高场磁共振鉴别骨肿瘤及肿瘤样病变的临床价值

Diagnostic value of high tesla magnetic resonance imaging in bone tumors and tumor-like lesions

目的:探讨磁共振平扫、磁共振动态增强(DCE-MRI)和扩散加权成像(DWI)对骨肿瘤及肿瘤样病变的诊断和鉴别诊断价值。方法:选择61例临床资料完整的骨肿瘤及肿瘤样病变患者,先行常规MRI平扫,然后依次进行不同b值的DWI扫描、DCE-MRI,最后进行延迟MRI增强扫描。结果:良、恶性骨肿瘤边缘形态和边界清晰度比较,差异均有统计学意义(χ2=32.262和45.131,P均<0.001),病变内信号均匀性和病灶周围有无骨髓水肿比较,差异无统计学意义(χ2=0.713和1.915,P均>0.05)。良、恶性骨肿瘤强化程度(Z=3.488,P<0.001)、时间-信号强度曲线(TIC)分布类型(χ2=15.826,P=0.001)比较,差异有统计学意义。TIC取Ⅰ、Ⅱ型曲线为恶性诊断标准,诊断恶性肿瘤的特异性为69.57%,准确性为72.13%,敏感性为73.68%,阳性预测值为80.00%,阴性预测值为61.54%。良、恶性骨肿瘤之间的DWI信号比较,差异无统计学意义(χ2=1.225,P=0.268)。结论:磁共振平扫、DCE-MRI和DWI有助于鉴别骨肿瘤良、恶性病变。

Aim：To analyze bone tumors and tumor-like lesions in plain MRI,dynamic contrast-enhanced MRI（DCE-MRI）and diffusion weighted imaging（DWI） and to explore the clinical diagnosis and differential diagnosis of them.Methods：A total of 61 cases were selected.The first step was MRI plain scan,and then turned to different b-value DWI scan,the DCE MRI scan,and finally conventional contrast-enhanced MRI scan.Results：The shape of the edge and boundary definition between benign and malignant lesions were both of statistical significance（χ2=32.262,45.131,P0.001）.The signal uniformity within lesions and the availability of bone marrow edema around lesions was not different（χ2=0.713,1.915,P0.05）.In the matter of strengthening extent,benign and malignant lesions were different（Z=3.488,P0.001）.TIC types of distribution between benign and malignant bone tumors were different（χ2=15.826,P=0.001）.Ⅰ,Ⅱ-type time-signal intensity curves were defined as malignant diagnostic criteria,and the sensitivity of diagnosis of malignant tumors reached 73.68%,specificity was 69.57%,accuracy was 72.13%,positive predicted value was 80.00%,and negative predicted value was 61.54%.DWI signal between benign and malignant bone tumor was not different（χ2=1.225,P=0.268）.Conclusion：Plain MRI,DCE-MRI and DWI might be helpful for the differentiation of bone tumors and tumor-like lesions.