MR动态增强成像在诊断良恶性骨病中的应用价值

The application of dynamic contrast-enhanced MRI in the diagnosis of differentiating benign skeletal masses from malignant ones

目的:探讨MR动态增强成像在诊断良恶性骨病中的应用价值。方法:36例骨病患者(良性14例,恶性22例)行DCE-MRI检查。于动态增强图像上测量信号增强幅度(SEE)、早期动态增强斜率值(Slope值)、向心性增强率(DER),判断TIC曲线类型,采用受试者操作特征(ROC)曲线选择良恶性病变鉴别诊断的阈值,计算各参数对病变潜在恶性估计的敏感度、特异度和准确度。结果:①36例病例中,恶性病变组共22例,均为Ⅲ型(100%);良性病变组共14例,呈Ⅲ型者2例(14.29%),呈Ⅱ型者5例(35.71%),Ⅰ型者7例(50%)。若以Ⅲ型为恶性病变,Ⅰ、Ⅱ型均视为良性病变为诊断标准,则TIC类型对病变潜在恶性评估的准确度为94.3%;②良恶性两组间SEE、Slope值、DER分别为227.96±172.08、325.6±125.86(P>0.05);(0.97±0.67)%/s、(2.53±0.91)%/s(P<0.05);0.2043±0.0487、0.2267±0.0402(P>0.05)。Slope值对病变潜在恶性估计的准确度为91.4%。结论:DCE-MRI可以反应病变组织的血管化与灌注,有助于鉴别骨骼系统病变的良恶性,且以TIC类型准确度最高,最有价值。

Objective：To assess the diagnostic potential of DCE-MRI in the accuracy of differentiating benign from malignant skeletal masses.Methods：DCE-MRI was performed on 36 patients using Siemens Sonata 1.5 T MR scanner.SEE,slope value and TIC type were gained on DCE-MRI.Subjective overall performance of the techniques was evaluated with ROC analysis.Results：① In 36 patients,Ⅲ curve was found in 24 cases（malignant for 22 and benign for 2）,Ⅱ curve in 5 cases and Ⅰ curve in 7 cases（all were benign）.As Ⅲ curve was considered malignant and Ⅰ,Ⅱ curve were regarded as benign,the diagnostic accuracy of TIC type was 94.3%;② SEE,Slope value and DER in benign and malignant group were respectively 227.96±172.08,325.6±125.86（P0.05）;（0.97±0.67）%s,（2.53±0.91）%s（P0.05）;0.2043±0.0487,0.2267±0.0402（P0.05）,The diagnostic accuracy of Slope value were 91.4%.Conclusion：DCE-MRI can depict tissue vascularization and perfusion.It was valuable in differentiating benign from malignant skeletal masses.The diagnostic accuracy of TIC type was the highest.