【作者】 曹金凤；

【导师】 林祥涛；

【作者基本信息】 山东大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的探讨弥散加权成像及磁共振动态对比增强在鉴别肌骨系统良、恶性病变中的应用价值。材料和方法1.选取有完整MRI资料且经病理证实的肌骨病变患者62例(良性29例,恶性33例),62例均行常规MRI和DWI检查,其中47例(良性22例,恶性25例)行DCE-MRI检查,将全部病例按病理结果分为良性病变组和恶性病变组。2.采用Siemens Sonata 1.5T超导MR成像仪,应用单激发回波平面成像序列(SH-EPI)行DWI检查,应用三维快速梯度回波T1加权磁共振成像序列(3D-VIBE)行DCE-MRI检查,分别于DWI和DCE-MRI图像上测量ADC值、SEE、Slope值、DER,判断TIC类型,采用受试者操作特征(ROC)曲线选择良恶性病变鉴别诊断的阈值,计算各参数对病变潜在恶性估计的敏感度、特异度和准确度。统计学分析均使用统计软件SPSS 17.0完成。结果1.良、恶性两组病变的ADC值结果对比62例病例中,良、恶性两组病变的ADC值分别为(179.95±21.21)×10-5mm2／s和(112.48±16.08)×10-5mm2／s(p<0.05)；利用ROC曲线得出,以115.43×10-5mm2／s为阈值,ADC值对病变潜在恶性评估的敏感度、特异度、准确度分别为69.7%、93.1%和80.65%。2.良、恶性两组病变的TIC类型结果对比47例病例中,TIC类型呈Ⅲ型者25例：恶性24例(96%),良性1例(4%)；呈Ⅱ型者15例：恶性1例(6.67%),良性14例(93.33%)；呈Ⅰ型者共7例,均为良性。若以Ⅲ型为恶性病变,Ⅰ、Ⅱ型均视为良性病变为诊断标准,则TIC类型对病变潜在恶性评估的敏感度、特异度、准确度分别为96%、95.45%、95.74%。3.良、恶性两组间SEE、Slope值、DER结果对比良、恶性两组间SEE、Slope值、DER分别为194.70±23.58、327.3±24.21(p<0.05)；1.1469±0.1678%／s、3.0501±0.6069%／s(p<0.05)；0.1636±0.03970、0.2244±0.0362(p>0.05)。利用ROC曲线得出,以227.7为阈值,SEE对病变潜在恶性评估的敏感度、特异度、准确度分别为80%、70%、75.56%；以1.2923%／s为阈值,Slope值诊断恶性病变的敏感度、特异度、准确度分别为96.0%、72.7%、85.11%。结论1.DWI在肌骨系统病变良恶性鉴别诊断中有一定的价值。2.DCE-MRI各参数中,DER在良、恶性两组间比较无统计学意义；SEE、Slope值及TIC类型中,TIC类型对肌骨病变潜在恶性评估准确度最高,最有价值。3.本研究中,DCE-MRI对肌骨系统病变良、恶性的鉴别诊断价值较DWI高。4.良、恶性病变间ADC值有一定交叉,DCE-MRI亦存在小部分重叠,联合应用DCE-MRI与DWI,能提高诊断的准确度和特异度。更多还原

【Abstract】 The Application of DWI and DCE-MRI in Differentiating Benign Musculoskeletal Masses from Malignant OnesObjective To assess the diagnostic potential of DWI and DCE-MRI in differentiating benign from malignant musculoskeletal masses.Methods1.62 patients with musculoskeletal diseases (29 cases of benign and 33 cases of malignant) were selected, which have complete MRI data. Routine MR examination and DWI was performed on 62 patients and DCE-MRI was performed on 47 patients (22 cases of benign and 25 cases of malignant) using Siemens Sonata 1.5T MR scanner. All the patients were divided into benign and malignant groups by pathology.2. ADC value is measured on DWI and SEE, Slope value, DER and TIC type were gained on DCE-MRI. Receiver operating characteristic (ROC) curve was used to select the threshold to calculate the sensitivity, specificity and accuracy. Statistical analyses were completed by using SPSS 17.0.Results1. In 62 Cases, the ADC values of two groups were (179.95±21.21)×10-5mm2/s, (112.48±16.08)×10-5mm2/s (p<0.05).Using 115.43×10-5mm2/s as the threshold, the diagnostic sensitivity, specificity, and accuracy were 69.7%,93.1%,80.65%, respectively.2. In 47 patients,Ⅲcurve was found in 25 cases(malignant for 24 and benign for 1),Ⅱcurve in 15 cases(malignant for 1 and benign for 14) andⅠcurve in 7 cases(all were benign). AsⅢcurve was considered malignant andⅠ,Ⅱcurve were regarded as benign, the diagnostic accuracy of TIC type was 95.74%.3. SEE, Slope value and DER in benign and malignant group were 194.70±23.58,327.3±24.21(p<0.05);1.1469±0.1678%/s,3.0501±0.6069%/s(p<0.05); 0.1636±0.03970,0.2244±0.0362(p>0.05), respectively. Using 227.7 as the threshold, the diagnostic sensitivity, specificity, and accuracy of SEE were 80%,70%,75.56%. And the diagnostic sensitivity, specificity, and accuracy of Slope value were 96.0%, 72.7%,85.11% using 1.2923%/s as the threshold.Conclusion1. DWI is valuable in the differential diagnosis of benign and malignant musculoskeletal lesions.2. In all the parameters of DCE-MRI, DER was not valuable in differentiating benign and malignant musculoskeletal lesions. SEE, Slope value and type in the TIC to TIC types was the most valuable parameter in DCE-MRI.3. In general, DCE-MRI was more valuable than DWI in differentiating benign from malignant musculoskeletal masses.4. To highly suspicious musculoskeletal lesions, DCE-MRI combining with DWI lead to higher diagnostic accuracy.更多还原