动态增强MRI对脊柱良恶性病变的鉴别诊断价值

Dynamic Contrast-enhanced MRI in Differentiation of Benign and Malignant Lesions in Spine

目的探讨早期动态增强MRI(DCE-MRI)对脊柱良恶性病变的鉴别诊断价值。资料与方法收集2008年6月—2010年10月于北京大学第三医院放射科进行检查的脊柱病变患者66例。所有患者均行早期DCE-MRI扫描,并对其信号强度-时间曲线的形态、信号强度增加值、信号强度增幅、最大上升线性斜率、达峰时间进行分析。结果Ⅰ型(速升-速降型)曲线的患者18例,恶性病变为100%,Ⅱ型(速升-平坦型)曲线患者18例,恶性病变率为38.3%。两组间比较差异有统计学意义(P<0.01);良性病变的曲线上升期信号增加值为248.80±105.02,低于恶性病变增加值为390.16±177.55,差异有统计学意义(t=-4.027,P<0.01);良性病变的信号强度增幅为1.48±0.62,低于恶性病变增幅1.97±1.04,差异有统计学意义(t=-2.198,P<0.05);良性病变的信号强度-时间曲线最大上升线性斜率为10.14±5.15,低于恶性病变斜率18.60±9.99,差异有统计学意义(t=-4.451,P<0.01);良性病变达峰时间(39.69±28.24)s,高于恶性病变达峰时间(28.57±9.40)s,差异有统计学意义(t=2.988,P<0.01)。结论早期DCE-MRI对脊柱良恶性病变具有一定的鉴别诊断价值,为表现不典型且MRI检查未能鉴别的良恶性病变提供一定的参考价值。

Purpose To investigate the value of early dynamic contrast enhanced MRI in differential diagnosis between benign and malignant lesions in spine. Materials and Methods Sixty-six patients with benign or malignant spinal lesions underwent dynamic contrast enhanced MR scan at Department of Radiology, Peking University Third Hospital from June 2008 to October 2010. Type of signal intensity-time（SI-T） curves, signal increase and signal increase percentum in ascending phase, maximum slope of SI-T curves and time to peak were statistically compared between benign and malignant lesions. Results All lesions with type Ⅰ SI-T curves were malignant; 38.3% lesions with type Ⅱ curves were malignant. There were obvious statistical difference in malignancy rate between lesions with type Ⅰ and type Ⅱ SI-T curves（P0.01）. The average value of signal increase of benign lesions in first pass period was significantly lower than that of malignant lesions（248.80±105.02 vs. 390.16±177.55, respectively, t=-4.027, P0.01）. The amplitude of signal increase of benign lesions was significantly lower than that of malignant lesion（1.48±0.62 vs. 1.97±1.04, respectively, t=-2.198, P0.05）; the average value of maximal slope of SI-T curves of benign lesions was significantly lower than that of malignant lesions（10.14±5.15 vs. 18.60±9.99, respectively, t=- 4.451, P0.01）. The average value of time to peak of benign lesions was significantly higher than that of malignant lesions [（39.69±28.24） s vs.（28.57±9.40） s, respectively, t=2.988, P0.01]. Conclusion Early dynamic contrast enhanced MRI is valuable in differential diagnosis between benign and malignant lesions in spine, especially when the manifestation is atypical or the differential diagnosis can not be made by routine MRI scan.