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目的:探讨及评价定量动态对比增强磁共振成像(qDCE-MRI)的药物代谢动力学参数在肺部良恶性病变诊断中的价值。方法:回顾性分析40例经病理学证实肺部占位性病变,行1.5T DCE-MRI检查,行血管参照模型和参考区域模型对比分析恶性、良性病变非参检验的定量参数。结果:在血管参照模型:良性病变组与恶性病变组间Ktrans、Kep、Ve、VP参数间无统计学差异,P>0.05。参考区域模型良性病变组与恶性病变组间RRKtrans、KepRR、KepTOI参数差异具有统计学意义(P<0.05);恶性病变组RRKtrans、KepRR、KepTOI高于良性病变组;TTP值在良性病变组中略高于恶性病变组,无显著性差异(P=0.94)。肺腺癌与肺鳞癌定量参数比较,鳞癌RRKtrans、KepRR、KepTOI较腺癌高,但无显著性差异。以病理结果为金标准绘制RRKtrans、KepRR、KepTOI三者ROC得到曲线下面积分别为0.946、0.827、0.855;三者最大约登指数为0.86、0.83、0.67;RRKtrans、kepRR、kepTOI判断肺部良恶性病变敏感度为96%、90%,73%,特异度为80%,76%、90%。定量参数与免疫组化相关性分析得出RRKtrans、KepRR、KepTOI值与MVD呈正相关性(P<0.01,r=0.872,0.838,0.714);与MVD表达亦呈正相关性(P<0.01,r=0.821,0.752,0.711)。结论:参考区域模型对肺部占位性病变良恶性作出鉴别诊断具有潜在的临床意义,DCEMRI定量参数可以预测标本MVD、VEGF水平。
Objective: To investigate and evaluate the value of quantitative dynamic contrast-enhanced magnetic resonance imaging (qDCE-MRI) pharmacokinetic parameters in the diagnosis of benign and malignant lung lesions. Methods: Forty patients with pathologically confirmed lung space-occupying lesions were studied retrospectively. The 1.5T DCE-MRI was performed to compare the non-parametric parameters of malignant and benign lesions with the reference model and vascular reference model. Results: In the vascular reference model, there was no significant difference in Ktrans, Kep, Ve and VP parameters between benign and malignant lesions (P> 0.05). The parameters of RRKtrans, KepRR and KepTOI between the benign and malignant lesions in the reference area model were statistically significant (P <0.05). The RRKtrans, KepRR and KepTOI in the malignant lesions were higher than those in the benign lesions. The TTP values were slightly higher in the benign lesions In the malignant group, there was no significant difference (P = 0.94). Lung adenocarcinoma and lung squamous cell carcinoma quantitative parameters, squamous cell carcinoma RRKtrans, KepRR, KepTOI higher than adenocarcinoma, but no significant difference. The pathological results as the golden standard to draw RRKtrans, KepRR, KepTOI three under the curve were ROC 0.946,0.827,0.855; the three maximum Youden index was 0.86,0.83,0.67; RRKtrans, kepRR, kepTOI to determine the benign and malignant lung Lesion sensitivity was 96%, 90%, 73%, specificity was 80%, 76%, 90%. Correlation analysis between quantitative parameters and immunohistochemistry showed that the values of RRKtrans, KepRR and KepTOI were positively correlated with MVD (P <0.01, r = 0.872,0.838,0.714), and positively correlated with MVD (P <0.01, r = 0.821, 0.752, 0.711). Conclusion: The reference regional model has potential clinical significance for the differential diagnosis of benign and malignant pulmonary space occupying lesions. The quantitative parameters of DCEMRI can predict the MVD and VEGF levels in the specimens.