动态对比增强MRI及PET-CT在孤立性肺结节良恶性鉴别诊断中的价值  

Differentiation of malignant and benign solitary pulmonary nodules with dynamic contrast-enhanced MRI versus PET-CT

作　　者：冯峰[1] 夏淦林[1] 曹鹏 强福林[1] 施冬辉[1] 傅爱燕[1] 李海明[1] 张明珠[1] 

机构地区：[1]南通大学附属南通市肿瘤医院影像科,226361 [2]通用电气医疗集团

出　　处：《中华放射学杂志》2015年第10期736-740,共5页Chinese Journal of Radiology

摘　　要：目的对照分析动态对比增强MRI（DCE．MRI）与18F-脱氧葡萄糖（FDG）PET—CT鉴别良恶性孤立性肺结节的价值。方法收集经病理证实的孤立性肺结节患者32例，其中恶性结节21例、良性结节11例，行动态增强MRI及18FFDGPET．CT检查。测量MRI定量参数容积转运常数（Ktrns）、血液回流常数（kep）、细胞外间隙对比剂容积分数（Ve）、血浆内对比剂容积分数（V。）及PET—CT最大标准化摄取值（SUVmax）。良恶性结节问各测量参数行独立样本t检验，采用Pearson相关性分析比较DCE-MRI4个定量参数值与SUVmax的相关性。最后绘制ROC曲线比较定量DCE．MRI与18FFDGPET-CT鉴别孤立性肺结节良恶性的诊断效能。结果恶性结节Ktrans、Kep、Ve、Vp与SUVmax分别为（0．422±0．202）min-1、（1．829±0．681）min-1、0．234±0．058、0．104±0．038和6．480±3．505，良性结节对应的参数分别为（0．225±0．053）min-1、（1．056±0．371）min-1、0．213±0．057、0．086±0．020和3．415±1．640。恶性结节与良性结节间Ktrans、Kep、SUVmax差异有统计学意义（t值分别为3．159、3．451、2．732，P值均〈0．05），恶性结节与良性结节间ve、vp差异无统计学意义（t值分别为0．992、1．514，P值均〉0．05）。Ktrans、Kep，分别与SUVmax之间存在正相关（r值分别为0．460、0．419，P值均〈0．05）。Ktrans、Kep，与SUVmax3个参数ROC曲线下面积分别为0．896、0．866和0．788，判断孤立性肺结节良恶性的敏感度分别为95．2％、90．5％和81．0％，特异度分别为81．8％、72．7％、72．7％。结论DCE-MRI参数Ktrans、Kep值与PET—CT参数SUVmax值可以对孤立性肺结节良恶性做出鉴别诊断，并表现出较高的诊断效能。Objective To compare the value of quantitative dynamic contrast enhanced MRI with that of combined positron emission tomography and CT （PET-CT） for differentiation between malignant and benign pulmonary nodules. Methods Thirty-two patients with solitary pulmonary nodules （21 cases of malignant nodules, 11 cases of benign nodules） proven by pathological results underwent contrast enhanced MRI, PET/CT. The quantitative MR pharmaeokinetic parameters including Ktrans, Kep, Ve and Vp and SUVmax were measured. These parameters of the two nodule groups were statistically compared using Student＇s t test. Pearson correlations were conducted between the four MR parameters and SUV Receiver operating characteristic （ROC） analyses were used to compare the diagnostic capability of the MRI and PET/CT indexes. Results The mean Ktrans, Kep, Ve, Vp and SUVmax of malignant nodules were （0.422±0.202）min-1, （1.829±0.681） min-1, 0.234±0.058, 0.104±0.038 and 6.48±3.505; the mean Ktrans Kep, Vep, Vp and SUVmax of benign nodules were （0.225±0.053） min-1, （1.056±0.371） rain-l, 0.213＋0.057, 0.086±0.020 and 3.415±1.640, respectively. There were significant differences between malignant nodules and benign nodules in K and ktrans （t=3.159, 3.451, respectively, P〈0.05）; There was a statistic difference between malignant nodules and benign nodules in SUVmax （t=2.732, P〈0.05）. There were no significant differences between malignant and benign nodules in Ve and Vp （t=0.992, 1.514, respectively, P〉0.05）. Significant positive correlations were found between Ktrans and SUV Kep and SUVmax （r=0.460, 0.419, respectively, P〈0.05）. The areas under the ROC curve （AUC） of Ktrans, Kop and SUVmax between malignant and benign nodules were 0.896, 0.866 and 0.788, respectively. The sensitivity of these five parameters were 95.2%, 90.5%, and 81.0% and specificity were 81.8%, 72.7%, 72.7% for the differential diagnosis of solitary pulmonary nodule if taken the maximum Youden index as cut-off. Co

关 键 词：孤立性肺结节 磁共振成像 体层摄影术 X线计算机 诊断 鉴别 

分 类 号：R563[医药卫生—呼吸系统] R817.4[医药卫生—内科学] R445.2[医药卫生—临床医学]