体素内不相干运动成像和扩散峰度成像在下肢良恶性骨与软组织肿瘤鉴别诊断中的价值  

The value of MRI intravoxel incoherent motion imaging(IVIM) and diffusion kurtosis imaging(DKI) in the differential diagnosis of benign and malignant bone and soft tissue tumors of lower extremity

作　　者：张晓莉[1] 吴刚[1] 谢如意 梁晓青[1] 刘宣林 李小明[1] ZHANG Xiao-li;WU Gang;XIE Ru-yi;LIANG Xiao-qing;LIU Xuan-lin;LI Xiao-ming

机构地区：[1]湖北省武汉市华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《磁共振成像》2018年第7期525-532,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金面上项目(编号:81571643)~~

摘　　要：目的探讨磁共振体素内不相干运动成像(intravoxel incoherent motion,IVIM)及扩散峰度成像(diffusion kurtosis imaging,DKI)在下肢良恶性骨与软组织肿瘤鉴别诊断中的价值。材料与方法搜集2016年11月至2018年1月在本院放射科做下肢MRI发现有肿块的患者54例,所有患者均行下肢3.0 T MRI平扫以及多b值(0、10、20、30、40、50、75、100、150、200、400、800、1000、1500 s/mm^2)体素内不相干运动扩散加权成像扫描检查以及多b值(0、100、700、1400、2100 s/mm^2)DKI扫描检查。经Siemens第三方软件(DKI_tool_3_4)分别获得IVIM模型和DKI模型的参数值ADC值、D值、f值、D*值以及MK值、MD值。根据病理结果,将肿瘤分为良恶性骨肿瘤与软组织肿瘤,应用独立样本t检验分别比较良恶性骨肿瘤与软组织肿瘤的IVIM各参数及DKI各参数是否有统计学差异。P<0.05认为差异有统计学意义。利用受试者工作曲线(receiver operating characteristic curve,ROC)评估各参数的诊断效能。利用Logistic回归分析评估联合IVIM和DKI模型参数在鉴别良恶性骨与软组织肿瘤中的价值。结果在54例肿瘤患者中,骨肿瘤28例,其中良性组7例,恶性组21例,软组织肿瘤26例,其中良性组11例,恶性组15例。恶性骨肿瘤的ADC值、D值、MD值分别为(1.23±0.27)×10^(-3) mm^2/s、(1.12±0.22)×10-3 mm^2/s、(1.26±0.46)×10^(-3) mm^2/s,明显低于良性组(1.95±0.39)×10^(-3) mm^2/s、(1.78±0.42)×10^(-3) mm^2/s、(1.91±0.53)×10^(-3) mm^2/s,差异有统计学意义(P<0.05);f值(10.0%±3.98%)明显高于良性组(3.43%±2.99%),差异有统计学意义(P<0.05);MK值为(0.76±0.45)×10^(-3) mm^2/,明显高于良性组(0.36±0.22×10^(-3) mm^2/s),差异有统计学意义(P<0.05);恶性组和良性组的D*值分别为(9.72±4.89)×10^(-3) mm^2/s、(6.86±3.53)×10^(-3) mm^2/s),差异无统计学意义(P>0.05)。恶性骨肿瘤ADC、D、f、D*、MK、MD值的ROC曲线下面积(area under curve,AUC)分别为0.935、0.939、0.891、0.70Objective:To evaluate the value of magnetic resonance intravoxel incoherent motion(IVIM)and diffusion kurtosis imaging in the differential diagnosis of benign and malignant bone and soft tissue tumors of lower extremity.Materials and Methods:We collected 54 patients who underwent lower extremity MRI examination found bone or soft tissue masses in the radiology department of our hospital in November 2016 to January 2018.All patients underwent IVIM scan with 14 b values(0,10,20,30,40,50,75,100,150,200,400,800,1000,1500 s/mm^2)and DKI scan with 5 b values(0,100,700,1400,2100 s/mm^2)and routine MRI examination with a 3.0 T MR scanner.IVIM and DKI parameters including ADC,D,D*,f,MK,MD values were measured at a workstation.Patients were divided into benign and malignant bone and soft tissue tumors according to pathological results.Independent two-samples t test was used to evaluate those parameters in differentiating benign and malignant bone and soft tissue tumors.ROC curves were used to evaluate the diagnostic performance of these parameters.Logistic analysis was used to evaluate the diagnostic performance when combinating the parameters of IVIM and DKI.Results:The ADC(1.23±0.27)×10^-3 mm^2/s),D(1.12±0.22)×10^-3 mm^2/s,MD(1.26±0.46)×10^-3 mm^2/s values of malignant bone tumors were statistically lower than that of benign bone tumors(1.95±0.39)×10^-3 mm^2/s,(1.78±0.42)×10^-3 mm^2/s,(1.91±0.53)×10^-3 mm^2/s(P<0.05).The f value of malignant tumors(10.0%±3.98%)was statistically higher than that of benign tumors(3.43%±2.99%)(P<0.05).The MK value[(0.76±0.45)×10^-3 mm^2/s]was statistically higher than that of benign tumors[(0.36±0.22)×10^-3 mm^2/s],(P<0.05).There were no significant difference between D*value of benign and malignant tumors(P>0.05).The area under the ROC curves of ADC,D,f,D*,MK,MD were 0.935,0.939,0.891,0.701,0.840,0.844.When the optimal threshold of ADC,D,MK and MD was 1.64×10^-3 mm^2/s,1.45×10^-3 mm^2/s,0.56×10^-3 mm^2/s,1.86×10^-3 mm^2/s,the corresponding diagnostic sensitivity and s

关 键 词：骨肿瘤 软组织肿瘤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.6[医药卫生—诊断学]