DCE-MRI和DWI对骶骨脊索瘤与骨巨细胞瘤的鉴别诊断价值

摘要

目的:探讨磁共振动态增强(DCE-MRI)和扩散加权成像(DWI)对骶骨脊索瘤与骨巨细胞瘤的鉴别诊断价值.方法:回顾性分析31例经病理证实的骶骨肿块(脊索瘤15例,骨巨细胞瘤16例)磁共振DWI和DCE-MRI表现,观察病灶大小、信号特征、强化方式,统计ADC值、时间-信号曲线(TIC)类型、达峰时间(TTP)、最大对比增强率(MCER)、增强峰值(EP),分别比较两组参数(ADC、 TTP、MCER、EP),以病理结果为金标准,绘制ROC曲线并计算曲线下面积(AUC).结果:ADC、MC-ER、EP鉴别诊断骶骨脊索瘤与骨巨细胞瘤的敏感度、特异度分别为80％、93. 7％; 75％,100％; 91. 7％、86. 7％.三种参数 AUC分别为0. 858;0. 883;0. 950.脊索瘤 TIC曲线 I型13例(86. 7％),Ⅱ型2例(13. 3％);骨巨细胞瘤TIC曲线例Ⅱ型5例(41. 7％), I型7例(58. 3％).结论:DWI和DEC-MRI有助于骶骨脊索瘤与骨巨细胞瘤的鉴别诊断.%Objective:To investigate the value of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) in the differential diagnosis of chordoma and bone giant cell tumor of sacrum. Methods: DWI and DCE-MRI features of 31 patients with sacral mass proven by pathology (chordoma, 15 cases: bone giant cell tumor, 16 cases) were retrospectively analyzed. The size, signal characteristics and dynamic enhancement type of lesions were evaluated. The parameters including statistical apparent diffusion coefficient (ADC) value, type of time signal intensity curve (TIC), time to peak (TTP), maximum contrast enhancement ratio (MCER), enhancement peak (EP) were studied, and the parameters of ADC, TTP, MCER, EP were respectively compared between the two groups. Taking the pathology diagnosis as golden standard, the ROC curve was drawn, and the area under the curve (AUC) was calculated. Results: The sensitivity and specificity of DWI (ADC), DCE-MRI (MCER,EP) were 80％ and 93. 7％,75％ and 100％,91. 7％ and 86. 7 respectively, in differentiating sacral chordoma and bone giant cell tumor. The AUC of three parameters were 0. 858, 0. 883, 0. 950, respectively. In patients of chordoma, type I TIC curve was found in 13 cases (86. 7 ％), type Ⅱ was found in 2 cases (13. 3％),in patients of bone giant cell tumor,type Ⅱ TIC curve was found in 5 cases (41. 7％), type Ⅱ was found in 7 cases (58. 3％). Conclusion: DWI and DEC-MRI might be helpful in the differential diagnosis of sacral chordoma and bone giant cell tumor in children.