快速对比增强MRI诊断良恶性软骨肿瘤价值探究.docVIP

快速对比增强MRI诊断良恶性软骨肿瘤价值探究 　 作者：初继栋，宋敏，宋善军，高维仁 【摘要】 目的：探讨利用快速对比增强MRI鉴别良恶性软骨肿瘤。方法：37例患者中，有8例内生软骨瘤，11例骨软骨瘤，18例软骨肉瘤。对其进行快速对比增强MRI扫描，按开始出现强化的时间不同分为：早期增强—动脉强化后10 s内开始强化；进展期增强—动脉强化后10 s~2 min之间；延迟期增强—动脉强化5 min后。结果显示与27例外科手术标本、3例刮除物标本和7例活检标本，结合长期随访结果和组织病例诊断相互关联。结果：强化的开端同良恶性肿瘤存在显著相关性(Plt;0.001)。早期增强可出现在软骨肉瘤病例中，亦出现在骺板未融合的骨软骨瘤病例中，但不出现在内生型软骨瘤中。诊断恶性软骨肿瘤的敏感度为89%，特异性为84%，阳性预测值为84%，阴性预测值为89%。结论：快速对比增强MRI成像有助于鉴别成人的良恶性软骨肿瘤。 【关键词】 快速对比增强；MRI；软骨肉瘤；骨软骨瘤；内生型软骨瘤；扰相GRE序列；软组织 　　Study on Diagnostic Value of Fast Contrast Materialenhanced MRI between Benign and Malignant Cartilaginous Tumors 　　Abstract: Objective To differentiate between benign and malignant cartilaginous tumors with fast contrast materialenhanced magnetic resonance(MR) imaging. Methods In 37patients, fast contrastenhancedMR images were obtained in eight enchondromas,11 osteochondromas, and 18 chondrosarcomas. Start of enhancement—early, within 10seconds after arterial enhancement; delayed enhancement, between 10 seconds and 2 minutes;late, after 5 minuteson spinecho images. Findings were correlated with the surgical specimen in 27 cases, curettage material in three cases, and biopsy sample in seven cases. Results Start of enhancement correlated significantly(Plt;0.001) with benign and malignant tumors. Early enhancement was seen in chondrosarcoma, not seen in enchondroma, and seen in osteochondroma only when growth plates were unfused. The sensitivity was 89%, specificity 84%, positive predictive value 84%,and negative predictive value 89%. Conclusion Preliminary results show that in the adult population fast contrastenhanced MRI imaging may assist in differentiation between benign and malignant cartilaginous tumors. 　　Key words: Fast contrastenhanced; MRI; Chondrosarcoma; Enchondroma; Osteochondroma; Magnetizationprepared GRE, Soft tissues 　　典型软骨肿瘤很容易在X线片上识别，但是良性和低度恶性软骨肿瘤的鉴别仍是一个临床难题，亦是放射学和组织学的挑战。通常，通过临床、影像学检查和组织学表现来综合诊断。尽管高度恶性的软骨肿瘤具备特征性的X线表现，但仍有很多低度恶性软骨肿瘤很难与内生型软骨瘤区别。区别良性和低度恶性软骨肿瘤的临床意义在于，良性病变一般不需要外科手术，但对于软骨肉瘤唯一有效的治疗措施是切