动态增强MRI在判断眼眶恶性肿瘤对骨质及眼外肌侵犯中的应用研究

The value of dynamic contrast-enhanced MRI in estimating adjacent bones' and extraocular muscles' involvement of orbital malignant neoplasm

目的探讨动态增强MRI在判断眼眶恶性肿瘤对周围结构累及情况中的作用。方法回顾分析2010年12月—2014年5月间就诊的17例眶内恶性肿瘤病人资料,所有病人诊断以及骨质、眼外肌受累与否均经临床病理证实。17例病人术前均行常规MRI及DCE-MRI检查。采用影像后处理软件分别得到肿瘤、相邻骨质、眼外肌的时间-信号强度曲线(TIC)和定量参数值。以临床病理诊断结果为标准,分析肿瘤、相邻受累结构、水肿结构曲线类型及定量参数值的特点。3组间比较采用Kruskal-Wallis检验,两组间比较采用Mann-Whitney检验。采用Pearson相关分析受累骨质、受累眼外肌与肿瘤定量参数值间的相关性,Spearman相关分析水肿骨髓、水肿眼外肌与肿瘤各定量参数值间的相关性。结果肿瘤周围结构DCE-MRI强化特点:1受累结构与肿瘤TIC类型高度一致;Ⅲ型曲线仅见于相邻受累结构。2受累骨质的Ktrans、ve、i AUC与肿瘤相应参数呈正相关,r=0.849、0.790、0.641(P<0.05);肿瘤各定量参数均大于水肿骨髓(P<0.05),两者参数无相关性(P>0.05)。3受累眼外肌Ktrans、i AUC值与肿瘤相应参数间具有相关性,r=0.830、0.692(P<0.05);肿瘤的Ktrans、i AUC值均大于水肿眼外肌(P<0.05),各参数间无相关性(P>0.05)。结论 DCE-MRI可作为常规MRI的重要补充,明确眼眶恶性肿瘤累及范围。

Objective To evaluate characteristics of surrounding bone, extraocular muscles of orbital malignant neoplasm using dynamic contrast-enhanced MRI （DEC-MRI）. Methods The pattern of time-intensity curve （TIC） and quantitative parameters （Ktrans, ve, and iAUC） of DCE-MRI for 17 cases were studied retrospectively. All of the cases were diagnozed pathologically between Dec. 2010 and May 2014. Differences in quantitative parameters among orbital malignant neoplasm, surrounding involved structures and edematous structures were analyzed using Kruskal-Wallis test and Mann-Whitney U test. Pearson and Spearman correlation coefficient were calculated to evaluate the correlation between parameters of involved structures and neoplasm, and between edematous structures and neoplasm, retrospectively. Results ① High consistency in TIC were detected between involved structures and orbital malignant neoplasm. TIC of type-Ⅲwas a sign of involvement.②Correlation coefficients of Ktrans, ve, and iAUC between involved bones and neoplasm were 0.849, 0.790, and 0.641, respectively （P〈0.05）. Values of Ktrans, ve, and iAUC of bone edema were significantly smaller than the values of the neoplasm （P〈0.05）, without correlations between them （P〉0.05）.③Correlation coefficients of Ktrans and iAUC between involved extraocular muscles were 0.830 and 0.692, respectively （P〈0.05）. Values of Ktrans and iAUC of edematous muscles were significantly smaller than the values of the neoplasm （P〈0.05）, without correlations between them （P〉0.05）. Conclusion DCE-MRI could be helpful in the diagnosis of structures’ involvement and is an important complement of conventional MRI.