全文数据库(CNKI)，查阅近年动态增强MRI 在骨关节方面应用的相关文献，最终保留55 篇文献进行总结分析。

结果与结论：①目前动态增强MRI 成像技术及数据处理尚未标准化，在骨关节主要采用T1WI 成像，可行定性、半定量及全定量分析；②定性分析及半定量分析操作简便，量化指标明确，能客观地描述曲线形态，但不能反映组织间、血管内的对比剂浓度，且容易受扫描参数序列的影响，无法检测组织药物代谢动力学信息；而定量分析能获得组织内亚结构间的对比剂浓度变化并生成参数，评估组织的微血管生成及其功能；③动态增强MRI 可无创性评估骨关节的微循环灌注，对许多骨关节疾病发病机制的探讨、诊断及鉴别诊断、预后预测、疗效评估以及治疗方式的选择都有一定参考价值。

国家自然科学基金面上项目()，项目负责人：赵德伟；辽宁省自然科学基金(2)，项目负责人：常晓丹

BACKGROUND:As a non-invasive detection method, dynamic contrast-enhanced magnetic resonance imaging is widely used in the field of tumor. It can be used for the differentiation of benign and malignant tumors, the grading of tumor grade and the prediction and evaluation of prognosis. In recent years, the application research in the field of bone and joint has gradually become a hot spot, which can be used in the determination of bone marrow blood perfusion, the evaluation of bone tissue activity, the early detection of bone perfusion abnormality and the evaluation of blood circulation of joint inflammatory lesions.

OBJECTIVE:To summarize the technical situation of dynamic contrast-enhanced magnetic resonance imaging and its application research in bone and joint.

METHODS:The keywords were “(bone OR joint) AND (dynamic contrast-enhanced MRI) OR dynamic contrast-enhanced magnetic resonance imaging) OR DCE-MRI” in English and Chinese, respectively. The first author searched PubMed, Springerlink and China National Knowledge Infrastructure databases for the articles published between 1984 and 2019. The relevant literature was reviewed on the application of dynamic contrast-enhanced magnetic resonance imaging in bone and joint in recent years. Finally, 55 articles were summarized and analyzed.

RESULTS AND CONCLUSION:(1) At present, dynamic contrast-enhanced magnetic resonance imaging technology and data processing have not been standardized. T1WI imaging is mainly used in bone and joint. Qualitative, semi-quantitative and full quantitative analysis of its data is feasible. (2) Qualitative analysis and semi-quantitative analysis are simple and easy to operate. Quantitative indicators are clear, can objectively describe the shape of the curve, but cannot reflect the concentration of contrast agent between tissues and blood vessels, and are easily affected by the sequence of scanning parameters, so cannot detect the pharmacokinetic information of tissue. Quantitative analysis can obtain the concentration changes and generation parameters of contrast media between substructures in tissues, and evaluate the microangiogenesis and function of tissues. (3) Dynamic contrast-enhanced magnetic resonance imaging can noninvasively evaluate the microcirculation perfusion of bone and joint. It has certain reference value for the discussion of the pathogenesis, diagnosis and differential diagnosis, prediction of prognosis, evaluation of curative effect and choice of treatment of many bone and joint diseases.

0 引言 Introduction

目前MRI检查因具有良好的组织对比、无创等优点，广泛应用于骨关节领域，普通MRI增强扫描可以提供病变血运方面的信息，但对病变的定性尚且有限[1]。近年来，随着MR软硬件的不断发展及越来越多的新技术在临床上的应用，MRI不仅能进一步改善影像质量，显示更精细的解剖细节，而且功能MRI技术已经实现定量或半定量地反映细胞水平的组织信息。动态增强磁共振成像(Dynamic contrast-enhanced magnetic reasonance imaging，DCE-MRI)为一种MRI功能成像技术，主要对血管外细胞外间隙内的对比剂比较敏感，可反映组织灌注程度、微血管通透性及血管外细胞外间隙的大小，因此适合渗透性成像，且具有无创、可重复、磁敏感伪影小、无对比剂偏差等特点，在评估血管微环境方面有广泛的应用价值[2-3]。在骨关节领域目前多用于肿瘤血管生成的评估[4-5]，如良恶性肿瘤的鉴别、化疗疗效的评价以及术后病灶复发的判断等方面[6-8]，此外可以通过DCE-MRI对正常骨灌注[9]、骨坏死、骨折、某些炎性疾病及相关并发症进行动态评估。在临床中DCE-MRI还未作为骨关节领域常规检查手 段[10]，现文章就其技术概况及其近年来在骨关节领域的应用研究进行综述。