摘要
目的 探讨MRI平扫、增强扫描序列及其定性、半定量、定量参数鉴别诊断良恶性实性孤立性肺结节(SPN)的应用价值.方法 回顾性分析2017年12月至2023年1月70例实性SPN患者临床及影像资料,所有患者均使用T1WI体积内插屏气检查(VIBE)序列、T2WI使用刀锋技术的快速自旋回波序列(blade)及其薄层序列、T2WI半傅立叶单次激发快速自旋回波(HASTE)序列、扩散加权成像(DWI)平面回波成像(EPI)序列、动态对比增强(DCE)3D-VIBE序列行肺部MRI检查.采用视觉评估定性参数信号强度(SI)评分,使用dicom阅读软件绘制感兴趣区(R0I)并获取半定量参数信号强度比值(SIR)及定量参数表观扩散系数(ADC)值[平均ADC(ADCmean)、最小ADC(ADCmin)],利用工作站后处理获取时间-信号强度曲线(TIC)与DCE-MRI定量参数[容积转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)、增强曲线下初始面积(iAUC)],通过受试者工作特征曲线(ROC)评估诊断效能及Logistic回归方法绘制联合诊断ROC曲线,并通过曲线下面积(AUC)评估诊断效能.结果 不同序列T2WI与DWI参数(SI评分与比值)、ADCmean、ADCmin、Ktrans、Kep、iAUC均对良恶性SPN的鉴别诊断具有良好价值(P＜0.05),从具有鉴别价值序列的不同参数中分别选取AUC最大的四个参数(Ktrans、T2 blade SIR、DWI SIR、ADCmin)绘制联合诊断ROC曲线,其诊断效能较单独诊断显著提高(P＜0.05).结论 T2WI、DWI、DCE-MRI检查及其定量、半定量、定性参数可以用于良恶性SPN的鉴别诊断,并且联合这些参数可以显著提高其诊断效能.
Abstract
Objective To explore the application value of plain and enhanced sequences of Magnetic Resonance Ima-ging(MRI)with their qualitative,semi-quantitative,and quantitative parameters in the differential diagnosis of benign and malignant solid Solitary Pulmonary Nodule(SPN).Methods From December 2017 to January 2023,the clinical and im-aging data of 70 patients with solid SPN were retrospectively analyzed.All patients received pulmonary MRI examination u-sing T1WI VIBE sequences,T2 WI blade with its thin-layer sequences,T2WI haste sequences,DWI EPI sequences,and dynamic contrast-enhanced MRI(DCE-MRI)3D-VIBE sequences.The parameter signal intensity(SI)score was qualita-tively evaluated by visual assessment.The DICOM file reading software was used to plot the regions of interest(ROIs)and obtain the semi-quantitative parameters of signal intensity ratio(SIR)and quantitative parameters of ADC values(ADCmean,ADCmin).The time-signal intensity curve(TIC)with DCE-MRI quantitative parameters(Ktrans,Kep,Ve,iAUC)was yielded by the workstation post-processing.The receiver operating characteristic(ROC)curves were used to assess the diagnostic efficacy,and the joint diagnostic ROC curve was plotted with the logistic regression method.The diag-nostic efficiency was assessed by the area under the curve(AUC).Results These DCE-MRI parameters(Ktrans,Kep,and iAUC),ADCmean,ADCmin,T2WI,and DWI parameters(SI score and SIR)had a good differential diagnostic value in benign and malignant solid SPN(P＜0.05).The four parameters(Ktrans,T2WI blade SIR,DWI SIR,ADCmin)with the largest AUC selected from the different parameters with discriminatory value sequences were plotted on a combined diagnos-tic ROC curve,and their diagnostic efficacy was significantly improved compared with that of the diagnosis alone(P＜0.05).Conclusion The T2WI,DWI,DCE-MRI examinations with their quantitative,semi-quantitative,and qualitative parameters can be used for the differential diagnosis of solid SPN,and the combination of these parameters can significantly improve the diagnostic efficacy.
维普
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