DCE-MRI与DWl单用和联合应用诊断肌骨系统良恶性病变的特异性与准确度

Differential diagnosis value of DCE-MRI combined with dwi in musculoskeletal system benign and malignant lesions

目的探讨磁共振动态对比增强(DCE-MR)和弥散加权成像(DWI)诊断肌骨系统良恶性病变的特异性与准确度。方法选取经病理确诊的肌骨肿瘤患者80例,依照确诊结果分为恶性组35例和良性组45例。采用DCEMR和DWI分别对患者的ADC、时间-信号强度曲线(TIC)等参数进行分析,对比两种方法联用及单独使用对肌骨系统良恶性病变诊断的特异性、敏感度及准确度。结果恶性组的ADC值、SEE值及Slope均显著高于良性组,差异具有统计学意义(P<0.05)。通过ROC曲线绘制得出ADC最佳诊断阈值为115.43×10-5 m2·s-1。两组间DER值差异不具有统计学意义(P>0.05)。恶性组中TIC曲线类型III型为主,占总比例的89.1%;良性病变组中TIC曲线I型为主,占总比例的57.7%,两组TIC曲线类型差异具有统计学意义(P<0.05)。DCE-MRI检测敏感度、特异度及准确度分别为87.09%,84.77%,89.02%;DWI检测敏感度、特异度及准确度分别为78.65%,85.01%,81.68%;两者联合检测的敏感度、特异度及准确度均高于单用检测结果,分别为91.33%,94.22%,90.18%。结论采用DCE-MRI以及DWI进行肌骨系统良恶性病变的诊断与检查具有鉴别价值,联合使用可以提高诊断敏感度、特异性及准确度。

Objective To explore the differential diagnosis value of DCE-MRI combined with DWI in musculoskel- etal system benign and malignant lesions. Methods 80 museuloskeletal tumor patients pathologically confirmed were in- volved in this study. They were divided into benign group （n=35） and malignant group （n=45）. All the patients were performed conventional DCE-MRI ,DWI examination, respectively. We analyzed the data of patients＇ ADC TIC and com- pared the diagnostic specificity, sensitivity and accuracy. Results The ADC figure, SEE figure and Slope in malignant group were apparently higher than those in benign group （P〈0.05）. The best diagnostic threshold of ADC was 115.43 ×10^-5m^2· s^-1 in ROC curve. The DER differences in malignant and benign group were without statistical value （P〉 0.05）. As for TJC curre, patients in malignant group were mostly Ⅲ type （89.1%）, while patients in benign group were mainly Ⅰ type curve（57.7%） （P〈0.05）. The sensitivity, specific degrees and accuracy in DCE-MRI were respec- tively 87.09%, 84.77% and 89.02%. The sensitivity,specific degrees and accuracy in DWI were 78.65%, 85.01% and 81.68%. Disimilarly,the sensitivity, specific degrees and accuracy combined DCE MRI with DWI were respectively 91. 33 %, 94.22 % and 90.18%. Conclusion There is high identification value of DCE-MRI and DWI in the examination and diagnosis of musculoskefatal system of benign and malignant lesions. Therefore, combining diagnosis can improve the specificity and accuracy degree of diagnosis.