轴向骨骼中脊索瘤和巨细胞瘤鉴别诊断的形态学及动态对比增强磁共振成像特征
Morphological and dynamic contrast enhanced MR imaging features for the differentiation of chordoma and giant cell tumors in the Axial Skeleton.
作者信息
Lang Ning, Su Min-Ying, Xing Xiaoying, Yu Hon J, Yuan Huishu
机构信息
Department of Radiology, Peking University Third Hospital, Beijing, China.
Tu & Yuen Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California, USA.
出版信息
J Magn Reson Imaging. 2017 Apr;45(4):1068-1075. doi: 10.1002/jmri.25414. Epub 2016 Aug 4.
PURPOSE
To characterize the morphological and dynamic-contrast-enhanced (DCE) MRI features of chordoma and giant cell tumor (GCT) of bone occurring in the axial skeleton.
MATERIALS AND METHODS
A total of 13 patients with chordoma and 26 patients with GCT who received conventional T1, T2, and DCE-MRI on 3 Tesla MR scanners were retrospectively identified and analyzed. Two radiologists evaluated morphological features independently, including the lesion location, expansile bone changes, vertebral compression, presence of paraspinal soft tissue mass, fibrous septa, and the signal intensity on T1WI and T2WI. The inter-observer agreement was evaluated by kappa test. The DCE kinetics was measured to obtain the initial area under curve (IAUC) and the wash-out slope; also the two-compartmental pharmacokinetic model was applied to obtain K and k . The diagnostic accuracy was evaluated by CHAID decision tree and ROC analysis.
RESULTS
Chordomas were more likely to show soft tissue mass than GCTs (13/13 = 100% versus 15/26 = 58%; P = 0.007), as well as fibrous septa (9/13 = 69% versus 0; P < 0.001). In decision tree analysis, presence of fibrous septa and lesion location yield 31/39 = 79% accuracy. The DCE-MRI pharmacokinetic parameters K and k of GCTs were significantly higher than those of chordomas, 0.13 ± 0.65 versus 0.06 ± 0.04 (1/min) for K , 0.62 ± 0.22 versus 0.17 ± 0.12 (1/min) for k , P < 0.001 for both. If using kep = 0.43/min as the cut-off value, it achieved 100% sensitivity and 92% specificity to differentiate chordoma from GCT, with an overall accuracy of 37/39 = 95%. The IAUC was highly correlated with K (r = 0.94), and the slope was highly correlated with k (r = 0.95).
CONCLUSION
Several morphological features were significantly different between chordoma and GCT, but their diagnostic performance was inferior to that of DCE-MRI.
LEVEL OF EVIDENCE
4 J. Magn. Reson. Imaging 2017;45:1068-1075.
目的
描述发生于中轴骨骼的脊索瘤和骨巨细胞瘤（GCT）的形态学及动态对比增强（DCE）MRI特征。
材料与方法
回顾性纳入并分析了13例接受3T MR扫描仪常规T1、T2及DCE-MRI检查的脊索瘤患者和26例GCT患者。两名放射科医生独立评估形态学特征，包括病变位置、骨质膨胀性改变、椎体压缩、椎旁软组织肿块、纤维分隔的存在情况以及T1WI和T2WI上的信号强度。通过kappa检验评估观察者间的一致性。测量DCE动力学以获得初始曲线下面积（IAUC）和廓清斜率；同时应用双室药代动力学模型获得K和k。通过CHAID决策树和ROC分析评估诊断准确性。
结果
脊索瘤比GCT更易出现软组织肿块（13/13 = 100% 对比15/26 = 58%；P = 0.007）以及纤维分隔（9/13 = 69% 对比0；P < 0.001）。在决策树分析中，纤维分隔的存在情况和病变位置的诊断准确率为31/39 = 79%。GCT的DCE-MRI药代动力学参数K和k显著高于脊索瘤，K值为0.13 ± 0.65对比0.06 ± 0.04（1/min），k值为0.62 ± 0.22对比0.17 ± 0.12（1/min），两者P均< 0.001。以kep = 0.43/min作为截断值，鉴别脊索瘤与GCT的敏感性为100%，特异性为92%，总体准确率为37/39 = 95%。IAUC与K高度相关（r = 0.94），斜率与k高度相关（r = 0.95）。
结论
脊索瘤和GCT之间的几种形态学特征存在显著差异，但其诊断性能不如DCE-MRI。
证据水平
4 J.Magn.Reson.Imaging 2017;45:1068 - 1075。
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