Schaefer Juergen F, Vollmar Joachim, Schick Fritz, Vonthein Reinhard, Seemann Marcus D, Aebert Herrmann, Dierkesmann Rainer, Friedel Godehard, Claussen Claus D
Department of Diagnostic Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany.
Radiology. 2004 Aug;232(2):544-53. doi: 10.1148/radiol.2322030515. Epub 2004 Jun 23.
To determine whether dynamic contrast material-enhanced magnetic resonance (MR) imaging with use of kinetic and morphologic parameters reveals statistically significant differences between malignant and benign solitary pulmonary nodules.
Fifty-eight patients met the inclusion criteria of a solitary 5-40-mm pulmonary nodule without calcification or fat at computed tomography. Fifty-one patients were examined successfully; 46 received a histologic diagnosis, and five received a diagnosis by means of observation over 2 years. Dynamic MR images were acquired every 10 seconds for a total of 4 minutes. Diagnostic characteristics for differentiation were examined by using threshold values for maximum peak enhancement, slope of enhancement, and washout. Receiver operating characteristic curves were calculated to test the usefulness of these parameters. The diagnostic performance of a combination of curve profiles and morphologic contrast material distribution were tested by using a decision tree.
Frequency of malignancy was 53% (27 of 51 nodules). Malignant nodules showed stronger enhancement with a higher maximum peak and a faster slope (P <.001). Significant washout (>0.1% increase in signal intensity per second) was found only in malignant lesions (14 of 27 lesions). Sensitivity, specificity, and accuracy were 96%, 88%, and 92%, respectively, for maximum peak; 96%, 75%, and 86% for slope; and 52%, 100%, and 75% for washout. When curve profiles and morphologic enhancement patterns were combined, sensitivity increased to 100%.
Dynamic MR imaging delineates significant kinetic and morphologic differences in vascularity and perfusion between malignant and benign solitary pulmonary nodules. Washout seems to be highly specific for malignancy.
确定使用动力学和形态学参数的动态对比剂增强磁共振（MR）成像是否能揭示恶性和良性孤立性肺结节之间的统计学显著差异。
58例患者符合计算机断层扫描显示有一个5 - 40毫米的孤立性肺结节且无钙化或脂肪的纳入标准。51例患者检查成功；46例获得组织学诊断，5例通过2年的观察获得诊断。每10秒采集一次动态MR图像，共采集4分钟。通过使用最大峰值增强、增强斜率和廓清的阈值来检查鉴别诊断特征。计算受试者操作特征曲线以测试这些参数的有效性。通过决策树测试曲线轮廓和形态学对比剂分布组合的诊断性能。
恶性率为53%（51个结节中的27个）。恶性结节显示出更强的增强，具有更高的最大峰值和更快的斜率（P <.001）。仅在恶性病变中发现显著廓清（每秒信号强度增加>0.1%）（27个病变中的14个）。最大峰值的敏感性、特异性和准确性分别为96%、88%和92%；斜率分别为96%、75%和86%；廓清分别为52%、100%和75%。当曲线轮廓和形态学增强模式相结合时，敏感性提高到100%。
动态MR成像显示恶性和良性孤立性肺结节在血管生成和灌注方面存在显著的动力学和形态学差异。廓清似乎对恶性肿瘤具有高度特异性。
