多参数MRI鉴别鼻腔鼻窦内翻性乳头状瘤恶变的价值  

Multiparametric MRI in differentiation between sinonasal inverted papilloma and malignant transformation of inverted papilloma

作　　者：王新艳[1] 陈青华[1] 王英[1] 宋丽媛[1] 鲜军舫[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730

出　　处：《中华放射学杂志》2017年第7期500-504,共5页Chinese Journal of Radiology

基　　金：北京市高层次卫生人才学科带头人（2014-2-005）;北京市医院管理局临床医学发展专项经费资助（“扬帆”计划眼耳鼻喉影像重点医学专业）（ZYLX201704）;科技部国家科技计划支撑项目（2015BA116H00）;北京市“百千万人才工程”（2014001）

摘　　要：目的探讨多参数MRI在鉴别鼻腔鼻窦内翻性乳头状瘤和内翻乳头状瘤恶变中的价值。方法回顾性分析内翻性乳头状瘤65例、内翻性乳头状瘤恶变12例的MRI资料，均行多参数MRI扫描，包括动态增强MRI及扩散加权成像MRI，所有病例均经组织学证实且肿块直径〉1 cm。评估的MRI参数包括常规MRI特征、ADC值、达峰时间（Tpeak）、最大强化指数（CImax）及动态增强曲线类型（TIC）。采用Fisher精确检验（计数资料）、秩和检验（非正态分布计量资料）及独立样本t检验（正态分布计量资料）比较两组间参数的差异。结果脑回征、眼眶受累、坏死征象在内翻性乳头状瘤与内翻性乳头状瘤恶变之间的差异具有统计学意义（P值均〈0.05）。内翻性乳头状瘤恶变的ADC值[（1.56±0.27）×10？3 mm2/s]低于内翻性乳头状瘤[（1.95±0.23）×10-3 mm2/s]，差异有统计学意义（t=5.214, P〈0.01）。两者的Tpeak（U=-4.313）、CImax（U=-2.893）及TIC类型（χ2=21.226）差异均有统计学意义（P值均〈0.01）。 结论多参数MRI有助于鉴别内翻性乳头状瘤与内翻性乳头状瘤恶变。ObjectiveTo identify the value of multiparametric MR imaging features including diffusion weighted （DW） and dynamic contrast-enhanced （DCE） MR imaging features in differentiation between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region.MethodsSeventy-seven patients were included in this study, including 12 malignant transformation of inverted papilloma and 65 inverted papillomas. Conventional MRI including nonenhanced and static contrast-enhanced imaging, DCE-and the DW-MRI were analyzed. Differences in conventional MRI features, ADCs and DCE-MRI parameters between the two entities were determined by Fisher exact test, independent samples t-test and Mann-Whitney U test, respectively.ResultsThere were significant differences in convoluted cerebriform pattern （P=0.045）, necrosis （P=0.003） and orbit involvement （P〈0.01） between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region. The ADCs of inverted papilloma were significantly lower than those of malignant transformation of inverted papilloma （P〈0.01）. There were significant differences in time to peak enhancement （P〈0.01）, maximum contrast index （P=0.004） and time intensity curve types （P〈0.01） between the two entities.ConclusionsA multiparametric approach using conventional MR imaging with added ADCs and DCE-MRI parameters had the potential to improve the differentiation between inverted papilloma and malignant transformation of inverted papilloma in the sinonasal region.

关 键 词：鼻腔 鼻窦 肿瘤 多参数磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.62[医药卫生—诊断学]