多参数动态增强磁共振成像在鉴别泪腺良恶性上皮性肿瘤中的价值  

The value of dynamic contrast‑enhanced MRI in the differentiation between benign and malignant lacrimal epithelial tumors

作　　者：王永哲[1] 鲜军舫[1] 王新艳[1] 郭健[1] 宋丽媛[1] Wang Yongzhe;Xian Junfang;Wang Xinyan;Guo Jian;Song Liyuan(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中华医学杂志》2023年第31期2427-2432,共6页National Medical Journal of China

基　　金：北京市医院管理局临床医学发展专项(ZYLX201704);北京市卫生系统高层次卫生技术学科带头人项目(2014‑2‑005)

摘　　要：目的探讨多参数动态增强磁共振成像(DCE‑MRI)对泪腺良恶性上皮性肿瘤的鉴别诊断价值。方法回顾性收集北京同仁医院2011年1月至2017年12月间行眼眶MRI扫描并符合入组标准的104例泪腺上皮性肿瘤的临床及影像资料,其中男48例,女56例,年龄12~77(43±7)岁。良性上皮性肿瘤63例,恶性上皮性肿瘤41例,均行DCE‑MRI检查。DCE‑MRI半定量参数包括达峰时间(Tpeak)、最大强化率(ERmax)、斜率(Slope)、流出率(WR)、时间‑信号强度曲线(TIC)类型,定量参数包括对比剂容积转移常数(K^(trans))、血管外细胞外间隙体积分数(V_(e))和对比剂转移速率常数(K_(ep))。对差异有统计学意义的DCE‑MRI参数,行受试者工作特征(ROC)曲线分析,计算曲线下面积(AUC),确定诊断阈值,评价其诊断效能。通过logistic回归分析确定鉴别泪腺良恶性上皮性肿瘤的最佳参数。结果DCE‑MRI半定量参数分析:泪腺恶性上皮性肿瘤的Tpeak小于良性上皮性肿瘤[(103.77±57.87)比(187.80±77.01)s,P<0.001],ERmax、Slope[M(Q_(1),Q_(3))]及WR大于良性上皮性肿瘤[(1.55±0.39)比(1.36±0.33),1.76(0.97,2.27)比0.62(0.50,0.93),7.70%(1.40%,21.60%)%比0(0,0);均P<0.05],良性上皮性肿瘤TIC曲线以持续上升型为主(49/63),而恶性上皮性肿瘤则以平台型为主(25/41)。定量参数分析:泪腺恶性上皮性肿瘤的K^(trans)、K_(ep)值[M(Q_(1),Q_(3))]大于良性上皮性肿瘤[(0.99±0.52)/min比(0.43±0.23)/min,1.33(0.83,1.55)/min比0.55(0.46,0.68)/min](均P<0.001),Ve值之间的差异无统计学意义[(0.76±0.20)比(0.73±0.22),P=0.467]。经统计学分析表明,在预测泪腺恶性上皮性肿瘤的诊断效能上,参数TIC类型(OR=3.887,95%CI:1.409~10.725)和K^(trans)(OR=50.979,95%CI:6.046~429.830)的诊断价值更高,相应的灵敏度、特异度分别为78.05%、77.78%和70.73%、95.24%,且定量参数K^(trans)的综合诊断表现优于半定量参数TIC,AUC差异具有统计学意义[0.875(0.796~0.932)比0.798(0.708~0.87Objective To investigate the diagnostic performance of multiparametric dynamic contrast‑enhanced MRI(DCE‑MRI)for the differentiation between benign and malignant larcrimal gland epithelial tumors.Methods The clinical and imaging data of 104 patients with epithelial tumors of the lacrimal gland who underwent orbital MRI scan and met the inclusion criteria in Beijing Tongren Hospital from January 2011 to December 2017 were retrospectively collected,including 48 males and 56 females,aged from 12 to 77(43±7)years.Sixty‑three cases of benign epithelial tumors and 41 cases of malignant epithelial tumors were examined by DCE‑MRI.The parameters of semiquantitative analysis including:time to peak enhancement(Tpeak),maximum enhancement ratio(ERmax),Slope,washout ratio(WR)and time‑signal intensity curve(TIC)types.The parameters of quantitative analysis including:volume transfer constant(K^(trans)),the extravascular extracellular volume fraction(V_(e))and rate constant(K_(ep)).Receiver operating characteristic(ROC)curve analysis was performed for DCE‑MRI parameters with statistically significant differences,the area under the curve(AUC)was calculated,the diagnostic threshold was determined,and the diagnostic performance was evaluated.Logistic regression analysis was used to determine the best parameters for differential diagnosis of benign and malignant epithelial tumors of the lacrimal gland.Results For the semiquantitative analysis of DCE‑MRI,malignant lacrimal gland epithelial tumor had a significantly shorter Tpeak than benign masses[(103.77±57.87)s vs(187.80±77.01)s,P<0.001],while had a higher value in ERmax,Slope[M(Q_(1),Q_(3))]and WR in malignant masses compared with benign one[1.55±0.39 vs 1.36±0.33;1.76(0.97,2.27)vs 0.62(0.50,0.93);7.70%(1.40%,21.60%)%vs 0(0,0),all P<0.05].The TICs of benign lacrimal tumors mainly showed a persistent type(49/63),while most malignant lacrimal tumors mainly showed a plateau type(25/41).For the quantitative analysis of DCE‑MRI,the values of K^(trans)and K_(ep)[M(Q_

关 键 词：泪腺 肿瘤 磁共振成像 动态增强扫描 定量分析 半定量分析 横断面研究 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.7[医药卫生—诊断学]