摘要
目的 探讨MRI多序列成像鉴别肺良恶性结节的可行性与关键参数.方法 选取70例肺部良性结节及54例肺癌患者的临床、影像及病理资料回顾性分析.患者均进行CT扫描、刀锋伪影校正快速自旋回波T2加权成像(BLADE-TSE-T2WI)、高分辨星形容积内插屏气检查脂肪抑制(STAR-VIBE-T1WI)、小视野扩散加权成像(ZooMit-DWI)、磁共振动态对比增强检查(DCE-VIBE-T1WI)序列扫描,并分别测量及计算其T1对比度(T1CR)、T2对比度(T2CR)、表观扩散系数(ADC)值、时间-信号强度曲线(TIC)类型、最大相对强化率(MER)、达峰时间(Tmax)、斜率、廓清速率,同时记录结节边界是否清晰、有无分叶及毛刺.分析数值及征象在肺部良恶性结节的差异性,运用受试者工作特征(ROC)曲线评价各参数的诊断效能,并比较CT及MRI的诊断效能.结果 CT、MRI平扫诊断良恶性实性结节曲线下面积(AUC)分别为58.1％、80.0％.肺癌与肺良性结节T1CR、T2CR、ADC值、TIC曲线类型、Tmax、斜率、廓清速率、边界、分叶、毛刺等参数存在差异(P＜0.05).而MER差异没有统计学意义(P＞0.05).ROC曲线显示:当ADC值取1.13×10-3 mm2/s时,AUC为80.1％,敏感度72.9％,特异度74.1％.ADC值与TIC曲线联合,AUC 95.5％,敏感度94.3％,特异度90.7％.结论 相比CT检查,多序列MRI成像可有效提高肺部良恶性结节的诊断效能.
Abstract
Objective To explore the feasibility and key parameters of multi-sequence MRI in differentiating benign and malignant pulmonary nodules.Methods The clinical,imaging and pathological data of 70 patients with benign pulmonary nodules and 54 patients with lung cancer were retrospectively analyzed.All patients underwent CT,BLADE-turbo spin echo-T2-weighted(BLADE-TSE-T2WI),STAR-volumetric interpolated breath-hold examination-fat suppression-T1-weighted imaging(STAR-VIBE-T1WI),zoomed imaging technique with parallel transmission diffusion-weighted imaging(ZooMit-DWI),dynamic contrast-enhanced(DCE)VIBE-T1WI.T1 contrast ratio(T1CR),T2 contrast ratio(T2CR),apparent diffusion coefficient(ADC),time-signal intensity curve(TIC)type,maximum relative strengthening rate(MER),time to peak(Tmax),slope and washout rate were measured.The difference in the boundary,lobulation and spiculation of benign and malignant nodules was assessed.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of the parameters on CT and MRI.Results The area under the ROC curve(AUC)of benign and malignant solid nodules diagnosed by CT and MRI were 58.1％and 80.0％,respectively.There were significant differences in T1CR,T2CR,ADC,TIC curve types,Tmax,slope,washout,clear boundary,lobulation and spiculation between lung cancer and benign pulmonary nodules(P＜0.05).The MER difference was not statistically significant(P＞0.05).At ADC value of 1.13×10-3 mm2/s,the AUC was 80.1％with 72.9％sensitivity and 74.1％specificity.When ADC value was combined with TIC curve,AUC was 95.5％with 94.3％sensitivity and 90.7％specificity.Conclusion Compared with CT,multi-sequence MRI can effectively improve the diagnostic efficiency of benign and malignant pulmonary nodules.
维普
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