目的: 探讨磁共振非对称回波的最小二乘估算法迭代水脂分离(iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence, IDEAL-IQ)技术参数—脂肪分数(fat fraction, FF)、R2弛豫率(R2*值)与骨密度(bone mineral density, BMD)的相关性,分析其在不同性别间的差异,并重点评估围绝经期女性骨髓微环境的演变规律。方法: 回顾性分析65例同时行腰椎DXA和3.0T MRI检查的受试者资料。依据DXA T值分为骨量正常、骨量减少及骨质疏松组。将男性受试者纳入作为性别对照,重点对比不同性别间IDEAL-IQ参数的差异;进一步将女性受试者按绝经年限分组,分析FF与R2*值的动态变化。结果: (1)整体层面:随骨量流失,FF值升高(P＜0.001),R2*值降低(P＜0.001),两者与BMD均呈高度相关(P＜0.001);R2*值诊断骨质疏松的效能(AUC=0.887)优于FF。(2)性别差异:女性椎体R2*值低于男性(P＜0.05),提示女性骨髓铁储备及微结构磁敏感性存在特异性降低;而FF值在两性间差异无统计学意义(P＞0.05)。(3)围绝经期特征:女性FF值随绝经年限延长而升高(P＜0.05),表现为绝经早期骨髓脂肪的快速堆积。结论: IDEAL-IQ技术可无创、定量评估骨髓脂肪代谢变化。R2*值是反映骨质疏松性别差异的敏感指标,而FF值能敏锐捕捉围绝经期女性“红退黄进”的骨髓转化过程。该技术有望成为DXA的有效补充,尤其适用于围绝经期女性的早期筛查。
Objective: To investigate the correlation between magnetic resonance iterative decomposition of water and fat with echo asymmetry and least squares estimation quantification sequence (IDEAL-IQ) parameters [fat fraction (FF) and R2* relaxation rate] and bone mineral density (BMD), to analyze their differences between sexes, and to specifically evaluate the evolution of the bone marrow microenvironment in perimenopausal women. Methods: The data of 65 subjects who underwent lumbar DXA and 3.0T MRI were retrospectively analyzed. According to the DXA T value, the patients were divided into normal bone mass group, osteopenia group and osteoporosis group. Male subjects were included as gender controls, and the differences in IDEAL-IQ parameters between different genders were compared. The female subjects were further grouped according to the years of menopause, and the dynamic changes of FF and R2 * values were analyzed. Results: (1) At the overall level: with the loss of bone mass, the FF value increased (P＜0.001) and the R2* value decreased (P＜0.001), both of which were highly correlated with BMD (P＜0.001). The efficacy of R2* in the diagnosis of osteoporosis (AUC=0.887) was better than that of FF. (2) Gender differences: The vertebral R2* value of female was lower than that of male (P＜0.05), suggesting that there was a specific decrease in bone marrow iron reserve and microstructure magnetic sensitivity in women. There was no significant difference in FF value between the male and female (P＞0.05). (3) Perimenopausal characteristics: The FF value of female increased with the extension of menopausal years (P＜0.05), which was manifested as the rapid accumulation of bone marrow fat in early menopause. Conclusion: IDEAL-IQ technology can noninvasively and quantitatively evaluate the changes of bone marrow fat metabolism. R2* value is a sensitive index to reflect the gender difference of osteoporosis, and FF value can sensitively capture the bone marrow transformation process of perimenopausal women. This technology is expected to be an effective supplement to DXA, especially for early screening of perimenopausal women.
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