Schaefer Juergen F, Schneider Vincent, Vollmar Joachim, Wehrmann Manfred, Aebert Hermann, Friedel Godehard, Vonthein Reinhard, Schick Fritz, Claussen Claus D
Department of Diagnostic Radiology, Eberhard-Karls-University, Tuebingen, Germany.
Lung Cancer. 2006 Jul;53(1):39-49. doi: 10.1016/j.lungcan.2006.03.010. Epub 2006 May 11.
To estimate the association between signal characteristic of dynamic enhanced MRI using curve types and angiogenesis in solitary pulmonary nodules.
Thirty-six patients with a solitary pulmonary nodule (SPN) ranging in size from 6 to 37 mm (median 17 mm) underwent dynamic contrast enhanced MRI with a time interval of 10 s over a total period of 4 min. Resulting from the time-intensity curves four different enhancement curve profiles (A-D) were defined: type A with strong increase followed by early washout, type B with strong increase without washout, type C with slow increase and type D without relevant increase. Maximum peak (Pmax), slope of the first bolus transit (slope) and washout were calculated. Microvessel densities (MVD) were counted at the margins and at the center of the nodules. The mean MVD of each nodule was calculated. Enhancement characteristics were correlated with MVD grouped by diagnosis and by curve types. Curve types were correlated with the score of vascular endothelial growth factor (VEGF).
The frequency of malignancy was 55% (20/36). Using curve types for differentiation between malignant and benign SPN, the sensitivity, specificity and accuracy were 100%, 75% and 89%, respectively. The correlation between Pmax and MVD(mean) for all nodules was moderate (r(s)=0.4, P=0.02). A relevant correlation was found between Pmax and MVD(margin) in curve type A (r(s)=0.63; P=0.04) and Pmax and MVD(mean) in curve type C (r(s)=0.86; P=0.006). No positive correlation was found between Pmax and MVD (mean, center and margin) in curve type B. No significant correlation was found for slope and washout. VEGF score correlated positively with curve types (r(s)=0.67; P<0.001).
A relevant association between perfusion curve profiles and angiogenesis was found in malignant nodules having early washout and in benign lesion with a slow increase of enhancement. In cases of strong signal increase without washout additional factors for enhancement must be considered. The use of curve profiles could allow for the estimation of the extent of VEGF.
评估利用曲线类型的动态增强磁共振成像（MRI）信号特征与孤立性肺结节血管生成之间的关联。
36例孤立性肺结节（SPN）患者，结节大小为6至37毫米（中位数17毫米），接受动态对比增强MRI检查，时间间隔为10秒，总时长4分钟。根据时间-强度曲线定义了四种不同的增强曲线类型（A-D）：A型为快速增强后早期廓清，B型为快速增强无廓清，C型为缓慢增强，D型为无明显增强。计算最大峰值（Pmax）、首剂通过斜率（斜率）和廓清率。在结节边缘和中心计数微血管密度（MVD）。计算每个结节的平均MVD。根据诊断和曲线类型将增强特征与MVD进行相关性分析。曲线类型与血管内皮生长因子（VEGF）评分进行相关性分析。
恶性病变的发生率为55%（20/36）。利用曲线类型鉴别恶性和良性SPN，敏感性、特异性和准确性分别为100%、75%和89%。所有结节的Pmax与平均MVD之间的相关性中等（r(s)=0.4，P=0.02）。在A型曲线中，Pmax与边缘MVD之间存在显著相关性（r(s)=0.63；P=0.04），在C型曲线中，Pmax与平均MVD之间存在显著相关性（r(s)=0.86；P=0.006）。在B型曲线中，Pmax与平均MVD（中心和边缘）之间未发现正相关。斜率和廓清率未发现显著相关性。VEGF评分与曲线类型呈正相关（r(s)=0.67；P<0.001）。
在早期廓清的恶性结节和增强缓慢的良性病变中，灌注曲线类型与血管生成之间存在显著关联。在快速增强无廓清的情况下，必须考虑其他增强因素。利用曲线类型可评估VEGF的程度。
