Lai Ying-Chieh, Juan Yu-Hsiang, Ng Shu-Hang, Lo Tzu-Chin, Chuang Wen-Yu, Chen Chun-Chieh, Liau Chi-Ting, Lin Gigin, Lin Yu-Jr, Lin Yu-Ching
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, Chang Gung University, Taoyuan 333, Taiwan.
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Taoyuan, Institute for Radiological Research, Chang Gung University, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2020 Dec 15;10(12):1094. doi: 10.3390/diagnostics10121094.
This retrospective study aimed to differentiate cyst-like musculoskeletal soft-tissue masses by using time-resolved magnetic resonance angiography (MRA). During May 2015 to November 2019, patients with cyst-like soft-tissue masses examined through contrast-enhanced MRI followed by histologic diagnosis were included. The masses were classified into vascular lesions, solid lesions, and true cysts. Size, T1 hyperintensity, T2 composition, perilesional edema, time-resolved MRA, and static internal enhancement were assessed. The time-resolved MRA manifestations were classified into vascular pooling, solid stain, and occult lesion. Imaging predictors for each type of mass were identified through logistic regression and were used to develop a diagnostic flowchart. A total of 80 patients (47 men; median age, 42 years) were included, with 22 vascular lesions, 38 solid lesions, and 20 true cysts. The T2 composition, time-resolved MRA, and static internal enhancement were significantly different among the masses. Vascular pooling on time-resolved MRA was the sole predictor of vascular lesions (odds ratio = 722.0, < 0.001). Solid stain on time-resolved MRA was the sole predictor of solid lesions (odds ratio = 73.6, < 0.001). Occult lesion on time-resolved MRA (odds ratio = 7.4, = 0.001) and absence of static internal enhancement (odds ratio = 80.0, < 0.001) both predicted true cysts, while the latter was the sole predictor of true cysts after multivariate analysis. A diagnostic flowchart based on time-resolved MRA correctly classified 89% of the masses. In conclusion, time-resolved MRA accurately differentiates cyst-like soft-tissue masses and provides guidance for management.
本回顾性研究旨在通过时间分辨磁共振血管造影（MRA）鉴别类囊性肌肉骨骼软组织肿块。在2015年5月至2019年11月期间，纳入了通过对比增强MRI检查并经组织学诊断的类囊性软组织肿块患者。这些肿块被分为血管性病变、实性病变和真性囊肿。评估了肿块的大小、T1高信号、T2成分、病灶周围水肿、时间分辨MRA以及静态内部强化情况。时间分辨MRA表现被分为血管池、实性染色和隐匿性病变。通过逻辑回归确定了每种类型肿块的影像预测指标，并用于制定诊断流程图。共纳入80例患者（47例男性；中位年龄42岁），其中血管性病变22例，实性病变38例，真性囊肿20例。不同类型肿块的T2成分、时间分辨MRA和静态内部强化情况存在显著差异。时间分辨MRA上的血管池是血管性病变的唯一预测指标（比值比=722.0，<0.001）。时间分辨MRA上的实性染色是实性病变的唯一预测指标（比值比=73.6，<0.001）。时间分辨MRA上的隐匿性病变（比值比=7.4，=0.001）和无静态内部强化（比值比=80.0，<0.001）均为真性囊肿的预测指标，而后者在多变量分析后是真性囊肿的唯一预测指标。基于时间分辨MRA的诊断流程图对89%的肿块进行了正确分类。总之，时间分辨MRA能准确鉴别类囊性软组织肿块，并为治疗提供指导。
