动态增强MRI鉴别鼻腔良性内翻乳头状瘤和其恶变的价值  

The value of dynamic enhanced MRI imaging in the differential diagnosis between benign IP and IP malignant transformation

作　　者：于京隔 闫浩[2] 刘延军 刘鹏涛 夏爽[3] YU Jingge;YAN Hao;LIU Yanjun;LIU Pengtao;XIA Shuang(Department of Radiology,the Third People's Hospital of Dezhou,Dezhou 253500,China;Department of E.N.T,Dezhou People's Hospital,Dezhou 253014,China;Department of Radiology,Ttanjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]德州市第三人民医院影像科,山东德州253500 [2]德州市人民医院耳鼻喉科,山东德州253014 [3]天津市第一中心医院放射科,天津300192

出　　处：《实用放射学杂志》2019年第3期362-366,共5页Journal of Practical Radiology

摘　　要：目的探讨DCE-MRI鉴别鼻腔良性内翻乳头状瘤(IP)和其恶变的价值。方法选取2012年1月至2018年1月行鼻腔平扫及DCE-MRI检查,并经手术及病理证实的鼻腔IP患者24例,其中良性IP组14例,IP恶变组10例。分析2组患者的动态增强参数,容积转移常数(K^trans),反流速率常数(Kep),血管外细胞外间隙容积分数(Ve)及初始曲线下面积(iAUC)及ADC值的差别,评价不同参数在鉴别良性IP和IP恶变的敏感性和特异性。结果良性IP组和IP恶变组的年龄、性别无统计学差别。良性IP和IP恶变的脑回样改变,2组之间有明显统计学差异(P=0.004)。2组在分期中无统计学差异(P=0.136)。良性IP组和IP恶变组的K^trans值分别为(0.21±0.53) min^-1、(0.36±0.93)min^-1,2组之间有显著统计学差异(P=0.000)。良性IP组和IP恶变组的iAUC值分别为29.05±5.45,41.14±9.47,2组间iAUC值差别有统计学意义(P=0.001)。良性IP和IP恶变的Kep、Ve无显著统计学差异(P>0.05)。结论良性IP的典型MRI表现为脑回状强化,脑回状强化的消失提示IP恶变。病变分期无法鉴别良性IP和IP恶变。DCE-MRI检查在评价良性IP和IP恶变中有很重要的价值,尤其是K^trans和iAUC。Objective To investigate the value of DCE-MRI imaging in differentiating malignant transformation inverted papilloma (IP) from benign IP. Methods 24 cases of IP confirmed by operation and pathology were collected from January 2012 to January 2018, including 14 cases with benign IP and 10 patients with IP malignant transformation.The dynamic enhancement parameters of the two groups, the product of transfer constant ( K^trans), the reflux rate constant (K^trans), the extra vascular extracellular space volume fraction ( Ve) and the differenee of the area under the initial curve (iAUC) were analyzed.The sensitivity and specificity of different parameters in the identification of benign IP and IP malignancy transformation were evaluatetl. Results There were differences no significant difference in age and sex between benign IP group and IP malignant transformation group.There was a significant difference about the convoluted cerebriform pattern between the two groups ( P =0.004 ).There was no significant difference of staging between the two groups (P = 0.136).The K^rans values of benign IP group and IP malignant transformation group were 0.21 ±0.53 ( min 1 ), 0.36±0.93 ( min 1 ),and there was a significant difference between the two groups (P =0.000).The iAUC values of benign IP group and IP malignant transformation group were 29.05i5.45,41.14zt9.47, respectively, a nd the difference of iAUC between two groups was statistically significant (P = 0.001).There was no significant difference in Kvp and Vt. between benign IP from IP malignant transformation(P>0.05).Conclusion Benign IP has a typical convoluted cerebriform pattern and the absence of it indicates malignant transformation.The staging of lesion can'i differentiate the benign IP from IP malignant transformation.DCE-MRI examination is worthy in the evaluation benign IP and IP malignant transformation, especially K^trans and iAUC values.

关 键 词：鼻腔 内翻乳头状瘤 磁共振成像 动态对比增强检查 

分 类 号：R739.62[医药卫生—肿瘤] R445.2[医药卫生—临床医学]