动态对比增强MRI在肺癌与肺炎性病变鉴别中的价值  

Application value of dynamic contrast-enhanced MRI in differentiating lung cancer from pulmonary inflammatory lesions

作　　者：易自生[1] 李倩[1] 易鑫 郭美琴 熊敏[1] 范琴[1] 张木根[2] YI Zisheng;LI Qian;YI Xin;GUO Meiqin;XIONG Min;FAN Qin;ZHANG Mugen(Department of Radiology,the 907th Hospital of the Joint Logistic Support Force of the PLA,N anping,Fujian Province 353000,China;Department of Interventional Therapy,the 907th Hospital of the Joint Logistic Support Force of the PLA,N anping,Fujian Province 353000,China)

机构地区：[1]中国人民解放军第九〇七医院放射科,福建南平353000 [2]中国人民解放军第九〇七医院介入治疗科,福建南平353000

出　　处：《实用放射学杂志》2023年第3期384-387,共4页Journal of Practical Radiology

基　　金：福建省南平市科技局科研基金项目(2019J29)。

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)在肺癌与肺炎性病变鉴别中的价值。方法选取25例肺部病变患者,均经手术或穿刺活检病理证实,其中肺癌13例(鳞癌8例,腺癌4例,典型类癌1例),肺炎性病变12例(结核8例,真菌3例,炎症并脓肿1例)。采用DCE-MRI容量转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e))、增强曲线下初始面积(iAUC)对肺癌、肺炎性病变进行分析比较,采用受试者工作特征(ROC)曲线比较鉴别诊断的效能。结果肺癌K^(trans)、K_(ep)、iAUC分别为(0.152±0.226)min^(-1)、(0.496±0.113)min^(-1)、15.324±3.328,均高于肺炎性病变[(0.083±0.023)min^(-1)、(0.296±0.086)min^(-1)、9.537±3.672],两者有显著统计学差异(P<0.05)。肺癌与肺炎性病变V_(e)比较(0.315±0.111、0.315±0.088),两者无明显统计学差异(P>0.05)。不同定量或半定量参数具有鉴别诊断效能,K^(trans)、K_(ep)、V_(e)、iAUC的曲线下面积(AUC)分别为0.974、0.929、0.506、0.904。当K^(trans)界值为0.105 min^(-1)时,敏感性为100%,特异性为83.3%;当K_(ep)界值为0.393 min^(-1)时,敏感性为84.6%,特异性为91.7%;当V_(e)界值为0.385时,敏感性为23.1%,特异性为91.3%;当iAUC界值为12.802时,敏感性为84.6%,特异性为91.7%。结论DCE-MRI可以量化肺部病变血流动力学,其定量参数K^(trans)、K_(ep)及半定量参数iAUC有助于肺癌与肺炎性病变的鉴别。Objective To explore the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in differentiating lung cancer from pulmonary inflammatory lesions.Methods Tweny-five patients of lung lesions were selected and pathologically confirmed by operation or biopsy,including 13 cases of lung cancer(8 cases of squamous carcinoma,4 cases of adenocarcinoma,1 case of typical carcinoid),and 12 cases of pulmonary inflammatory lesions(8 cases of tuberculosis,3 cases of fungus,1 case of inflammation with abscess).DCE-MRI K^(trans),K_(ep),V_(e) and initial area under enhanced curve(iAUC)were used to analyze and compare lung cancer and pulmonary infammatory lesions,and receiver operating characteristic(ROC)curve was used to co m pare the efficacy of differential diagnosis.Results K^(trans),K_(ep) and iAUC of lung cancer were(0.152±0.226)min^(-1),(0.496±0.113)min^(-1) and 15.324±3.328,respectively,which were higher than those in pulmonary inflam m atory lesions[(0.083±0.023)min^(-1),(0.296±0.086)min^(-1),9.537±3.672],and there was significant statistical difference between them(P<0.05).There was no significant difference in V_(e) between lung cancer and pulmonary inflammatory lesions(0.315±0.111,0.315±0.088)(P>0.05).Different quantitative or semi-quantitative parameters had differential diagnostic efficacy.The area under the curve(AUC)of K^(trans),K_(ep),V_(e) and iAUC were 0.974,0.929,0.506 and 0.904,respectively.When the K^(trans) threshold was 0.105 min^(-1),the sensitivity and specificity were 100%and 83.3%,respectively.When the K_(ep) threshold was 0.393 min^(-1),the sensitivity and specificity were 84.6%and 91.7%,respectively.When the V_(e) threshold was 0.385,the sensitivity and specificity were 23.1%and 91.3%,respectively.When the iAUC threshold was 12.802,the sensitivity and specificity were 84.6%and 91.7%,respectively.Conclusion DCE-MRI can quantify hemodynamics of lung lesions,and its quantitative parameters K^(trans),K_(ep) and semi-quantitative parameters iAUC can help differentiating lung cancer

关 键 词：肺癌 肺炎性病变 动态对比增强磁共振成像 

分 类 号：R734.2[医药卫生—肿瘤] R563.1[医药卫生—临床医学] R445.2