定量与半定量动态增强MRI鉴别甲状腺良恶性结节的临床价值  

The Role of Quantitative and Qualitative DCE⁃MRI in Distinguishing Benign and Malignant of Thyroids Nodules

作　　者：陶全 吕意凡 徐红[2] 陈克敏[3] 张贵祥 周永明[1] 韩善花 王明明[1] 惠俊国 罗禹 TAO Quan;LÜYifan;XU Hong;CHEN Kemin;ZHANG Guixiang;ZHOU Yongming;HAN Shanhua;WANG Mingming;HUI Junguo;LUO Yu(Department of Radiology,Shanghai Fourth People's Hospital,School of Medicine,Tongji University;Department of Surgery,Shanghai Fourth People's Hospital,School of Medicine,Tongji University;Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine)

机构地区：[1]同济大学附属上海市第四人民医院放射影像科 [2]同济大学附属上海市第四人民医院外科 [3]上海交通大学附属瑞金医院放射影像科

出　　处：《中国医学计算机成像杂志》2022年第1期38-43,共6页Chinese Computed Medical Imaging

基　　金：上海市卫生和计划生育委员会科研课题(20164Y0271)。

摘　　要：目的:研究动态增强MRI定量与半定量参数在鉴别甲状腺结节良、恶性的临床价值。方法:收集2017—2020年在同济大学附属上海市第四人民医院接受甲状腺手术治疗,且术前均行动态增强MRI检查病例30例。共51个甲状腺结节入组,按病理结果分为良、恶性两组,良性结节35枚,恶性结节16枚。利用西门子后处理工作站对结节同一个感兴趣区域进行定量与半定量模型计算,定量指标包括容积转运常数(Ktrans)、速率常数(Kep)、血管外细胞外容积分数(Ve)、造影剂到达后60 s内曲线下初始面积(iAUC),半定量指标包括每分钟浓度流入增加量(wash⁃in)、每分钟浓度流出变化率(wash⁃out)、造影剂达到最大浓度时间(TTP)、造影剂到达时间(AT)、峰值增强强度(PEI)、iAUC。结果:恶性甲状腺结节组定量指标Ktrans、Kep、Ve、iAUC值明显小于良性甲状腺结节组(P<0.05,其中Ktrans、iAUC值P<0.001)。恶性甲状腺结节组半定量指标wash⁃in、wash⁃out、PEI、iAUC值明显小于良性甲状腺结节组(P<0.001);TTP与AT值在良恶性组之间差异无统计学意义。Ktrans、Kep、Ve、定量iAUC、wash⁃in、wash⁃out、PEI、半定量iAUC各指标单独鉴别甲状腺结节的曲线下面积分别为0.839、0.727、0.780、0.848、0.871、0.850、0.855、0.871。两个模型约登指数最高的分别是Ktrans(0.675)和wash⁃in(0.761),最佳诊断阈值为0.385、1.111。结论:动态增强MRI可应用定量指标Ktrans、iAUC和半定量指标wash⁃in、wash⁃out、PEI、iAUC对甲状腺结节的良、恶性进行鉴别诊断,其中Ktrans和wash⁃in的诊断效果更好。Purpose:To study the clinical value of quantitative and semi-quantitative parameters of dynamic contrast-enhanced MRI in identifying benign and malignant thyroid nodules.Methods:Thirty cases of patients with thyroid nodules(n=51)who undergoing surgical treatment from 2017 to 2020 at Shanghai Fourth People's Hospital were collected,and dynamic contrast-enhanced MRI was performed pre-operatively.A total of 51 thyroid nodules were enrolled and divided into two groups of benign and malignant according to pathological findings,including 35 nodules in the benign group and 16 nodules in the malignant group.The quantitative and semi-quantitative models were calculated using a Siemens post-processing workstation on the same region of interest of the nodules,yielding quantitative indices,including volume transfer constant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve)and the initial area under the enhancement curve(iAUC),and semi-quantitative indices,including washin,wash-out,time to peak(TTP),arrival time(AT),peak enhancement intensity(PEI)and iAUC.Results:The values of Ktrans,Kep,Ve and iAUC in the malignant thyroid nodule group were significantly smaller than those in the benign thyroid nodule group(P<0.05,P<0.001 for Ktrans and iAUC).the semi-quantitative indicators wash-in,wash-out,PEI and iAUC were significantly smaller in the malignant thyroid nodule group than in the benign thyroid nodule group(P<0.001);there was no difference between the benign and malignant groups in TTP and AT values.The area under the ROC curve of Ktrans,Kep,Ve,quantitative iAUC and wash-in,wash-out,TTP,PEI and semi-quantitative iAUC for identifing thyroid nodules were 0.839,0.727,0.780,0.848,0.871,0.850,0.855,and 0.871 respectively.The two models with the highest Youden indices were Ktrans(0.675)and wash-in(0.761),respectively,with optimal diagnostic thresholds of 0.385 and 1.111.Conclusion:Dynamic contrast-enhanced MRI may identify benign and malignant thyroid nodules,and may make quantitative diagnosis,among which

关 键 词：甲状腺结节 动态对比增强 磁共振 定量分析 半定量分析 

分 类 号：R445.2[医药卫生—影像医学与核医学]