显微镜高分辨率MRI鉴别皮肤良、恶性局灶隆起性结节  

Differentiation of benign and malignant skin focal protuberant nodules using microscope high-resolution MRI

作　　者：靳新娟 蔡大幸[2] 范金蕾 邓展昊 李楠[2] 于德新[1] 李安宁[1] JIN Xinjuan;CAI Daxing;FAN Jinlei;DENG Zhanhao;LI Nan;YU Dexin;LI Anning(Department of Radiology,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Dermatology,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Imaging,Yantaishan Hospital,Yantai 264001,Shandong,China)

机构地区：[1]山东大学齐鲁医院放射科,山东济南250012 [2]山东大学齐鲁医院皮肤科,山东济南250012 [3]烟台市烟台山医院放射科,山东烟台264001

出　　处：《山东大学学报（医学版）》2023年第12期51-61,共11页Journal of Shandong University:Health Sciences

摘　　要：目的探讨显微镜高分辨磁共振成像(MHR-MRI)在皮肤局灶隆起性结节良、恶性鉴别中的价值。方法对2020年4月至2023年4月于山东大学齐鲁医院就诊并行术前MHR-MRI检查的45例皮肤局灶隆起性结节进行前瞻性分析。根据术后病理结果将其分为良性组(n=19)和恶性组(n=26)。分别对两组病灶的MHRMRI特征进行测量及评估,并对良、恶性组,以及基底细胞癌、隆突性皮肤纤维肉瘤和鳞癌三个类型之间的差异进行比较,计算其诊断恶性皮肤局灶隆起性结节的灵敏度、特异度、约登指数、受试者工作特征曲线下面积(AUC)及联合诊断效能。结果在恶性组,MHR-MRI显示病灶更易出现尖角楔入征(P<0.001)、累及表皮真皮(P<0.001)、边界不清(P=0.003),以及存在周围血管(P=0.003),综合影像指标(尖角楔入征阳性、侵犯表皮真皮、边界不清、T2WI高信号、合并周围血管)诊断恶性局灶隆起性结节的约登指数为0.909(灵敏度为0.962,特异度为0.947),AUC值为0.995。在基底细胞癌、隆突性皮肤纤维肉瘤、鳞癌之间,MHR-MRI显示基底细胞癌及隆突性皮肤纤维肉瘤的宽基底特征较鳞癌更多见(P=0.021),隆突性皮肤纤维肉瘤和鳞癌比基底细胞癌更常出现尖角楔入征(P=0.001)。结论MHR-MRI作为一种新型的皮肤高清成像方法,有助于皮肤良、恶性局灶隆起性结节及常见恶性肿瘤的鉴别。Objective To explore the value of microscope high-resolution magnetic resonance imaging(MHR-MRI)in the differentiation of benign and malignant skin focal protuberant nodules.Methods A total of 45 patients with skin focal protuberant nodules admitted to Qilu Hospital of Shandong University during April 2020 and April 2023 and examined with preoperative MHR-MRI were prospectively analyzed.Based on pathological results,they were divided into benign group(n=19)and malignant group(n=26).The MHR-MRI characteristics of the lesions in the two groups were assessed.Differences between the benign and malignant groups,and among basal-cell carcinoma,protuberant skin fibrosarcoma and squamous cell carcinoma were compared.The sensitivity,specificity,Youden index and the area under the operating characteristic curve(AUC)and diagnostic efficiency of MHR-MRI were calculated.Results Lesions in the malignant group were more commonly characterized by sharp-angle-wedge sign(P<0.001),involvement of the epidermis and dermis(P<0.001),unclear boundaries(P=0.003),and the presence of surrounding vessels(P=0.003).The Youden index for a combined imaging parameters(sharp-angle-wedge sign,invasion of the epidermis and dermis,poorly defined borders,high signal intensity on T2WI,and combination of peripheral vessels)was 0.909(sensitivity 0.962,specificity 0.947)with an AUC of 0.995.The basal-cell carcinoma and protuberant skin fibrosarcoma were more often characterized by a wide base of the focus than the squamous cell carcinoma on MHR-MRI(P=0.021).The protuberant skin fibrosarcoma and squamous cell carcinoma were more often associated with sharp-angle-wedge sign than basal-cell carcinoma(P=0.001).Conclusion MHR-MRI is helpful in the differentiation of benign and malignant skin focal protuberant nodules and common malignant tumors.

关 键 词：皮肤局灶隆起性结节 显微镜高分辨磁共振成像 良恶性 鉴别诊断 

分 类 号：R751[医药卫生—皮肤病学与性病学]