MRI动态增强扫描对脊柱结核和脊柱转移瘤的鉴别诊断价值

发布时间：2018-01-19 05:30

本文关键词： 结核脊柱脊柱肿瘤磁共振成像图像增强诊断鉴别　出处：《中国医学影像学杂志》2015年05期 　论文类型：期刊论文

【摘要】：目的探讨MR T1WI动态增强成像半定量和定量分析对脊柱结核和脊柱转移瘤的鉴别诊断价值,提高术前影像诊断准确性。资料与方法对24例脊柱结核和22例脊柱转移瘤进行MR T1WI动态增强扫描,对图像后处理分析得到的时间-信号强度曲线、上升期病变信号强度增幅、最大上升线性斜率及应用双室药物代谢动力学分析获得的血管通透性常数(Ktrans)和转运常数(kep)进行比较。结果 24例脊柱结核患者中,仅1例(4.2%)呈速降型曲线,12例(50.0%)呈平台型,11例(45.8%)呈持续增强型;22例脊柱转移瘤中,12例(54.5%)呈速降型曲线,7例(31.8%)呈平台型曲线,3例(13.6%)呈持续增强型曲线。脊柱结核组和脊柱转移瘤组信号强度增幅[(198±81)%与(165±60)%]、时间-信号强度曲线最大上升线性斜率[(100±55)%与(111±41)%]和Ktrans[(0.077±0.036)/min与(0.077±0.028)/min]差异均无统计学意义(t=1.56、0.76、0,P0.05)。脊柱结核组kep明显低于转移瘤组[(0.270±0.015)/min与(0.490±0.023)/min,t=38.74,P0.001]。结论MR T1WI动态增强成像可以为表现不典型、常规MRI检查不易鉴别的脊柱结核和脊柱转移瘤的鉴别诊断提供一定的参考。
[Abstract]:Objective to evaluate the value of semi-quantitative and quantitative analysis of Mr T1WI dynamic contrast-enhanced imaging in the differential diagnosis of spinal tuberculosis and spinal metastases. Materials and methods 24 cases of spinal tuberculosis and 22 cases of spinal metastases were examined by dynamic enhanced Mr T 1WI. The time-signal intensity curve obtained by image post-processing analysis, and the increase of signal intensity of ascending pathological changes. The maximum ascending linear slope and the vascular permeability constant (Ktrans) and transport constant (Kepp) obtained by bicompartment pharmacokinetic analysis were compared. Results 24 patients with spinal tuberculosis were compared. Only one case (4.2%) showed a rapid descending curve in 12 cases (50.0%) and a platform type in 11 cases (45.8%). In 22 cases of spinal metastases, 12 cases (54.5%) showed rapid descending curve and 7 cases (31.8%) showed plateau curve. The signal intensity increased in spinal tuberculosis and spinal metastases. [The maximum linear slope of time-signal intensity curve was obtained by means of 198 卤81% and 165 卤60% respectively. [100 卤55% and 111 卤41%] and Ktrans. [There was no significant difference between 0.077 卤0.036 / min and 0.077 卤0.028 / min. The kep of spinal tuberculosis group was significantly lower than that of metastatic tumor group. [0.270 卤0.015 / min and 0.490 卤0.023 / min / min respectively. Conclusion dynamic contrast-enhanced Mr T _ 1WI can provide some reference for differential diagnosis of spinal tuberculosis and spinal metastases which are not typical and difficult to differentiate by conventional MRI.
【作者单位】：北京大学第三医院放射科;美国加利福尼亚大学Tu&Yun肿瘤功能成像中心;
【基金】：国家自然科学基金项目(81471634)
【分类号】：R529.2;R738;R445.2
【正文快照】： 椎体转移瘤与脊柱结核是比较常见的疾病,脊柱结核和脊柱转移瘤在影像学上均表现为椎体骨质破坏和局部肿块影,均可以多发或单发。如果病变影像学表现典型,通过椎间盘是否受累、周围软组织为脓肿或软组织肿块可以较为容易地对两者进行鉴别诊断。然而,如果患者进行检查时病变处于

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