基于磁共振的青年男性股四头肌的测量和评估

doi:10.19723/j.issn.1671-167X.2021.05.006

摘要/Abstract

摘要：

目的: 通过观测髌骨上缘不同水平位置股四头肌横截面积(cross-sectional area,CSA)与体积(quadriceps muscle volume,QMV)的相关性,探讨评估股四头肌肌肉参数的最佳测量位置。方法: 对22例单侧前交叉韧带(anterior cruciate ligament,ACL)断裂男性患者行双侧大腿磁共振成像检查,患者平均年龄(29±6)岁,分别选取髌骨上缘18、15和12 cm处,利用半自动分割和医学影像处理软件确定QMV和各水平位置CSA。通过拟合回归方程建立模型估计QMV,采用Bland-Altman分析评价两者之间的一致性。结果: 受试者健侧QMV平均为(1 944.45±323.77) cm³。髌骨上缘18、15和12 cm处的股四头肌CSA分别为(80.80±12.16) cm²、(77.53±12.03) cm²和(72.68±10.51) cm²,拟合方程R²分别为0.819、0.755、0.684(P均<0.001),QMV估计值的标准误(standard error of the estimate,SEE)分别为7.4%、8.7%、9.8%(以体积的百分比表示)。三个水平位置的拟合方程均较好,但以髌骨上缘18 cm处的拟合度最高。Bland-Altman散点图结果显示,髌骨上缘18、15和12 cm处的QMV差值平均值分别为0.8 cm³、-1.1 cm³、0.9 cm³,95%一致性界限分别为(-268.8, 270.5)、(-315.2, 313.1)、(-355.7, 357.5),髌骨上缘18 cm处QMV的估计值与实测值一致性最好,患侧与健侧结果一致。结论: 以髌骨上缘作为基线探讨青年男性QMV与CSA的相关性具有可靠性和一致性,其中以髌骨上缘18 cm处的股四头肌CSA与QMV的相关性最好,但对于股四头肌的不同损伤部位,可选择不同观测位置。

关键词: 磁共振成像, 股四头肌, 横截面积, 测量

Abstract:

Objective: To investigate the correlation between the quadriceps cross-sectional area (CSA) and quadriceps muscle volume (QMV) at different horizontal levels from the upper edge of the patella, and to determine the best observation position. Methods: Thigh magnetic resonance imaging (MRI) images of 22 Chinese young men [age: (29±6) years] with anterior cruciate ligament (ACL) rupture were examined. The CSA was measured at 18, 15, and 12 cm above the upper edge of the pate-lla (denoted by CSA-18, CSA-15 and CSA-12 respectively), and the QMV and CSA were determined by semiautomatic segmentation. A curve model was established to estimate QMV. Bland-Altman analysis was performed to determine the confidence limits of the volumes. Results: On the unaffected side, the mean QMV was (1 944.45±323.77) cm³. The quadriceps CSA at the upper edge of the patella at 18, 15, and 12 cm was (80.80±12.16) cm², (77.53±12.03) cm², and (72.68±10.51) cm², respectively. The coefficients of determination (R²), ascertained using curve estimation models, for the 3 positions were 0.819, 0.755, and 0.684 (P<0.001), and the standard deviations of the volume estimated value (SEE) were 7.4%, 8.7%, and 9.8%. The fitting equations of the three horizontal positions were all good, but the fitting degree of CSA-18 was the highest. The Bland-Altman scatter plot showed that the arithmetic means of the QMV at 18, 15 and 12 cm from the upper edge of the patella 0.8 cm³, -1.1 cm³, and 0.9 cm³ and 95% limits of agreement (LoA) were (-268.8, 270.5), (-315.2, 313.1), and (-355.7, 357.5), respectively. The estimated QMV was in good agreement with the measured value. The difference between the estimated CSA-18 and measured values was the smallest. The results on the affected side were consistent. Conclusion: The correlation between QMV and CSA in the young men with the upper edge of patella as baseline was reliable and consistent. Among them, CSA-18 had the highest correlation with the QMV. However, different observation sites could be selected for different injuries of the quadriceps.

Key words: Magnetic resonance imaging, Quadriceps muscle, Cross-sectional area, Measurement

中图分类号:

R873

吴一凡,张晓圆,任爽,玉应香,常翠青. 基于磁共振的青年男性股四头肌的测量和评估[J]. 北京大学学报（医学版）, 2021, 53(5): 843-849.

Yi-fan WU,Xiao-yuan ZHANG,Shuang REN,Ying-xiang YU,Cui-qing CHANG. Measurement and evaluation of the quadriceps muscle mass in young men based on magnetic resonance imaging[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 843-849.

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Items	CSA of quadriceps/cm²			F value	P value
Items	CSA-18	CSA-15	CSA-12	F value	P value
Unaffected side
Quadriceps	80.80±12.16	77.53±12.03	72.68±10.51	92.876	<0.001
RF	9.53±2.36	7.01±1.67	3.66±1.28	209.987	<0.001
VM	14.97±3.46	20.09±4.51	23.04±4.90	336.556	<0.001
VL	28.71±4.93	25.84±4.71	22.06±3.85	121.180	<0.001
VI	27.59±4.58	24.60±4.11	21.19±3.95	132.113	<0.001
Affected side
Quadriceps	73.79±15.83	71.16±15.25	66.41±14.02	58.739	<0.001
RF	9.49±2.34	7.05±1.86	4.24±1.19	226.089	<0.001
VM	13.43±3.89	17.78±4.37	22.29±5.46	239.172	<0.001
VL	26.07±6.73	23.63±5.90	20.23±5.35	58.258	<0.001
VI	24.80±5.10	22.70±5.08	19.64±4.48	101.731	<0.001

Items	Unaffected side			Affected side
Items	r	R²	P value	r	R²	P value
QMV
CSA-18	0.891	0.793	<0.001	0.953	0.909	<0.001
CSA-15	0.843	0.711	<0.001	0.926	0.857	<0.001
CSA-12	0.808	0.652	<0.001	0.904	0.818	<0.001
Height	0.404	0.163	0.062	0.447	0.199	0.037
Weight	0.705	0.497	<0.001	0.658	0.433	0.001
Height
CSA-18	0.135	0.018	0.548	0.247	0.061	0.268
CSA-15	0.058	0.003	0.796	0.197	0.039	0.378
CSA-12	-0.025	0.001	0.912	0.196	0.038	0.383
Weight
CSA-18	0.657	0.432	0.001	0.571	0.326	0.005
CSA-15	0.597	0.357	0.003	0.567	0.322	0.006
CSA-12	0.509	0.259	0.016	0.508	0.258	0.016

	R²	SEE	F value	P value	Constant	b1	b2
Unaffected side
CSA-18	0.819	144.64	43.111	<0.001	-2 221.800	79.618	-0.340
CSA-15	0.755	168.51	29.265	<0.001	-2 506.692	92.559	-0.443
CSA-12	0.684	191.29	20.580	<0.001	-2 311.765	93.240	-0.468
Affected side
CSA-18	0.923	123.05	114.104	<0.001	-1 423.204	62.000	-0.247
CSA-15	0.883	151.52	72.009	<0.001	-1 766.642	75.312	-0.349
CSA-12	0.871	159.67	63.904	<0.001	-1 992.903	87.521	-0.451

QMV	Unaffected side	Affected side
Measured value/cm³	1 944.45±323.77	1 747.36±422.18
Estimated value of CSA-18/cm³	1 943.62±292.85	1 747.76±405.79
Estimated value of CSA-15/cm³	1 945.52±281.62	1 747.83±396.99
Estimated value of CSA-12/cm³	1 943.54±267.56	1 745.81±393.31