摘要
目的探讨多体素氢质子 MR 波谱(~1H-MRS)在鉴别良恶性肌骨病变方面的应用价值。方法搜集经病理证实的骨与软组织良恶性病变患者47例,男28例,女19例。良性病变9例,恶性病变38例。所有病例在~1H-MRS 检查前均行动态和延迟增强扫描。统计动态增强扫描中 MR 信号强度-时间(SI-T)曲线最大线性斜率(5.09)鉴别良恶性病变的敏感度、特异度和准确度。将~1H-MRS 谱线分为2型:Ⅰ型,谱线中3.2 ppm(×10^(-6))处有明显的胆碱(Cho)峰;Ⅱ型,谱线中3.2 ppm处无明显的 Cho 峰。统计良恶性病变出现2种谱线的例数,并计算诊断良恶性病变的敏感度、特异度和准确度。结果 9例良性病变的 SI-T 曲线最大线性斜率范围为0.07～8.54,平均为3.48±2.30。38例恶性病变最大线性斜率范围为2.89～32.50,平均9.56±5.16,以5.09作为 SI-T 曲线最大斜率的良恶性病变界值时,诊断的敏感度为97.30%,特异度为80.00%,准确度为93.62%。47例中有42例多体素~1H-MRS 效果满意,9例良性病变中出现Ⅰ型谱线2例,Ⅱ型谱线7例;33例恶性肿瘤中出现Ⅰ型谱线27例,Ⅱ型谱线6例,良恶性谱线类型例数比较,χ~2=9.13,P<0.01。Ⅰ型谱线诊断恶性肿瘤的敏感度为93.10%,特异度为53.80%,准确度为80.95%;若不计钙化、骨化成分较多的6例,则敏感度为93.10%,特异度为100%,准确度为94.44%。结论 ~1H-MRS谱线的类型对评价肌骨病变的生物学活性价值较高,对钙化和骨化较少的病变良恶性的鉴别效果与 MR 动态增强扫描的效果相当。
Objective To investigate the value of ^1H-MRS in differential diagnosis of benign from malignant musculoskeletal lesions primarily. Methods Forty-seven patients including 28 males and 19 females with bone and soft tissue lesions （9 benign and 38 malignant） were researched. All patients were performed MR dynamic and delay enhancement scan before ^1H-MRS. Diagnostic sensitivity, specificity and accuracy of maximal slope value 5.09 of SI-T curves in differential diagnosis of benign and malignant were calculated . Two types of ^1H-MRS curves were found, there was identifiable choline apex at 3. 2ppm in Type Ⅰ , and no obvious choline apex at the same position in Type Ⅱ , X^2 test was performed between the number of benign and malignant lesions. Results The average maximal slope value ± Std. deviation of 9 benign lesions was 3.48 ± 2. 30, range 0. 07-8. 54, the average maximal slope value ± Std. deviation of 38 malignant lesions was 9. 56 ± 5. 16, range 2. 89-32. 50. With maximal slope value 5.09 as the threshold of malignant in MR dynamic enhancement, the diagnostic sensitivity was 97. 30%, specificity was 80.00% and accuracy was 93.62%. 42 of the 47 eases acquired satisfactory ^1 H-MRS. Type Ⅰ ^1 H-MRS was found in 2 benign and 27 malignant, and type Ⅱ ^1 H-MRS was found in 7 benign and 6 malignant. Numbers of different type of ^1H-MRS was compared between benign and malignant, X^2 =9. 13 P 〈0. 01. Making Type Ⅰ ^1H-MRS curve as standard of malignant, the sensitivity was 93.10%, specificity was 53. 80% and accuracy was 80. 95%. If the 6 lesions with much ealeiiieation or ossification were excluded, the sensitivity,specificity and accuracy became 93. 10%, 100% and 94. 44%. Conclusion Type of ^1 H-MRS was valuable for identifying biological activity of musculoskeletal lesions. For lesions with little or no calcification or ossification, the differential effect of benign from malignant was correspond to that of MR dynamic enhancement.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2007年第3期264-268,共5页
Chinese Journal of Radiology
关键词
骨肿瘤
软组织肿瘤
磁共振波谱学
诊断
鉴别
Bone neoplasm
Soft tissue neoplasm
Magnetic resonance spectroscopy
Diagnosis, differential
