CT灌注成像对溶骨性骨肿瘤性质鉴别的定量研究

Differentiation of Osteolytic Bone Tumors:Quantitative Assessment with CT Perfusion

目的探讨最大强化速率(MER)和CT灌注在溶骨性骨肿瘤中的诊断和鉴别诊断价值。资料与方法对32例患者的32例溶骨性骨肿瘤行CT灌注检查,其中恶性骨肿瘤18例,良性骨肿瘤14例。比较分析良恶性骨肿瘤MER和CT灌注参数。结果骨肿瘤的血流速度、血流量和MER与骨肿瘤的微血管密度均呈正线性相关。边缘-中心血流量差异率(Rrim-cenBF)和边缘-中心血容量差异率(Rrim-cenBV)值在良恶性骨肿瘤之间的差异有统计学意义(P<0.01)。Rrim-cenBF和Rrim-cenBV的ROC曲线下的面积分别为0.966、0.895,鉴别良恶性骨肿瘤的阈值分别为Rrim-cenBF:0.11(敏感性:94.4%;特异性:85.7%);Rrim-cenBV:0.08(敏感性:88.9%;特异性:78.5%)。结论MER可定量地评估骨肿瘤的血供情况,Rrim-cenBF和Rrim-cenBV有助于溶骨性骨肿瘤良恶性鉴别。

Objective To evaluate the value of maximal enhancement rate（MER） and CT perfusion parameters in the diagnosis and differential diagnosis of osteolytic bone tumors. Materials and Methods CT perfusion was performed in 32 patients with osteolytic bone tumor or tumorlike mass including 18 patients with malignant tumor and 14 patients with benign tumor. MER and perfusion parameters of benign and malignant osteolytic bone tumors were analysed and compared. Results There was positively linear correlation between microvessel density of the tumor and blood flow, blood volume and MER of the tumor. There was significant difference in the rim to center differential blood flow ratio （Rrim-cenBF） and rim to center differential blood volume ratio （Rrim-cenBV） between benign bone tumors and malignant bone tumors （ P 〈 0. 01 ）. The area under ROC curve was 0. 966 when a cutoff value was 0.11 for Rrim-eenBF （ the sensitivity was 94.4 and the specificity was 85.7% ）. The area under ROC curve was 0. 895 when a cutoff value was 0.08 for Rrim-eenBV （the sensitivity was 88.9% and the specificity was 78.5% ）. Conclusion MER could quantitatively evaluate vascular supply of bone tumors and the Rrim-cenBF and Rrim-eenBV might be a usefully quantitative indicator in the differential diagnosis of benign and malignant osteolytie bone tumors.