阳性亲淋巴对比剂增强MR淋巴成像对淋巴结病变的诊断价值
양성친림파대비제증강MR림파성상대림파결병변적진단개치
Evaluation of MR lymphography with positive lymphotropic contrast agent in diagnosing lymph node lesions
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2010年 4期 434-439 ,共6页

    周正扬%俞海平%陈君坤%朱斌

    주정양%유해평%진군곤%주빈

    淋巴造影术%造影剂%磁共振成像%肿瘤转移%炎症 淋巴造影術%造影劑%磁共振成像%腫瘤轉移%炎癥
    림파조영술%조영제%자공진성상%종류전이%염증
    Lymphography%Contrast media%Magnetic resonance imaging%Neoplasm metastasis%Inflammation
    目的 探讨大分子阳性亲淋巴对比剂在间质MR淋巴成像中对肿瘤转移、炎性增生淋巴结的鉴别诊断价值.方法 采用18只纯种新西兰大白兔,体质量2.0～2.5 kg.在其中9只兔一侧后肢各趾蹼处注射完全型免疫佐剂,用于建立腘窝淋巴结炎性增生模型(炎性增生组);另9只兔一侧后肢肌肉接种VX~2瘤建立腘窝淋巴结肿瘤转移模型(肿瘤转移组).对侧正常腘窝淋巴结作为对照.各组每只兔接种前后行MR淋巴成像检查.将0.2 ml二氨基乙基乙二醇醚-DTPA酰胺共聚物钆配合物(Gd-poly-DTPA-EOEA)注入各组每只兔双侧后肢足背部各趾蹼处的皮下.在注射对比剂前后分别进行3D T_1WI扫描和MIP图像重组.在增强3D MIP图像上测量每一腘窝淋巴结短轴最大径(MSAD),在每只兔胭窝淋巴结中选取直径最大者测量其延迟扫描各观察时点的信噪比(SNR).采用成组设计t检验比较炎性增生组与肿瘤转移组腘窝淋巴结接种后MSAD的差异和每一观察时点炎性增生组、肿瘤转移组、正常对照侧腘窝淋巴结间的SNR差异.分析各组腘窝淋巴结的MR淋巴成像图像,并与病理检查相对照.结果 肿瘤组2只兔接种未成功,其他模型形成良好.13个炎性增生、11个肿瘤转移腘窝淋巴结的MSAD分别为(1.32±0.14)cm和(1.33±0.12)cm,差异无统计学意义(t=0.186,P＞0.05).延迟扫描5、15、30、60、90、120 min,9个炎性增生腘窝淋巴结与正常对照侧腘窝淋巴结的SNR值分别为17.31±0.37和17.19±0.29、27.42±0.50和27.39±0.48、38.44±0.47和38.19±0.27、37.10±0.09和36.97±0.10、36.32±0.61和36.20±0.80、34.60±0.44和34.71±0.32,两组间各对应时点SNR值的差异均无统计学意义(t值分别为0.78、0.14、1.43、1.00、0.36、-0.62,P值均＞0.05).7个肿瘤转移腘窝淋巴结和正常对照侧腘窝淋巴结的SNR值分别为6.00±0.22和17.21±0.28、7.87±0.16和27.17±0.23、8.14±0.24和38.16±0.19、8.09±0.28和36.94±0.30、7.59±0.20和35.96±0.72、7.50±0.14和34.81±0.27,两组间各对应时点SNR值的差异均有统计学意义(t值分别为-84.00、-182.72、-261.27、-186.48、-100.22、-239.00,P值均＜0.01).炎性增生组淋巴结的SNR值明显高于肿瘤转移组,差异有统计学意义(t值分别为83.97、174.07、158.49、152.71、96.06、154.57,P值均＜0.01).肿瘤转移淋巴结在MR淋巴成像图像上表现为淋巴结完全或部分的信号缺损.结论 通过阳性亲淋巴对比剂增强MR淋巴成像可提供解剖背景下淋巴结解剖和功能方面的信息,是特异性地鉴别良、恶性淋巴结的敏感检查方法.
    목적 탐토대분자양성친림파대비제재간질MR림파성상중대종류전이、염성증생림파결적감별진단개치.방법 채용18지순충신서란대백토,체질량2.0～2.5 kg.재기중9지토일측후지각지복처주사완전형면역좌제,용우건립객와림파결염성증생모형(염성증생조);령9지토일측후지기육접충VX~2류건립객와림파결종류전이모형(종류전이조).대측정상객와림파결작위대조.각조매지토접충전후행MR림파성상검사.장0.2 ml이안기을기을이순미-DTPA선알공취물구배합물(Gd-poly-DTPA-EOEA)주입각조매지토쌍측후지족배부각지복처적피하.재주사대비제전후분별진행3D T_1WI소묘화MIP도상중조.재증강3D MIP도상상측량매일객와림파결단축최대경(MSAD),재매지토연와림파결중선취직경최대자측량기연지소묘각관찰시점적신조비(SNR).채용성조설계t검험비교염성증생조여종류전이조객와림파결접충후MSAD적차이화매일관찰시점염성증생조、종류전이조、정상대조측객와림파결간적SNR차이.분석각조객와림파결적MR림파성상도상,병여병리검사상대조.결과 종류조2지토접충미성공,기타모형형성량호.13개염성증생、11개종류전이객와림파결적MSAD분별위(1.32±0.14)cm화(1.33±0.12)cm,차이무통계학의의(t=0.186,P＞0.05).연지소묘5、15、30、60、90、120 min,9개염성증생객와림파결여정상대조측객와림파결적SNR치분별위17.31±0.37화17.19±0.29、27.42±0.50화27.39±0.48、38.44±0.47화38.19±0.27、37.10±0.09화36.97±0.10、36.32±0.61화36.20±0.80、34.60±0.44화34.71±0.32,량조간각대응시점SNR치적차이균무통계학의의(t치분별위0.78、0.14、1.43、1.00、0.36、-0.62,P치균＞0.05).7개종류전이객와림파결화정상대조측객와림파결적SNR치분별위6.00±0.22화17.21±0.28、7.87±0.16화27.17±0.23、8.14±0.24화38.16±0.19、8.09±0.28화36.94±0.30、7.59±0.20화35.96±0.72、7.50±0.14화34.81±0.27,량조간각대응시점SNR치적차이균유통계학의의(t치분별위-84.00、-182.72、-261.27、-186.48、-100.22、-239.00,P치균＜0.01).염성증생조림파결적SNR치명현고우종류전이조,차이유통계학의의(t치분별위83.97、174.07、158.49、152.71、96.06、154.57,P치균＜0.01).종류전이림파결재MR림파성상도상상표현위림파결완전혹부분적신호결손.결론 통과양성친림파대비제증강MR림파성상가제공해부배경하림파결해부화공능방면적신식,시특이성지감별량、악성림파결적민감검사방법.
    Objective To evaluate the interstital MR lymphography using positive lymphotropic contrast agent for differentiation of metastatic lymph nodes from inflammatory lymph nodes hyperplasm.Methods Eighteen New Zealand white rabbits weighted at 2.0-2.5 kg were used.Inflammatory hyperplastic popliteal lymph node model was established in 9 rabbits by injection of complete freund adjuvant into the interdigitial skin of the dorsal aspect of one hind leg,and tumor-bearing popliteal lymph node model was established in another 9 rabbits by injection of VX~2 tumor cell suspension.The popliteal lymph nodes of another hind leg of all 18 rabbits were assigned to the normal contral group.In each group,every rabbit underwent MR lymphography examination before and after the inoculation.Volumes of 0.2 ml of Gd[DTPA-bis(2-aminoethoxy)ethane]polymeric contrast agent(Gd-poly-DTPA-EOEA)injection were injected subcutaneously into the dorsal feet of both hind legs of two groups of rabbits.T_1-weighted 3D gradient-echo images were obtained,and source images were used to reconstruct images of MIP before and after the administration of agent.The maximum short-axis diameter(MSAD)of each popliteal lymph node was measured on the enhanced 3D MIP images,and the signal-to-noise ratio(SNR)measurement was performed in the largest popliteal node of each rabbit at each time point in delayed scan.Independentsamples t test was used to compare the sizes of popliteal nodes in MSADs between inflammatorily hyperplastic and tumor-bearing nodes after the inoculation,and the values of SNRs of popliteal nodes at each time point between inflammatorily hyperplastic,tumor-bearing and normal popliteal lymph nodes.Imaging results of the popliteal nodes were analyzed and correlated with pathological findings.Results All of the rabbits were successfully inoculated except of the 2 rabbits in tumor-bearing nodal group.The size in MSAD of 13 inflammatorily hyperplastic and 11 tumor-bearing nodes was(1.32±0.14)and(1.33±0.12)cm,respectively.There was no significant statistical difference between the sizes of the two groups(t=0.186,P＞0.05).At the time of 5,15,30,60,90,120 minutes after the injection of the agent,the value of SNR of 9 inflammatorily hyperplastic and 9 contralateral normal nodes was 17.31±0.37 and 17.19±0.29,27.42±0.50 and 27.39±0.48,38.44±0.47 and 38.19±0.27,37.10±0.09 and 36.97±0.10,36.32±0.61 and 36.20±0.80,34.60±0.44 and 34.71±0.32,respectively.There was no significant statistical difference between the values of the two groups(t=0.78,0.14,1.43,1.00,0.36,-0.62,respectively,P＞0.05).The value of SNR of seven tumor-bearing and seven contralateral normal nodes was 6.00±0.22 and 17.21±0.28,7.87±0.16 and 27.17±0.23,8.14±0.24 and 38.16±0.19,8.09±0.28 and 36.94±0.30,7.59±0.20 and 35.96±0.72,7.50±0.14 and 34.81±0.27,respectively.There was significant statistical difference between the values of the two groups(t=-84.00,-182.72,-261.27,-186.48,-100.22,-239.00,respectively,P＜0.01).At each time point,inflammatorily hyperplastic nodes had significantly higher values of SNRs compared to tumor-bearing nodes(t=83.97,174.07,158.49,152.71,96.06,154.57,respectively,P＜0.01).A complete or part signal filling defect occurred in the tumor-bearing lymph node on the MR lymphographic images.Conclusions The internal anatomy and function of the lymph nodes were effectively visualized by interstitial MR lymphography with positive lymphotropic contrast agent,which provide a sensitively diagnostic way for the differentiation of benign lymph nodes from malignant ones.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문