三维彩色血管能量成像对肌肉骨骼系统肿瘤血供分布研究

Study on vascularity of musculoskeletal system tumor by three-dimensional color power angiography

目的探讨三维彩色血管能量成像对肌肉骨骼系统肿瘤的诊断价值。方法应用三维彩色血管能量成像（3D-CPA）及虚拟器官计算机辅助分析（VOCAL）检测不同病理类型肌肉骨骼系统肿瘤108例，评定血管分型（3D-CPAⅠ～Ⅲ型），计算肿瘤血管指数（Ⅵ）。结果①48例肌骨恶性肿瘤中3D-CPAⅢ型37例，Ⅱ型11例；60例肌骨良性肿瘤3D-CPAI型31例，Ⅱ型15例，Ⅲ型14例（全部为血管瘤）。以3D-CPAIH型诊断恶性肌肉骨骼系统肿瘤敏感性为77％，特异性为76％。②恶性肌骨肿瘤VI为19．25±9．67，良性肌骨肿瘤Ⅵ为4．71±3．21，二者比较差异有统计学意义（P〈0．01）。以Ⅵ≥9．58诊断肌肉骨骼系统恶性肿瘤的敏感性为93％，特异性为9 ％。结论3D-CPA可清晰、立体、完整显示肌肉骨骼系统肿瘤的血管分布，其血管分型及血管指数对肌骨系统良恶性肿瘤的诊断及鉴别诊断有重要的应用价值。

Objective To evaluate the diagnostic value of three-dimensional color power angiography （3D-CPA） to musculoskeletal system tumor. Methods One hundred and eight patients with different pathological types of musculoskeletal system tumors were examined with 3D-CPA and virtual organ computer-aided analysis （VOCAL）. The vascular pattern of musculoskeletal system tumor and vascularization index（VI） were assessed. Results ① Thirty-seven of the 48 musculoskeletal malignant tumors were 3D-CPA Ⅲ, 11 of which were 3D-CPA Ⅱ. Thirty-one of the 60 musculoskeletal benign tumors were 3D-CPA Ⅰ , 15 of which were 3D-CPA Ⅱ , 14 of which were 3D-CPA Ⅲ （all of these cases were hemangioma）. Using the vascular pattern of 3D-CPA Ⅲ （except hemangioma）, the sensitivity and specificity in diagnosing musculoskeletal malignant tumor were 100% and 78% respectively. ②VI obtained from musculoskeletal malignant tumors was 19.25 ±9.67 and was 4. 71 ± 3.21 from musculoskeletal benign tumors, there was significant difference between malignant tumors and benign tumors. Using VI 99.58 as a standard, the sensitivity and specificity in diagnosing musculoskeletal malignant tumor were 93 % and 90% respectively. Conclusions 3D-CPA could show overall vascular perfusion of different musculoskeletal tumors clearly. Vascular pattern and VI of 3D-CPA are helpful to diagnose and differentiate musculoskeletal tumors.