定量DCE-MRI在肺部良恶性病变诊断中的初步应用

DCE-MRIPilot Study in the Diagnosis of Benign and Malignant Lung Lessions

目的:探讨及评价定量动态对比增强磁共振成像(qDCE-MRI)的药物代谢动力学参数在肺部良恶性病变诊断中的价值。方法:回顾性分析40例经病理学证实肺部占位性病变,行1.5T DCE-MRI检查,行血管参照模型和参考区域模型对比分析恶性、良性病变非参检验的定量参数。结果:在血管参照模型:良性病变组与恶性病变组间Ktrans、Kep、Ve、VP参数间无统计学差异,P>0.05。参考区域模型良性病变组与恶性病变组间RRKtrans、KepRR、KepTOI参数差异具有统计学意义(P<0.05);恶性病变组RRKtrans、KepRR、KepTOI高于良性病变组;TTP值在良性病变组中略高于恶性病变组,无显著性差异(P=0.94)。肺腺癌与肺鳞癌定量参数比较,鳞癌RRKtrans、KepRR、KepTOI较腺癌高,但无显著性差异。以病理结果为金标准绘制RRKtrans、KepRR、KepTOI三者ROC得到曲线下面积分别为0.946、0.827、0.855;三者最大约登指数为0.86、0.83、0.67;RRKtrans、kepRR、kepTOI判断肺部良恶性病变敏感度为96%、90%,73%,特异度为80%,76%、90%。定量参数与免疫组化相关性分析得出RRKtrans、KepRR、KepTOI值与MVD呈正相关性(P<0.01,r=0.872,0.838,0.714);与MVD表达亦呈正相关性(P<0.01,r=0.821,0.752,0.711)。结论:参考区域模型对肺部占位性病变良恶性作出鉴别诊断具有潜在的临床意义,DCEMRI定量参数可以预测标本MVD、VEGF水平。

Objective：To preliminarily explore and estimate pharmacokinetic parameters from quantitative dynamic contrast enhancement MRI（DCE-MRI）values in differentiating diagnosis between the benign and malignant lung mass based on region reference model and extended tofts linear model.Methods：We retrospectively analyzed 40 patients with lung neoplasia,who were all pathologically confirmed and underwent 1.5Tquantitative dynamic contrast-enhanced MR imaging.The extended tofts linear model and the reference region model were applied for the non-parametric test and obtaining quantitative parameters,respectively.Results：The parameters of the reference region model such as RRKtrans,KepRR,and KepTOI were significantly different（P〈0.05）between benign and malignant lesions,while those of the extended tofts linear model such as Ktrans,Kep,Ve,and Vpwere found no differences（P〉0.05）.RRKtrans,KepRR,and KepTOI werehigher in malignant group than that in the benign group.In contrast,TTP appeared slightly lower in the benign group than that in the malignant group,but showed no statistical significance（P=0.94）.The parameters of squamous cell lung cancer such as RRKtrans,KepRR,KepTOI were high comparing to adenocarcinoma,but were not statistically significant.Using pathological results as gold standard,ROC curves of RRKtrans,KepRR,and KepTOI were drawn,and areas under the curve were 0.946,0.827,and 0.855,respectively.Gordon＇s index was calculated according to ROC curve,and the sensitivity and specificity of RRKtrans,KepRR,KepTOI were determined to distinguish the benign and malignant lung neoplasms.Additionally,RRKtrans,KepRR,and KepTOI were positively correlated with MVD,rather than VEGF.Conclusion：The reference region model has the potential to distinguish benign and malignant lung neoplasms.The quantitative parameters of DCE-MRI can predict the level of VEGF and MVD.