T2 加权 MRI 对鉴别肾上腺转移瘤与乏脂性肾上腺腺瘤的作用。
Utility of T2-weighted MRI to Differentiate Adrenal Metastases from Lipid-Poor Adrenal Adenomas.
机构信息
Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, C1 Radiology, Ottawa, ON, Canada K1Y 4E9 (W.T., J.A.G., A.U., N.S.); and Department of Radiology and Medical Imaging, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia (A.A.).
出版信息
Radiol Imaging Cancer. 2020 Oct 30;2(6):e200011. doi: 10.1148/rycan.2020200011. eCollection 2020 Nov.
PURPOSE
To evaluate T2-weighted MRI features to differentiate adrenal metastases from lipid-poor adenomas.
MATERIALS AND METHODS
With institutional review board approval, this study retrospectively compared 40 consecutive patients (mean age, 66 years ± 10 [standard deviation]) with metastases to 23 patients (mean age, 60 years ± 15) with lipid-poor adenomas at 1.5- and 3-T MRI between June 2016 and March 2019. A blinded radiologist measured T2-weighted signal intensity (SI) ratio (SI/SI), T2-weighted histogram features, and chemical shift SI index. Two blinded radiologists (radiologist 1 and radiologist 2) assessed T2-weighted SI and T2-weighted heterogeneity using five-point Likert scales.
RESULTS
Subjectively, T2-weighted SI ( < .001 for radiologist 1 and radiologist 2) and T2-weighted heterogeneity ( < .001, for radiologist 1 and radiologist 2) were higher in metastases compared with adenomas when assessed by both radiologists. Agreement between the radiologists was substantial for T2-weighted SI (Cohen κ = 0.67) and T2-weighted heterogeneity (κ = 0.62). Metastases had higher T2-weighted SI ratio than adenomas (3.6 ± 1.7 [95% confidence interval {CI}: 0.2, 8.2] vs 2.2 ± 1.0 [95% CI: 0.6, 4.3], < .001) and higher T2-weighted entropy (6.6 ± 0.6 [95% CI: 4.9, 7.5] vs 5.0 ± 0.8 [95% CI: 3.5, 6.6], < .001). At multivariate analysis, T2-weighted entropy was the best differentiating feature ( < 001). Chemical shift SI index did not differ between metastases and adenomas ( = .748). Area under the receiver operating characteristic curve (AUC) for T2-weighted SI ratio and T2-weighted entropy were 0.76 (95% CI: 0.64, 0.88) and 0.94 (95% CI: 0.88, 0.99). The logistic regression model combining T2-weighted SI ratio with T2-weighted entropy yielded AUC of 0.95 (95% CI: 0.91, 0.99) and did not differ compared with T2-weighted entropy alone ( = .268). There was no difference in logistic regression model accuracy comparing the data by either field strength, 1.5- or 3-T MRI ( > .05).
CONCLUSION
Logistic regression models combining T2-weighted SI and T2-weighted heterogeneity can differentiate metastases from lipid-poor adenomas. Validation of these preliminary results is required. Adrenal, MR-Imaging, Urinary© RSNA, 2020.
目的
评估 T2 加权 MRI 特征以区分肾上腺转移瘤与乏脂性腺瘤。
材料与方法
本研究经机构审查委员会批准，回顾性比较了 2016 年 6 月至 2019 年 3 月期间在 1.5-T 和 3-T MRI 上连续 40 例转移瘤患者（平均年龄 66 岁±10[标准差]）与 23 例乏脂性腺瘤患者（平均年龄 60 岁±15）的 T2 加权信号强度（SI）比（SI/SI）、T2 加权直方图特征和化学位移 SI 指数。一名盲法放射科医生测量 T2 加权 SI 和 T2 加权异质性（放射科医生 1 和放射科医生 2），采用 5 分李克特量表进行评估。
结果
主观上，当两位放射科医生进行评估时，转移瘤的 T2 加权 SI（<0.001，放射科医生 1 和放射科医生 2）和 T2 加权异质性（<0.001，放射科医生 1 和放射科医生 2）均高于腺瘤。T2 加权 SI（κ=0.67）和 T2 加权异质性（κ=0.62）的两位放射科医生之间的一致性较高。转移瘤的 T2 加权 SI 比值（3.6±1.7[95%置信区间{CI}：0.2，8.2]）高于腺瘤（2.2±1.0[95%CI：0.6，4.3]，<0.001），T2 加权熵（6.6±0.6[95%CI：4.9，7.5]）也高于腺瘤（5.0±0.8[95%CI：3.5，6.6]，<0.001）。多变量分析显示，T2 加权熵是最佳鉴别特征（<0.001）。转移瘤与腺瘤的化学位移 SI 指数无差异（=0.748）。T2 加权 SI 比值和 T2 加权熵的受试者工作特征曲线（ROC）曲线下面积（AUC）分别为 0.76（95%CI：0.64，0.88）和 0.94（95%CI：0.88，0.99）。结合 T2 加权 SI 比值和 T2 加权熵的逻辑回归模型 AUC 为 0.95（95%CI：0.91，0.99），与单独使用 T2 加权熵无差异（=0.268）。两种场强（1.5-T 和 3-T MRI）的数据比较，逻辑回归模型准确性无差异（>0.05）。
结论
结合 T2 加权 SI 和 T2 加权异质性的逻辑回归模型可区分肾上腺转移瘤与乏脂性腺瘤。需要对这些初步结果进行验证。
肾上腺；磁共振成像；尿
©RSNA，2020
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