摘要
目的研究肺癌动态对比增强MRI特点,初步探讨动态增强磁共振成像(DCEMRI)定量参数及半定量时间一信号强度(TIC)曲线鉴别肺癌不同病理类型的价值。资料与方法前瞻性选取经手术病理证实为肺癌的33例患者,均行常规MRI T1WI、T2WI平扫及DCE-MRI检查,计算K^(trans),V_e、K_(ep)值,分析DCE-MRI TIC曲线类型。采用受试者操作特征曲线计算曲线下面积(AUC),分析不同定量参数对肺小细胞癌与非小细胞癌的诊断效能,确定最佳诊断阈值。结果①33例患者中,腺癌18例,鳞癌8例,小细胞癌7例;中央型12例,周围型21例;肿瘤大小为1.3~6.6 cm,平均(3.6±1.3)cm;病灶呈不规则形、分叶状或斑片状12例,结节状6例,肿块型15例;边界不清26例,边界相对较清7例。②腺癌14例TIC曲线呈流出型,平台型3例,流入型1例;8例鳞癌TIC曲线均呈流出型;小细胞癌5例TIC曲线呈流出型,2例呈平台型。③不同病理类型肺癌K^(trans),K_(ep),V_e值比较差异有统计学意义(P<0.05);腺癌K^(trans),K_(ep)、V_e值均高于鳞癌与小细胞癌(P<0.05);非小细胞癌K^(trans)、K_(ep)、V_e值均高于小细胞癌(P<0.05、P<0.01)。④K^(trans)、K_(ep)、V_e值对诊断小细胞与非小细胞肺癌具有中等诊断效能,其AUC分别为0.821、0.772、0.830,当K^(trans)、K_(ep)、V_e值分别设为0.082/min、0.388/min、0.253时,其诊断敏感度与特异度分别为73.1%、69.2%、69.2%和85.7%、84.3%、100.0%。结论DCE-MRI定量参数能较准确、无创地诊断不同病理类型肺癌,为临床治疗方案选择提供一定的帮助。
Purpose To investigate the imaging features of lung carcinomas using dynamic contrast enhanced MRI(DCE-MRI),and to explore the quantitative parameters and the characteristics of time intensity curve(TIC) types in differentiating histopathological subtypes in lung carcinomas.Materials and Methods Thirty-three patients with different subtypes of lung carcinomas were selected.All patients received MRI and DCE-MRI examinations.The K^trans Ve and Kep values were calculated.The curve types of TIC were analyzed.The area under the curve(AUC) was computed using the receiver operating characteristic(ROC) curve,and the differential diagnostic efficacies of K^trans,Kep,Ve values on small cell lung carcinomas and non-small carcinomas were analyzed.The optimal diagnostic threshold was determined.Results ① There were 18 cases of adenocarcinoma,8 squamous cell carcinomas,and 7 cases of small cell lung carcinomas,of which 12 were centrally located,21 were peripherally located.The tumor size was 1.3-6.6 cm.The tumor was irregular,lobulated or patchy in 12 cases,nodular in 6 cases,and masslike in 15 cases.In 26 cases the boundary was not circumscribed.② The types of TIC included washout curve in 14 cases of adenocarcinomas,plateau in 3 cases and wash-in in 1 case.The TIC in squamous cell carcinomas was washout curve in all 8 patients.The TIC curve in the 5 cases of small cell carcinomas was washout type,and plateau type in 2 cases.③ The K^trans,Kep,and Ve values of the different pathological types of lung carcinomas were significantly different(P〈0.05);the K^trans,Kep,Ve values of adenocarcinomas were higher than squamous cell carcinomas and small cell carcinomas(P〈0.05);the K^trans,Kep,Ve values of non-small cell carcinomas were higher than small cell carcinomas(P〈0.05,P〈0.01).④The K^trans,Kep,Ve values had better differential diagnosis accuracy to differentiate small cell lung carcinomas and non-small cell carcinomas,with AUC values of 0.821,0.772 and 0.830,respectively.When the threshold of K^trans,Kep,Ve values were 0.082/min,0.388/min and0.253,the sensitivity and specificity were 73.1%,69.2%,69.2%and 85.7%,84.3%,100.0%,respectively.Conclusion The quantitative parameters on DCE-MRI can accurately diagnose different type of lung carcinomas to help selecting treatments.
出处
《中国医学影像学杂志》
CSCD
北大核心
2016年第2期100-105,共6页
Chinese Journal of Medical Imaging
基金
福建省卫生系统中青年骨干人才培养项目(2013-ZQN-JC-5)
关键词
肺肿瘤
磁共振成像
图像增强
病理学
外科
Lung neoplasms
Magnetic resonance imaging
Image enhancement
Pathology
surgical