定量动态增强MRI在甲状腺乳头状癌与非乳头状癌鉴别诊断中的应用

目的探讨定量动态增强MRI在甲状腺乳头状癌与非乳头状癌鉴别诊断中的应用价值。方法对临床拟诊为甲状腺疾病的患者及健康对照人群行动态增强MRI检查。通过Tofts双室血流动力学模型分析获得感兴趣区微血管渗透性定量参数结果,包括容量转移常数(K~(trans))、速率常数(K_(ep))及血管外细胞外间隙容积比(V_e),以病理结果为"金标准"比较定量参数值在不同组间的差异;其次构建受试者工作特征曲线,分别评估三组定量参数值及其联合诊断在甲状腺乳头状癌与非乳头状癌鉴别诊断中的诊断效能,并确定诊断临界值。结果在乳头状癌组、非乳头状癌组及对照组中,K~(trans)、K_(ep)及V_e在非乳头状癌组与乳头状癌组间的差异均具有统计学意义(P0.001,0.003,0.001);非乳头状癌组与乳头状癌组的K~(trans),K_(ep)和V_e均与对照组间不同程度地具有显著性差异。非乳头状癌组和乳头状癌组的ROC结果显示:K~(trans)、K_(ep)及V_e三者P0.001;以最大约登指数为最佳诊断切入点,则三者诊断临界值分别为0.436,0.871,0.369。三者联合分析的敏感度和特异性分别为79.5%,73.3%,曲线下面积为0.793。结论利用K~(trans)、K_(ep)及V_e三种指标对甲状腺乳头状癌进行术前鉴别诊断均表现出较高的诊断效能。

Quantitative Dynamic Contrast-enhanced MRI in Differential Diagnosis between The Yroidpapillary Carcinoma and Non-thyroid Papillary Carcinoma

Objective To investigate the value of quantitative Dynamic Contrast-Enhanced MlRIin differential diagnosis between thyroid papillary carcinoma and non-thyroid papillary carcinoma.Methods The patients suspected thyroid lesionsand the controls contained healthy peopleunderwent DCE-MRI scanning.The microvesselpermeability quantitative parametersin the ROI includingvolume transfer constant(Ktrans),rare constant Kep) and extravascular extracellular volumeffaction(Ve) obtained by Extended Tofts Linear model.Taking surgical pathologic results as the gold standard.Analyzedthe differences of the quantitative parameters respectively and combined the three quantitative parameters amongthe different groups.Then used the receiver operating characteristic curves.Assessed the diagnosis efficacy of the three quantitative parameters among thyroid papillary carcinoma,non-thyroid papillary carcinoma and the controls respectively,and maked the cut-off values.Results In thyroid papillary carcinomagroup,noupapillary carcinoma groupand the controls The difference of Ktrans,Kep and Vewas statistically significantberween non-papillary carcinoma group and papillary carcinoma group(P＜0.001 0.003 and 0.001.respectively).Meantime,the difference of Ktrans,Kep and Vewas different degrees ofstatistically significantamongthe three gToups.Additionally,Analyse the ROC made of non-papillary carcinoma group and papillary carcinoma group,the results showed:the Pvalue of Ktrans.Kep and Vewas＜0.001 all.If taken the maximum Youden's Index as cut-off.The cut-off vaule was 0.436,0.871and 0.369,respectively.Combined the three quanntative parameters as associanon index(P=0.001).The sensitivity,and the specificity was 79.50％.73.3％.respectively,the areas under the ROC curve was 0.793.Conclusion It shows higher diagnosticefficacy for the preoperative differential diagnosisbetween non-papillary carcinoma group and papillary carcinoma group with the quantitative parameters ofKtrans.Kep and Ve.