DCE-MRI定量渗透性参数联合ADC值在肺部良恶性病变中鉴别诊断价值

目的探讨利用动态增强磁共振成像(dynamic contrast-enhanced MRI,DCE-MRI)的血流动力学双室模型渗透性参数联合ADC值鉴别诊断肺部良恶性病变的应用价值。材料与方法搜集2014年7月至2015年3月在我院行肺部CT增强检查、常规MRI扫描、DWI成像及DCE-MRI扫描的患者共49例(恶性病变29例,良性病变20例),MRI动态增强扫描采用三维快速容积扫描技术,通过MRI后处理工作站计算病灶的ADC值,血流动力学定量分析软件Omni-Kinetics计算病灶的微血管渗透性参数Ktrans、Kep等。结果 CT联合ADC值、DCE-MRI定量渗透性参数鉴别诊断肺良恶性结节准确率为93.9%;CT联合ADC值鉴别诊断肺良恶性结节准确率为85.7%;CT鉴别肺良恶性结节准确率为75.5%,CT联合ADC值、DCE-MRI定量渗透性参数鉴别肺良恶性结节准确性与CT有显著性差异(P0.05)。结论 DCE-MRI定量分析微血管渗透性参数Ktrans、Kep联合ADC值对肺部良恶性病变诊断效能高于CT,而且真正实现定量分析鉴别诊断肺部结节良恶性,值得广泛应用于临床工作。

The value of DCE-MRI quantitative permeability parameter combined with ADC in differential diagnosis of benign and malignant lung lesions

AbstractObjective:To investigate the application value of quantitative assessment of pulmonary benign and malignant lesions by kinetic parameters of DCE-MRI imaging combined ADC. Materials and Methods:A total of 49 patients with pulmonary lesions (29 malignant lesions, 20 benign lesions) underwent CT contrast enhanced scanning, routine MR scanning, diffusion-weighted imaging MRI (DWI-MRI), and dynamic enhanced MRI. MRI dynamic enhanced scan with 3D rapid volumetric scanning technology. The ADC values of the lesions were calculated by MRI post-processing workstation, and the kinetic parameters such as Ktrans, Kep et al were calculated by the Omni-Kinetics software.Results:DCE-MRI and DWI-MRI technique for the differential diagnosis of benign and malignant nodules of lung nodules accuracy was 93.9%, ADC value combined with CT in the differential diagnosis of lung nodules accuracy was 85.7%, CT in the differential diagnosis of lung nodules accuracy was 75.5%, the accuracy of DCE-MRI combined with DWI-MRI for differentiating benign and malignant pulmonary nodules was significantly different from CT (P<0.05). Conclusion:DCE-MRI hemodynamic parameters such as Ktrans and Kep combined with ADC values of pulmonary benign and malignant lesions were higher than that of CT,and can be used as a quantitative method of differential diagnosis. It should be widely used in clinical work.