动态增强磁共振成像在孤立性富血供肺结节良恶性鉴别诊断中的临床研究

Clinical Study of Dynamic Contrast-enhanced MR Imaging in Differential Diagnosis of Solitary Pulmonary Nodules with Abundant Blood Supply

目的:评价功能磁共振成像技术包括动态增强磁共振DCE-MR检查及其各种强化参数对肺内良、恶性结节鉴别诊断中的应用价值。方法:收集在2007年10月至2010年12期间行MR扫描且临床资料完整的孤立性肺结节病例55例,所有患者MRI检查包括常规MRI、DCE-MR。DCE-MR检查的主要测量参数包括,SIep、SImax、SIen、MER、SIep%、上升Slope、下降Slope和washout等。结果:本研究针对具备富血供特点的良、恶性肺结节的DCE-MR的各种强化参数进行对照研究发现:SIep、SImax、SIen、MER和washout等参数在富血供肺结节良、恶性的鉴别中均有显著统计学差异(P<0.05),其中SIep、SImax和washout等参数有非常显著统计学差异(P<0.01)。本研究同时对P<0.01的三种参数进行临界值的选取与分析,结果发现:将同时符合这三个条件(SIep<510、SImax<550和washout<12)作为恶性肺结节的诊断依据时,其诊断灵敏度、特异度、阳性预测值、阴性预测值、正确指数、诊断符合率分别是78.57%、90%、95.65%、60%、0.686、81.58%。结论:应用DCE-MR检查有助于对临床上难以区分的富血供的肺部良、恶性结节进行鉴别。

Objective： The aim of our study was to investigate the application value on dynamic contrast-enhanced MR （DCE-MR） imaging and its various enhanced parameters between benign and malignant pulmonary lesions. Methods： From 2007 October to 2010 December, fifty-five consecutive patients were prospectively enrolled in the study. All patients underwent DCE-MR imaging on a 1.5-T MR1 unit. Main measurement parameters of DCE-MR included signal intensity of early perk （SIep）, signal intensity of maximum perk （SImax）, signal intensity of end （SIen）, maximum enhance ratio （MER）, Slep%, ascending slope, descending slope and washout. Results： Various enhancement parameters of DCE-MR were analyzed to distinguish malignant and benign nodules with well blood supply. For DCE-MR, compared with various enhancement parameters of benign and malignant nodules with well blood supply, significant differences （P 〈 0.05） were observed in Slep, Slmax, SIen, MER and washout. And special significant differences （P 〈 0.01） were observed in SIep, Si and washout. Critical values of three parameters with P 〈 0.01 were selected and analyzed. When malignant nodules were diagnosed in the light of this condition, simultaneously conforming to SIep 〈 510, SImax 〈 550 and washout 〈 12, sensitivity, specifity, positive predictive value, negative predictive value, right index and diagnostic coincidence rate of its malignant diagnosis were 78.57%, 90%, 95.65%, 60%, 0.686, 81.58% respectively. Conclusion： DCE-MR could help for effective differential diagnosis between both nodules of hypervascularity, since it was very difficult for differesntial diagnosis in clinic.