DCE-MRI Extended tofts模型和Reference Region模型在肺部结节/肿块良恶性诊断中的应用价值
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摘要
目的对比分析定量动态增强磁共振(DCE-MRI)药代动力学Extended tofts模型与Reference Region模型应用于肺结节/肿块良恶性鉴别诊断中的价值。方法回顾性分析65例肺部结节/肿块(良性22例,恶性43例)病例资料,所有患者均在CT引导下行肺穿刺活检或手术前行DCE-MRI检查。分别应用Extended tofts和Reference Region模型测量良恶性肺结节/肿块的定量参数:容积转移常数K~(trans)(min~(-1))、组织间隙-血浆速率常数K_(ep)(min~(-1))、细胞外间隙容积分数V_e(mL)。采用独立样本t检验比较良恶性病变各定量参数之间的差异。以病理结果为金标准绘制ROC曲线评估定量DCE-MRI鉴别肺结节/肿块良恶性的诊断效能。结果 Extended tofts模型中K~(trans)、K_(ep)对肺部结节/肿块良恶性有鉴别意义(P<0.05)。Reference Region模型参数K~(trans)、K_(ep)在良恶性病变间差异无统计学意义。结论在时间分辨率较高的前提下,Extended tofts模型比Reference Region模型更适合应用于肺结节/肿块良恶性鉴别诊断,其定量参数K~(trans)较K_(ep)的诊断效能高。
Objective To investigate and compare the diagnostic values of Extended tofts model and Reference Region model in dynamic contrast enhancement magnetic resonance imaging(DCE-MRI) analysis of benign and malignant pulmonary nodules/masses. Methods For this study, we recruited retrospectively 65 patients with pulmonary nodules/masses(22 benign and 43 malignant) confirmed by pathological results who underwent DCE-MRI by 3.0 T MR. The quantitative MR pharmacokinetic parameters including K~(trans), K_(ep), and V_e were calculated by Extended tofts and Reference Region models. Results The parameters of Extended tofts model K~(trans) and K_(ep) were significant in differentiating benign and malignant nodules/masses(P<0.05), while the parameters of Reference Region models K~(trans) and K_(ep) did not differ significantly in the differentiation of benign and malignant ones. Conclusion On the premises of high temporal resolution, the Extended tofts model is more appropriate for the diagnosis of benign and malignant pulmonary nodules/masses than the Reference Region model, and its quantitative parameter K~(trans) has a higher diagnostic efficiency than K_(ep).
Objective To investigate and compare the diagnostic values of Extended tofts model and Reference Region model in dynamic contrast enhancement magnetic resonance imaging(DCE-MRI) analysis of benign and malignant pulmonary nodules/masses. Methods For this study, we recruited retrospectively 65 patients with pulmonary nodules/masses(22 benign and 43 malignant) confirmed by pathological results who underwent DCE-MRI by 3.0 T MR. The quantitative MR pharmacokinetic parameters including K~(trans), K_(ep), and V_e were calculated by Extended tofts and Reference Region models. Results The parameters of Extended tofts model K~(trans) and K_(ep) were significant in differentiating benign and malignant nodules/masses(P<0.05), while the parameters of Reference Region models K~(trans) and K_(ep) did not differ significantly in the differentiation of benign and malignant ones. Conclusion On the premises of high temporal resolution, the Extended tofts model is more appropriate for the diagnosis of benign and malignant pulmonary nodules/masses than the Reference Region model, and its quantitative parameter K~(trans) has a higher diagnostic efficiency than K_(ep).
引文
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[2] VLAHOS I,STEFANIDIS K,SHEARD S,et al.Lung cancer screening:Nodule identification and characterization[J].Transl Lung Cancer Res,2018,7(3):288-303.
[3] TOFTS PS.Modeling tracer kinetics in dynamicGd-DTPA MR imaging[J].J Magn Reson Imaging,1997,7(1):91-101.
[4] JACKSON A,O’CONNOR JP,PARKER GJ,et al.Imaging tumor vascular heterogeneity and angiogenesis using dynamic contrast-enhanced magnetic resonance imaging[J].Clin Cancer Res,2007,13(12):3449-3459.
[5] ZAHRA MA,HOLLINGSWORTH KG,SALA E,et al.Dynamic contrast-enhanced MRI as a predictor of tumour response to radiotherapy[J].Lancet Oncol,2007,8(1):63-74.
[6] CHEN J,QIAN T,ZHANG H,et al.Combining dynamic contrast enhanced magnetic resonance imaging andmicrovessel density to assess the angiogenesis after PEI in a rabbit VX2 liver tumor model[J].Magn Reson Imaging,2016,34(2):177-182.
[7] LI L,WANG K,SUN X,et al.Parameters of dynamic contrast-enhanced MRI as imaging markers for angiogenesis and proliferation in human breast cancer[J].MedSci Monit,2015,21:376-382.
[8] TOFTS PS,BRIX G,BUCKLEY DL,et al.Estimating kinetic parameters from dynamic contrast-enhanced T1-weighted MRI of adiffusable tracer:Standardized quantities and symbols[J].J Magn Reson Imaging,1999,10(3):223-232.
[9] YIN P,XIONG H,LIU Y,et al.Measurement of the permeability,perfusion,and histogram characteristics in relapsing-remitting multiple sclerosis using dynamic contrast-enhanced MRI with extended Tofts linear model[J].Neurol India,2018,66(3):709-715.
[10] SCHIMPF O,HINDEL S,LüDEMANN L.Assessment ofmicronecrotic tumor tissue using dynamic contrast-enhanced magnetic resonance imaging[J].Phys Med,2017,34:38-47.
[11] WANG H,SU Z,XU X,et al.Dynamic contrast-enhanced MR imaging in renal cell carcinoma:Reproducibility of histogram analysis on pharmacokinetic parameters[J].Sci Rep,2016,6:29146.
[12] LEE J,PLATT S,KENT M,et al.An analysis of the pharmacokinetic parameter ratios in DCE-MRI using the reference region model[J].Magn Reson Imaging,2012,30(1):26-35.
[13] 丁婕,朱蓉蓉,黄宁,等.动态对比增强不同时间分辨率下MRI线性参照模型和双室Tofts模型鉴别乳腺良、恶性病变的价值[J].中华放射学杂志,2015,49(11):828-832.
[14] 徐佳,文之,曹鹏,等.定量DCE-MRI在肺部良恶性病变诊断中的初步应用[J].武汉大学学报(医学版),2016,37(1):91-96.
[15] FENG F,QIANG F,SHEN A,et al.Dynamic contrast-enhanced MRI versus 18F-FDG PET/CT:Which is better in differentiation between malignant and benign solitary pulmonary nodules?[J].Chin J Cancer Res,2018,30(1):21-30.