MR T2W及T1W灌注对良恶性肌骨病变鉴别诊断价值.doc

MR T2W及T1W灌注对良恶性肌骨病变鉴别诊断价值 　【摘要】 目的 对比MR T2W与T1W灌注对良恶性肌骨病变鉴别诊断的效果, 评价MR T2W灌注的临床应用价值。 方法 94例良恶性肌骨病变先后行MR T1、T2W灌注，记录灌注曲线的形态、造影剂首过（FP）期信号最大增/降幅、信号强度-时间（SI-T）曲线最大斜率和造影剂首过时间。将2种灌注的曲线各分4型，并分别对良恶性病灶SI-T曲线的形态、FP期信号增/降幅、SI-T曲线最大斜率和首过时间进行统计学比较；采用ROC曲线法确定恶性诊断的阈值，计算敏感性、特异性和准确率。观察2种灌注方法显示的最高灌注区一致性程度。 结果 （1）T2W。Ⅰ型和Ⅳ型SI-T曲线在良恶性病变的鉴别中有一定参考价值，良恶性病变FP期信号最大降幅与SI-T曲线最大斜率及首过时间比较差别无统计学意义。（2）T1W。Ⅰ型SI-T曲线多见于恶性病灶，Ⅲ型、Ⅳ型SI-T曲线多见于良性病灶；良性病变的FP期信号增幅均值为29.20%，恶性病变均值为73.92%（P＜0.001）；良性病变的SI-T曲线最大斜率均值为3.49，恶性病变均值为9.57（P＜0.001）。（3）以首过增幅44.50%作为诊断恶性的界值，其敏感性为98.50%，特异性为86.70%，准确率为88.30%；以SI-T曲线最大斜率5.09作为恶性的界值，敏感性为96.20%，特异性为85.60%, 准确率为86.17%。2种研究方法显示最高灌注区位于同一区域14例（14.90%），不同区域80例（85.10%）。 结论 T2W灌注扫描鉴别良恶性肌骨病变的价值不如T1W灌注。MR T1W和T2W灌注扫描FP期信号变化可能是Gd-DTPA在血管内和血管外间隙共同作用的结果。 【关键词】 骨肿瘤； 软组织肿瘤； 磁共振成像； 灌注，局部； 诊断，鉴别 　 ABSTRACT: Objective Contrast-study the effects of MR T2W and T1W perfusion in differential diagnosis and of benign from malignant musculoskeletal lesions and to evaluate the clinical significance of T2W perfusion. Methods 94 patients with musculoskeletal lesions were performed MR T2W perfusion after T1W perfusion, shapes of time versus signal intensity(SI-T) curves，maximum variance as well as maximum slope of the curves and first pass(FP) time were recorded. SI-T curves were divided into four types both in T1 and T2W perfusion. Receive operrating characteristic curse(ROC) was used to determine the threshold of malignant, its sensitivity, specificity as well as accuracy were calculated respectively. The consistency of maximum perfusion areas of two methods was observed. Results Type Ⅰ and type Ⅳ curves of T2W perfusion can differentiate benign and malignant lesions on some extent. Maximum signal decrease, maximum slop of SI-T curves and FP time in T2W perfusion had no significant differences between benign and malignant lesions(P＞0.05). For T1W perfusion，on the other hand, most lesions with type Ⅰ SI-T curves were malignant, and most lesions of type Ⅲ or Ⅳ curves were benign. The average value of