复发性内翻性乳头状瘤：采用药代动力学动态钆增强磁共振成像进行诊断

Recurrent inverted papilloma: diagnosis with pharmacokinetic dynamic gadolinium-enhanced MR imaging.

作者信息

Lai P H, Yang C F, Pan H B, Wu M T, Chu S T, Ger L P, Huang W C, Hsu C C, Lee C N

机构信息

Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang-Ming College, Taiwan, ROC, USA.

出版信息

AJNR Am J Neuroradiol. 1999 Sep;20(8):1445-51.

PMID:10512227

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7657741/

Abstract

BACKGROUND AND PURPOSE

Dynamic gadolinium-enhanced MR imaging has been used successfully to identify post-treatment recurrence or postoperative changes in rectal and cervical carcinoma. Our purpose was to evaluate the usefulness of dynamic gadolinium-enhanced MR imaging for distinguishing recurrent inverted papilloma (IP) from postoperative changes.

METHODS

Fifteen patients with 20 pathologically proved lesions (recurrent IP, 12; fibrosis or granulation tissue, eight) were enrolled in the study. Three observers, blinded to pathologic results, independently evaluated conventional MR images, including T1-weighted (unenhanced and postcontrast), proton-density-weighted, and T2-weighted spin-echo images. Results then were determined by consensus. Dynamic images were obtained using fast spin-echo sequences at 5, 30, 60, 90, 120, 150, 180, and 300 seconds after the injection of gadolinium-diethylene-triamine penta-acetic acid. Time-signal intensity curves of suspected lesions were analyzed by a pharmacokinetic model. The calculated amplitude and tissue distribution time were used to characterize tissue, and their values were displayed as a color-coded overlay.

RESULTS

T2-weighted images yielded a sensitivity of 67%, a specificity of 75%, and an accuracy of 70% in the diagnosis of recurrent IP. Contrast-enhanced T1-weighted images yielded a sensitivity of 75%, a specificity of 50%, and an accuracy of 65%. Pharmacokinetic analysis showed that recurrent IP had faster (distribution time, 41 versus 88 seconds) and higher (amplitude, 2.4 versus 1.2 arbitrary units) enhancement than did fibrosis or granulation tissue. A cut-off of 65 seconds for distribution time and 1.6 units for amplitude yielded a sensitivity of 100% and a specificity of 100% for diagnosing recurrent IP.

CONCLUSION

Dynamic MR imaging can differentiate accurately recurrent IP from postoperative changes and seems to be a valuable diagnostic tool.

摘要

背景与目的

动态钆增强磁共振成像已成功用于识别直肠癌和宫颈癌治疗后的复发或术后改变。我们的目的是评估动态钆增强磁共振成像在鉴别复发性内翻性乳头状瘤（IP）与术后改变方面的效用。

方法

15例患者共20个经病理证实的病变（复发性IP 12个；纤维化或肉芽组织8个）纳入本研究。3名对病理结果不知情的观察者独立评估常规磁共振图像，包括T1加权（平扫及增强后）、质子密度加权和T2加权自旋回波图像。然后通过共识确定结果。在注射钆喷酸葡胺后5、30、60、90、120、150、180和300秒，使用快速自旋回波序列获取动态图像。通过药代动力学模型分析可疑病变的时间-信号强度曲线。计算得出的幅度和组织分布时间用于表征组织，其值以彩色编码叠加显示。

结果

T2加权图像诊断复发性IP的敏感性为67%，特异性为75%，准确性为70%。对比增强T1加权图像的敏感性为75%，特异性为50%，准确性为65%。药代动力学分析显示，复发性IP的强化比纤维化或肉芽组织更快（分布时间，41秒对88秒）且更高（幅度，2.4对1.2任意单位）。分布时间截断值为65秒、幅度截断值为1.6单位时，诊断复发性IP的敏感性和特异性均为100%。