多参数 MRI 鉴别卵巢良恶性肿块。
Differentiation between benign and malignant ovarian masses using multiparametric MRI.
机构信息
Department of Radiology, Denizli State Hospital, 20010 Denizli, Turkey.
Department of Radiology, School of Medicine, Suleyman Demirel University, 32260 Isparta, Turkey.
出版信息
Diagn Interv Imaging. 2020 Mar;101(3):147-155. doi: 10.1016/j.diii.2020.01.006. Epub 2020 Jan 25.
PURPOSE
To investigate the capabilities of multiparametric MRI including dynamic contrast enhanced (DCE) perfusion and diffusion-weighted imaging (DWI) to discriminate between benign and malignant ovarian masses.
METHODS
A total of 43 women with a total of 43 ovarian masses were retrospectively included. They had a mean age of 51.26±18.05 (SD) years (range: 20-88years). Twenty women had benign and 23 had malignant ovarian tumors. All women had multiparametric MRI examinations including DWI (b50-b800) and DCE perfusion imaging at 1-5T. Results of DWI (apparent diffusion coefficient [ADC], b-800) and DCE imaging (volume transfer coefficient [K], rate constant [K], interstitial volume [V], initial area under the curve [iAUC]) were compared between benign and malignant ovarian masses.
RESULTS
Mean ADC was significantly lowed in malignant tumors (0.92±0.25 [SD]×10 mm/s (range: 0.6-1.6×10 mm/s) than in benign tumors (1.37±0.69 [SD]×10 mm/s; range: 0.4-2.9×10 mm/s) (P=0.011). B-800 was significantly greater in malignant tumors (80.61±24.73 [SD] s/mm; range: 24-110 s/mm) than in benign ones (61.15±22.17 [SD] s/mm; range: 38-155 s/mm) (P=0.010). K was lower in benign tumors (0.13±0.06 [SD] min; range: 0-0.2min) than in malignant ones (0.25±0.16 [SD] min; range: 0.1-0.8min) (P=0.002). K was significantly greater in malignant tumors (0.55±0.19 [SD] min; range: 0.1-1.9min) than in benign ones (0.44±0.38 [SD] min; range: 0.2-1.1min) (P=0.003). iAUC was greater in malignant tumors (15.59±7.98 [SD] mM/min; range: 6.6-42.1mM/min) than in benign ones (7.98±5.06 [SD] mM/min; range: 0.2-17.7mM/min) (P=0.001). No differences in V were found between benign and malignant masses (P=0.084). The area under the ROC curve was significant for all parameters but V. Logistic regression analysis revealed 5.590 and 11.637 times higher malignancy risk for an ADC≤0.93×10 mm/s and an iAUC≥13.88mM/min, respectively.
CONCLUSION
Multiparametric MRI has high accuracy in discrimination between benign and malignant ovarian masses. Therefore, adding these methods to the more common MRI protocol can help select the best treatment option in women with ovarian mass.
目的
研究多参数 MRI（包括动态对比增强（DCE）灌注和弥散加权成像（DWI））在鉴别卵巢良恶性肿块中的能力。
方法
回顾性纳入 43 名患有 43 个卵巢肿块的女性。她们的平均年龄为 51.26±18.05（SD）岁（范围：20-88 岁）。20 名女性患有良性卵巢肿瘤，23 名女性患有恶性卵巢肿瘤。所有女性均进行多参数 MRI 检查，包括 DWI（b50-b800）和 1-5T 下的 DCE 灌注成像。比较良性和恶性卵巢肿块之间的 DWI（表观扩散系数[ADC]，b-800）和 DCE 成像（容积转移系数[K]，速率常数[K]，间质容积[V]，初始曲线下面积[iAUC]）的结果。
结果
恶性肿瘤的平均 ADC 值明显低于良性肿瘤（0.92±0.25（SD）×10 mm/s（范围：0.6-1.6×10 mm/s），而良性肿瘤为 1.37±0.69（SD）×10 mm/s（范围：0.4-2.9×10 mm/s））（P=0.011）。恶性肿瘤的 b-800 值明显高于良性肿瘤（80.61±24.73（SD）s/mm（范围：24-110 s/mm），而良性肿瘤为 61.15±22.17（SD）s/mm（范围：38-155 s/mm））（P=0.010）。良性肿瘤的 K 值低于恶性肿瘤（0.13±0.06（SD）min（范围：0-0.2min），而恶性肿瘤为 0.25±0.16（SD）min（范围：0.1-0.8min））（P=0.002）。恶性肿瘤的 K 值明显高于良性肿瘤（0.55±0.19（SD）min（范围：0.1-1.9min），而良性肿瘤为 0.44±0.38（SD）min（范围：0.2-1.1min））（P=0.003）。恶性肿瘤的 iAUC 值明显高于良性肿瘤（15.59±7.98（SD）mM/min（范围：6.6-42.1mM/min），而良性肿瘤为 7.98±5.06（SD）mM/min（范围：0.2-17.7mM/min））（P=0.001）。良性和恶性肿块之间的 V 值没有差异（P=0.084）。ROC 曲线下的面积对于所有参数均具有统计学意义，但 V 除外。Logistic 回归分析显示，ADC≤0.93×10 mm/s 和 iAUC≥13.88 mM/min 的恶性肿瘤风险分别增加 5.590 倍和 11.637 倍。
结论
多参数 MRI 在鉴别卵巢良恶性肿块方面具有较高的准确性。因此，在患有卵巢肿块的女性中，增加这些方法可以帮助选择最佳的治疗方案。
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