Tello R, Fenlon H M, Gagliano T, deCarvalho V L, Yucel E K
Department of Radiology, Boston University School of Medicine, Boston Medical Center, 88 E. Newton St., Atrium 2, , MA 02118, USA.
AJR Am J Roentgenol. 2001 Apr;176(4):879-84. doi: 10.2214/ajr.176.4.1760879.
Our aims were to establish factors that are most predictive of hepatic lesion malignancy and to formulate a prediction rule.
A cross-sectional study of 227 abdominal MR imaging examinations revealed 85 lesions in 67 patients (29 men, 38 women; age range, 29-78 years; mean age, 51.4 years) who were being examined for primary malignancy (n = 42) or unknown lesion characterization (n = 25). All were referred for MR imaging after CT or sonography. Patient demographics (age, sex, history of malignancy), lesion size and morphology, quantitative T2 calculation, and pattern of enhancement on gadopentetate dimeglumine administration were evaluated for predictive ability.
Thirty-two liver lesions were malignant (eight colon cancer, five breast cancer, four cervical cancer, three renal cancer, three lung cancer, and nine miscellaneous cancers), 53 were benign (37 hemangiomas, 15 cysts, and one focal nodular hyperplasia). Calculated T2 relaxation times (mean +/- standard deviation [SD]) were as follows: malignant tumors (91.72 +/- 21.9 msec), hemangiomas (136.1 +/- 26.3 msec), cysts (284.1 +/- 38.2 msec) (p < 0.001). Logistic regression analysis indicated that lesion size and sex and age of patient were not significant independent predictors (p > 0.05). However, the combination of a history of malignancy, T2 value, and gadopentetate dimeglumine-enhancement pattern allowed generation of a prediction rule with an area under the receiver operating characteristic curve of 0.95. The patient's weight, lesion morphology, and cell type of the primary malignancy did not provide additional predictive information (p > 0.2).
We recommend using the combination of T2 quantification and patient history of malignancy before deciding to administer gadopentetate dimeglumine for optimal lesion characterization, especially for equivocal lesions with T2 values between 90 and 130 msec. These factors allowed the construction of a prediction rule for lesion characterization.
我们的目标是确定最能预测肝脏病变恶性程度的因素，并制定一个预测规则。
一项对227例腹部磁共振成像检查的横断面研究发现，67例患者（29例男性，38例女性；年龄范围29 - 78岁；平均年龄51.4岁）有85个病变，这些患者正在接受原发性恶性肿瘤检查（n = 42）或不明病变特征检查（n = 25）。所有患者在CT或超声检查后接受磁共振成像检查。评估患者人口统计学特征（年龄、性别、恶性肿瘤病史）、病变大小和形态、定量T2计算以及钆喷酸葡胺给药后的强化模式的预测能力。
三十二个肝脏病变为恶性（八个结肠癌、五个乳腺癌、四个宫颈癌、三个肾癌、三个肺癌和九个其他癌症），五十三个为良性（37个血管瘤、15个囊肿和1个局灶性结节性增生）。计算得到的T2弛豫时间（平均值±标准差[SD]）如下：恶性肿瘤（91.72±21.9毫秒）、血管瘤（136.1±26.3毫秒）、囊肿（284.1±38.2毫秒）（p < 0.001）。逻辑回归分析表明，病变大小、患者性别和年龄不是显著的独立预测因素（p > 0.05）。然而，恶性肿瘤病史、T2值和钆喷酸葡胺强化模式的组合可生成一个预测规则，其受试者操作特征曲线下面积为0.95。患者体重、病变形态和原发性恶性肿瘤的细胞类型未提供额外的预测信息（p > 0.2）。
我们建议在决定使用钆喷酸葡胺进行最佳病变特征描述之前，结合T2定量和患者恶性肿瘤病史，特别是对于T2值在90至130毫秒之间的可疑病变。这些因素有助于构建病变特征描述的预测规则。
