动态增强MRI鉴别长骨中心型高低级别软骨肉瘤的价值  

The value of dynamic enhancement MRI in distinguishing high-grade from low-grade chondrosarcoma in long bones

作　　者：谭敏仪 曾燕妮 袁强[1] 吴志成[1] 严宗伟[1] TAN Minyi;ZENG Yanni;YUAN Qiang;WU Zhicheng;YAN Zongwei(Department of Radiology, Huadu Distinct People’s Hospital of Guangzhou, Guangzhou 510800, China)

机构地区：[1]广州市花都区人民医院放射科

出　　处：《国际医学放射学杂志》2019年第5期526-530,共5页International Journal of Medical Radiology

摘　　要：目的探讨可否通过常规MRI和动态增强时间信号强度曲线(TIC)鉴别高、低级别软骨肉瘤。方法回顾性分析38例经手术病理证实的长骨中心型软骨肉瘤病人。低级别组20例,男女各10例,平均年龄(48±8)岁;高级别组18例,男8例,女10例,平均年龄(61±7)岁。全部病人均行常规MRI和动态增强MRI(DCE-MRI)检查,对肿瘤MRI影像征象进行评估,包括标准MRI影像和通过后处理软件观察肿瘤的强化模式和TIC类型。采用t检验比较2组肿瘤最长径,Fisher精确检验比较高低级别软骨肉瘤组间TIC类型分布差异。结果低级别组和高级别组的肿瘤最长径分别为(7.3±5.8) cm、(13.1±6.4) cm,差异有统计学意义(t=3.084,P=0.004)。低级别软骨肉瘤的肿瘤强化程度轻且强化缓慢,边缘轻度线状强化或无明显强化, TIC曲线分布以Ⅰ型(13例,65.0%)、Ⅱ型(5例,25.0%)为主。高级别软骨肉瘤早期即出现结节状、花环状显著强化,强化持续时间长,TIC曲线分布以Ⅱ型(4例,22.2%)、Ⅲ型(11例,61.1%)为主。2组TIC分布差异具有统计学意义(P=0.02)。结论常规MRI和动态增强MRI是鉴别长骨高低级别软骨肉瘤的重要辅助手段,可有助于鉴别高低级别软骨肉瘤。Objective To explore whether it is possible to distinguish high-grade from low-grade chondrosarcoma in long bones via standard MRI and dynamic enhanced time intensity curve(TIC). Methods Thrity-eight cases with long bone central chondrosarcoma confirmed by surgery and pathology were retrospectively analyzed, including 10 males and 10 females(age, 48±8 years) in low-grade group, and 8 males and 10 females(age, 61±7 years) in high-grade group. All patients underwent MRI examinations. Imaging protocol included standard MRI and dynamic enhanced MRI(DCE-MRI). Tumor enhancement patterns and TIC types were determined with post-processing software. Comparing the longest diameter of the tumor and TIC type distribution between low and high grade chondrosarcomas respectively by t test and Fisher test. Results The mean maximum diameter of tumor in the low and high grade groups were 7.3 ±5.8 cm and 13.1 ±6.4 cm, respectively,which were statistically significant between the two groups(t =3.084,P =0.004). In the low grade group, the enhancement extent of tumor was light and slow, and the edge of chondrosarcoma was enhanced linearly or without obvious enhancement;the distributions of TIC were mainly types Ⅰ(13, 65.0%) and Ⅱ(5, 25.0%). In the high grade group, tumors appeared nodular or flower ring-like strong enhancement and slow washout;the distributions of TIC were mainly types Ⅱ(4, 22.2%)and Ⅲ(11, 61.1%). The difference in TIC distribution was statistically significant between the two groups(P =0.02).Conclusion Conventional MRI and DCE-MRI are important auxiliary means for differentiating high and low grade chondrosarcoma of long bones.

关 键 词：动态增强 磁共振成像 时间信号强度曲线 软骨肉瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.3[医药卫生—诊断学]