磁共振体素内不相干性运动在肌骨系统肿瘤定性诊断中的作用

目的：评价磁共振体素内不相干性运动（IVIM）参数在肌骨系统肿瘤定性诊断中的价值。方法：本研究中的38例肌骨系统肿瘤的患者，均采用1．5T MR 扫描仪进行检查，在常规扫描后进行 IVIM 扫描。IVIM 使用的9个 b 值分别为0，20，40，60，80，100，250，500和750 s／mm2。分别测量病变区和作为对照组的正常肌肉组织 IVIM 参数 ADC、ADCslow 、ADCfast 及 PF 值。根据病理结果，将病变分为良性（12例）、交界性（14例）及恶性肿瘤（12例），并对三组肿瘤之间以及肿瘤与对照组之间 ADC、ADCslow 、ADCfast 及 PF 值的差异进行统计学分析。结果：交界性肿瘤的 ADC 及 ADCslow 值分别为（1．02±0．15）×10－3 mm2／s 和（1．02±0．16）×10－3 mm2／s，明显低于对照组（1．38±0．20）×10－3 mm2／s 和（1．38±0．17）×10－3 mm2／s，差异具有统计学意义（P ＝0．001）。恶性肿瘤的 ADC 及 ADCslow 值分别为（0．90±0．13）×10－3 mm2／s和（0．88±0．14）×10－3 mm2／s，明显低于对照组（1．48±0．12）×10－3 mm2／s 和（1．48±0．09）×10－3 mm2／s，差异具有统计学意义（P ＜0．001）。而良性肿瘤的 ADC 及 ADCslow 与对照组之间差异无统计学意义（P ＝0．564，0．480）。ADCfast 以及 PF 值在肿瘤与对照组之间无统计学差异。交界性、恶性肿瘤的 ADC 和 ADCslow 值明显低于良性肿瘤，差异具有统计学意义（P 值均＜0．001），但交界性肿瘤与恶性肿瘤之间的 ADC 和 ADCslow 值差异无统计学意义。良性、交界性和恶性肿瘤之间的 ADCfast 和 PF 值的差异没有统计学意义。结论：IVIM 参数 ADC 和 ADCslow 有助于区分良性肿瘤与交界性、恶性肿瘤，提高肌骨系统肿瘤的诊断准确性。

The value of MRI intravoxel incoherent motion technique in the differential diagnosis of musculoskeletal tumor

Objective:To evaluate the value of magnetic resonance intravoxel incoherent motion (IVIM)parameters in the differential diagnosis of musculoskeletal tumor.Methods:Thirty eight patients with musculoskeletal tumor were recrui-ted in this study.IVIM was performed in addition to routine MRI examination with a 1.5T MR scanner.Nine b values inclu-ding 0,20,40,60,80,100,250,500 and 750s/mm2 were used.IVIM parameters of tumor and normal muscle (control group)including ADC,ADCslow ,ADCfast and perfusion fraction (PF)values were measured.Patients were divided into be-nign (12 cases),borderline (14 cases)and malignant tumor (12 cases)according to pathology diagnosis.The ADC, ADCslow ,ADCfast and PF values between three groups of tumor and between tumor and control group were compared and an-alyzed statistically.Results:The ADC and ADCslow values of borderline tumor ADC=(1.02±0.15)×10 -3 mm2/s,ADCslow=(1.02±0.16)×10 -3 mm2/s]were significantly lower than that of control group ADC=(1.38 ±0.20)×10 -3 mm2/s;ADCslow =(1.38 ±0.17)×10 -3 mm2/s](P =0.001 ).The ADC and ADCslow values of malignant tumor ADC=(0.90 ± 0.13)×10 -3 mm2/s,ADCslow =(0.88±0.14)×10 -3 mm2/s]were also significantly lower than that of control group ADC=(1.48±0.12)×10 -3 mm2/s;ADCslow =(1.48 ±0.09)×10 -3 mm2/s](P <0.001).However,the ADC and ADCslow val-ues of benign tumor had no statistical difference compared with that of control group (P =0.564,0.480).There was no sig-nificant difference in the ADCfast and PF values between tumor group and control group.The ADC and ADCslow values of borderline tumor and malignant tumor were markedly lower than that of benign tumors,with statistical difference (P <0. 001).Yet,there were no significant differences between the ADC and ADCslow values of borderline tumor and malignant tumor.Also,there were no significant statistic differences between the ADCfast and PF values of benign,borderline and ma-lignant tumors.Conclusion:IVIM parameters (ADC and ADCslow value)are helpful in differentiating benign tumor and bor-derline as well as malignant tumors of musculoskeletal system,which is useful to improve the accuracy of the diagnosis of musculoskeletal tumors.