磁共振动态增强扫描定量分析方法评价肺部肿块良恶性初步研究

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摘要目的：探讨动态增强磁共振（DCE-MRI）扫描定量参数测定对鉴别肺部肿块良恶性的可行性。方法：77例肺部肿块患者行3.0T MR动态增强扫描，并经手术或穿刺活检病理证实，测量定量参数：容量转移常数（Ktrans）、速率常数（Kep）和血管外细胞外间隙容积比（ve），分别对良性病变、恶性病变定量参数值进行统计学分析；最后绘制ROC曲线。结果：恶性病变组：低分化腺癌Ktrans、Kep、ve均值分别为（0.270±0.089） min-1、（0.926±0.475） min-1、0.340±0.144，低分化鳞癌分别为（0.268±0.066） min-1、（0.997±0.464） min-1、0.293±0.091，小细胞癌均值为（0.238±0.074） min-1、（0.617±0.369） min-1、0.412±0.312；良性病变组Ktrans、Kep、ve均值分别为（0.190±0.084） min-1、（0.569±0271） min-1、0.392±0.207。良、组行独立样本t检验，Ktrans、Kep值均有统计学差异（P值均<0.05），ve值无统计学差异（P值＞0.05），良性病灶组分别与低分化腺癌、低分化鳞癌组行成组设计方差分析， Ktrans及Kep差异均有统计学意义（P值均＜0.05），ve均无统计学差异（P值均＞0.05）；低分化腺癌与低分化鳞癌Ktrans、Kep、ve差异均无统计学意义（P值均＞0.05）。良性病灶组及恶性病灶组ROC曲线下面积分别为0.741、0.715，敏感性分别为88.4％、39.5％；特异性分别为54.2％、95.8％。结论：DCE-MRI定量参数Ktrans、Kep值鉴别诊断肺部肿块具有可行性，有助于对肺癌及肺部良性病灶进行鉴别。

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	史昭菲
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关键词 ：肺肿瘤, 活组织检查, 针吸, 磁共振成像

Abstract：Objective: To investigate the feasibility of quantitative analysis parameters of dynamic contrast-enhanced MRI (DCE-MRI) in diagnosis of lung neoplasms and assess the differences of quantitative MR pharmacokinetic parameters volume transfer constant(Ktrans), exchange rate constant(Kep) and extravascular extracellular volume fraction(ve) in lung neoplasms. Methods: Three Tesla MR examinations were performed in 77 patients confirmed by biopsy and the quantitative MR pharmaeokinetic parameters including Ktrans, Kep and ve were obtained. Independent two sample t test was used between benign and malignant lung lesions. Finally, the areas under the ROC curve(AUC) of Ktrans, Kep and ve between malignant and benign lesions were compared. Results: The mean Ktrans, Kep and ve of poorly differentiated adenocarcinoma(n=26) were(0.270±0.089) min-1, (0.926±0.475) min-1 and (0.340±0.144). The mean Ktrans, Kep and ve of poorly differentiated squamous cell carcinoma(n=13) were (0.268±0.066) min-1, (0.997±0.464) min-1 and (0.293±0.091). The mean Ktrans, Kep and ve of small-cell lung cancer were (0.238±0.074) min-1, (0.617±0.369) min-1 and (0.412±0.312). The mean Ktrans, Kep and ve of benign lesions(n=24) were (0.190±0.084) min-1, (0.569±0.271) min-1 and (0.392±0.207). There was significant difference between malignant and benign lesions in either Ktrans or Kep(t=3.697, 3.883, respectively, P<0.05). There was no significant difference between malignant and benign lesions in ve(t=1.341, P＞0.05). Ktrans and Kep values of benign lesions were significantly lower than those of squamous cell carcinoma and adenocarcinoma(both P＜0.05). No significant difference was observed between squamous cell carcinoma and adenocarcinoma in Ktrans or Kep(both P＞0.05). The AUCs of Ktrans and Kep between malignant and benign lesions were 0.741 and 0.715. The sensitivity of Ktrans and Kep were 88.4％ and 39.5％, and the specificity of Ktrans and Kep were 54.2％ and 95.8％. Conclusion: The differential diagnosis of benign and malignant lung lesions by Ktrans and Kep is applicable.

Key words： Lung neoplasms Biopsy, needle Magnetic resonance imaging

收稿日期: 2017-02-08

PACS:	Ｒ734.2
	Ｒ445.2

通讯作者: 柏根基，南京医科大学附属淮安第一医院，223300。E-mail：hybgj0451@163.com

作者简介: 史昭菲（1987-），女，江苏泗阳人，住院医师。E-mail：18262639853@163.com

引用本文:

史昭菲，刘绪忠，柏根基. 磁共振动态增强扫描定量分析方法评价肺部肿块良恶性初步研究[J]. 中国临床医学影像杂志, 2017, 28(7): 475-479.
SHI Zhao-fei, LIU Xu-zhong, BO Gen-ji. A preliminary study of diagnosing lung neoplasms with quantitative analysis of DCE-MRI. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(7): 475-479.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I7/475

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