Qi Zi-hua, Li Chuan-fu, Ma Xiang-xing, Yang Hui, Jiang Bao-dong, Zhang Kai, Yu De-xin
Department of Radiology, Shandong University, Jinan,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2012 Apr;34(2):138-45. doi: 10.3881/j.issn.1000-503X.2012.02.008.
To evaluate the value of magnetic resonance dynamic contrast-enhanced (MR-DCE) and magnetic resonance diffusion-weighted imaging (MR-DWI) in the differentiation of benign and malignant musculoskeletal tumors.
Sixty-three patients with pathologically confirmed musculoskeletal tumors were examined with MR-DCE and MR-DWI. Using single shot spin echo planar imaging sequence and different b values of 400, 600, 800 and 1000 s/mm(2), we obtained the apparent diffusion coefficient (ADC) of the lesions. ADC values were measured before and after MR-DCE, with a b value of 600 s/mm(2). The 3D fast acquired multiple phase enhanced fast spoiled gradient recalled echo sequence was obtained for multi-slice of the entire lesion. The time-signal intensity curve (TIC), dynamic contrast-enhanced parameters, maximum slope of increase (MSI), positive enhancement integral, signal enhancement ratio, and time to peak (T(peak)) were also recorded.
ADC showed no significant difference between benign and malignant tumors when the b value was 400, 600, 800, or 1000 s/mm(2), and it was not significantly different between benign and malignant tumors in both pre-MR-DCE and post-MR-DCE with b value of 600 s/mm(2). TIC were classified into four types type1 showed rapid progression and gradual drainage; type2 showed rapid progression but had no or slight progression; type 3 showed gradual progression; and type 4 had no or slight progression. Most lesions of type1 or type2 were malignant, whereas most lesions of type 3 or type 4 were benign. When using type1 and type 2 as the standards of malignancy, the diagnostic sensitivity and specificity was 87.23% and 50.00%, respectively. The types of TIC showed significant difference between benign and malignant musculoskeletal tumors(χ(2)=17.009,P=0.001). When using MSI 366.62 ± 174.84 as the standard of malignancy, the diagnostic sensitivity and specificity was 86.78% and 78.67%, respectively. When using T(peak)≤70s as the standard of malignancy, the diagnostic sensitivity and specificity was 82.89%and 85.78%, respectively. Positive enhancement integral and signal enhancement ratio showed no significant difference between benign and malignant musculoskeletal tumors.
TIC, MSI and T(peak) of MR-DCE are valuable in differentiating benign from malignant musculoskeletal tumors. T(peak) has the highest diagnostic specificity, and TIC has the highest diagnostic sensitivity. The mean ADC value are no significant difference between benign and malignant tumors.
评估磁共振动态对比增强成像（MR-DCE）及磁共振扩散加权成像（MR-DWI）在鉴别骨骼肌肉系统良恶性肿瘤中的价值。
对63例经病理证实的骨骼肌肉系统肿瘤患者进行MR-DCE及MR-DWI检查。采用单次激发自旋回波平面成像序列，设置400、600、800和1000 s/mm(2) 不同的b值，测量病变的表观扩散系数（ADC）。在MR-DCE检查前后，b值为600 s/mm(2) 时测量ADC值。对整个病变进行多层面三维快速采集多期增强快速扰相梯度回波序列扫描。记录时间-信号强度曲线（TIC）、动态对比增强参数、最大上升斜率（MSI）、正性增强积分、信号增强率及达峰时间（T(peak)）。
当b值为400、600、800或1000 s/mm(2) 时，良性和恶性肿瘤的ADC值无显著差异；在b值为600 s/mm(2) 的MR-DCE检查前后，良性和恶性肿瘤的ADC值也无显著差异。TIC分为四种类型：1型表现为快速强化并逐渐廓清；2型表现为快速强化但无强化或仅有轻微强化；3型表现为逐渐强化；4型无强化或仅有轻微强化。大多数1型或2型病变为恶性，而大多数3型或4型病变为良性。以1型和2型作为恶性标准时，诊断敏感性和特异性分别为87.23%和50.00%。TIC类型在骨骼肌肉系统良恶性肿瘤之间存在显著差异（χ(2)=17.009，P=0.001）。以MSI 366.62±174.84作为恶性标准时，诊断敏感性和特异性分别为86.78%和78.67%。以T(peak)≤70s作为恶性标准时，诊断敏感性和特异性分别为82.89%和85.78%。正性增强积分和信号增强率在骨骼肌肉系统良恶性肿瘤之间无显著差异。
MR-DCE的TIC、MSI及T(peak) 在鉴别骨骼肌肉系统良恶性肿瘤方面具有重要价值。T(peak) 具有最高的诊断特异性，TIC具有最高的诊断敏感性。良性和恶性肿瘤的平均ADC值无显著差异。
