DCE-MRI定量参数在不同病理类型腮腺肿瘤鉴别诊断中的初步研究

目的探讨动态增强磁共振(dynamic contrast-enhanced MRI,DCEMRI)定量参数鉴别腮腺不同病理类型肿瘤的价值,以期为腮腺肿瘤术前精准诊断提供有用的定量指标。材料与方法 47例经手术病理证实的腮腺肿瘤患者均行DCE-MRI检查,分析肿瘤时间-信号强度曲线(time intensity curve,TIC)类型并计算K~(trans)、V_e、K_(ep)值,探讨K~(trans)、V_e、K_(ep)值在腮腺不同病理类型肿瘤中的鉴别诊断效能。结果 (1)47例患者中良性肿瘤37例,恶性肿瘤10例。37例腮腺良性肿瘤中TIC曲线表现为A型有11例,B型有9例,C型有17例;10例恶性肿瘤中TIC曲线表现为B型有2例,C型有8例;腮腺良恶性肿瘤TIC曲线类型的组间差异(P0.05)无统计学意义。(2)腮腺良性肿瘤(不包括腺淋巴瘤)的K~(trans)、K_(ep)值低于恶性肿瘤,V_e值高于恶性肿瘤,组间差异有统计学意义(P0.05);混合瘤的K~(trans)、K_(ep)值低于恶性肿瘤及腺淋巴瘤,而V_e值高于恶性肿瘤及腺淋巴瘤,组间差异有统计学意义(P0.05);腺淋巴瘤的K~(trans)、K_(ep)值均高于恶性肿瘤,组间差异有统计学意义(P0.05);K~(trans)、K_(ep)、V_e值在混合瘤与恶性肿瘤、腺淋巴瘤的鉴别诊断中具有很好的诊断效能。结论 DCE-MRI定量参数能较准确、无创地诊断不同病理类型腮腺肿瘤,尤其为缺乏形态学特征的腮腺肿瘤鉴别诊断提供有用的定量参数。

An initial study using the quantitative parameters of dynamic contrast-enhanced MRI in differential diagnosis for parotid tumors with different pathological types

Objective: To investigate the value of the quantitative parameters of dynamic contrast-enhanced (DCE) MRI-derived parameters in differential diagnosis for parotid tumor with different pathologic types, in order to provide useful quantitative indicators for accurate preoperative diagnosis of parotid tumors. Materials and Methods: Forty-seven patients with different pathological types of parotid tumors were enrolled and performed DCE-MRI examinations. The region of interest was delineated around the tumor margin, time intensity curve (TIC) and quantitative parameters including Ktrans, Ve, Kep were calculated. The differences of TIC and DCE-MRI-derived quantitative parameters were analyzed among different pathologic type of parotid tumors. Results: (1) Among the 47 patients, the numbers of benign and malignant parotid tumor were 37 and 10. No significant difference was demonstrated about the TIC type between the benign (Type A, B, D: 20. Type C: 17) and malignant parotid tumor (Type A, B, D: 2. Type C: 8) (P>0.05). (2) The Ktrans, Kep values of benign parotid tumor (not included adenolymphoma) were significantly lower than malignant parotid tumor, while the value of Ve was significantly higher than malignant parotid tumor (P<0.05). The Ktrans, Kep values of mix parotid tumor were significantly lower than that of malignant parotid tumor and adenolymphoma (P<0.05). The Ve values of mix parotid tumor were significantly higher than malignant parotid tumor and adenolymphoma (P<0.05). The Ktrans, Kep values of adenolymphoma were significantly higher than malignant parotid tumor (P<0.05). High diagnostic efficiency were demonstrated for Ktrans, Ve, Kep values in differential diagnosis of mix parotid tumor from malignant parotid tumor and adenolymphoma. Conclusions: DCE-MRI derived quantitative parameters can differentiate parotid tumors among different pathological types, especially provides a useful quantitative parameters for the differential diagnosis of parotid tumors which were lack of MRI feature.