中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
23期
1837-1841
,共5页
磁共振成像%催乳素瘤%垂体%图像增强
磁共振成像%催乳素瘤%垂體%圖像增彊
자공진성상%최유소류%수체%도상증강
Magnetic resonance imaging%Prolactinoma%Pituitary gland%Image enhancement
目的 探讨动态增强磁共振成像(DCE-MRI)定量分析对垂体腺瘤的诊断价值.方法 收集皖南医学院第一附属医院2013年6月至2014年12月以病理及随访等结果作为金标准判定67例微腺瘤、20例大腺瘤和15例正常垂体,对其行常规扫描和动态增强扫描,观察病灶图像特征并测量正常垂体、微腺瘤以及大腺瘤的定量参数:容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积比(Ve)数值大小.对微腺瘤、大腺瘤和正常垂体间及微腺瘤中的泌乳素瘤和生长激素瘤间各定量参数值进行比较,并绘制ROC曲线.结果 67例微腺瘤通过常规检查可诊断61例,诊断准确率为91.1％.正常垂体的Ktrans、Kep、Ve均值分别为(0.90±0.23)/min,(1.14±0.58)/min,1.02±0.51;垂体微腺瘤分别为(0.46±0.23)/min,(0.80 ±0.27)/min,0.73 ±0.32;垂体大腺瘤分别为(0.41 ±0.25)/min,(0.71 ±0.48)/min,0.66±0.40.正常垂体Ktrans值分别高于微腺瘤和大腺瘤,差异均有统计学意义(均P ＜0.05);正常垂体Kep值也分别高于微腺瘤和大腺瘤,差异均有统计学意义(均P＜0.05);三组间Ve值差异无统计学意义.泌乳素瘤Ktrans值高于生长激素瘤,差异有统计学意义(P＜0.05),两者间Kep和Ve差异无统计学意义.在检出微腺瘤时Ktrans、Kep的ROC曲线下面积分别为0.915、0.738,二者诊断垂体微腺瘤的敏感性分别为92.3％、53.8％,特异性分别为85％、100％.结论 DCE-MRI定量参数Ktrans、Kep有助于垂体腺瘤的检出,且Ktrans诊断效能更高,Ktrans的诊断价值高于MRI常规方法;同时Ktrans对不同分泌类型的垂体微腺瘤有一定的鉴别诊断价值.
目的 探討動態增彊磁共振成像(DCE-MRI)定量分析對垂體腺瘤的診斷價值.方法 收集皖南醫學院第一附屬醫院2013年6月至2014年12月以病理及隨訪等結果作為金標準判定67例微腺瘤、20例大腺瘤和15例正常垂體,對其行常規掃描和動態增彊掃描,觀察病竈圖像特徵併測量正常垂體、微腺瘤以及大腺瘤的定量參數:容量轉移常數(Ktrans)、速率常數(Kep)、血管外細胞外間隙容積比(Ve)數值大小.對微腺瘤、大腺瘤和正常垂體間及微腺瘤中的泌乳素瘤和生長激素瘤間各定量參數值進行比較,併繪製ROC麯線.結果 67例微腺瘤通過常規檢查可診斷61例,診斷準確率為91.1％.正常垂體的Ktrans、Kep、Ve均值分彆為(0.90±0.23)/min,(1.14±0.58)/min,1.02±0.51;垂體微腺瘤分彆為(0.46±0.23)/min,(0.80 ±0.27)/min,0.73 ±0.32;垂體大腺瘤分彆為(0.41 ±0.25)/min,(0.71 ±0.48)/min,0.66±0.40.正常垂體Ktrans值分彆高于微腺瘤和大腺瘤,差異均有統計學意義(均P ＜0.05);正常垂體Kep值也分彆高于微腺瘤和大腺瘤,差異均有統計學意義(均P＜0.05);三組間Ve值差異無統計學意義.泌乳素瘤Ktrans值高于生長激素瘤,差異有統計學意義(P＜0.05),兩者間Kep和Ve差異無統計學意義.在檢齣微腺瘤時Ktrans、Kep的ROC麯線下麵積分彆為0.915、0.738,二者診斷垂體微腺瘤的敏感性分彆為92.3％、53.8％,特異性分彆為85％、100％.結論 DCE-MRI定量參數Ktrans、Kep有助于垂體腺瘤的檢齣,且Ktrans診斷效能更高,Ktrans的診斷價值高于MRI常規方法;同時Ktrans對不同分泌類型的垂體微腺瘤有一定的鑒彆診斷價值.
목적 탐토동태증강자공진성상(DCE-MRI)정량분석대수체선류적진단개치.방법 수집환남의학원제일부속의원2013년6월지2014년12월이병리급수방등결과작위금표준판정67례미선류、20례대선류화15례정상수체,대기행상규소묘화동태증강소묘,관찰병조도상특정병측량정상수체、미선류이급대선류적정량삼수:용량전이상수(Ktrans)、속솔상수(Kep)、혈관외세포외간극용적비(Ve)수치대소.대미선류、대선류화정상수체간급미선류중적비유소류화생장격소류간각정량삼수치진행비교,병회제ROC곡선.결과 67례미선류통과상규검사가진단61례,진단준학솔위91.1％.정상수체적Ktrans、Kep、Ve균치분별위(0.90±0.23)/min,(1.14±0.58)/min,1.02±0.51;수체미선류분별위(0.46±0.23)/min,(0.80 ±0.27)/min,0.73 ±0.32;수체대선류분별위(0.41 ±0.25)/min,(0.71 ±0.48)/min,0.66±0.40.정상수체Ktrans치분별고우미선류화대선류,차이균유통계학의의(균P ＜0.05);정상수체Kep치야분별고우미선류화대선류,차이균유통계학의의(균P＜0.05);삼조간Ve치차이무통계학의의.비유소류Ktrans치고우생장격소류,차이유통계학의의(P＜0.05),량자간Kep화Ve차이무통계학의의.재검출미선류시Ktrans、Kep적ROC곡선하면적분별위0.915、0.738,이자진단수체미선류적민감성분별위92.3％、53.8％,특이성분별위85％、100％.결론 DCE-MRI정량삼수Ktrans、Kep유조우수체선류적검출,차Ktrans진단효능경고,Ktrans적진단개치고우MRI상규방법;동시Ktrans대불동분비류형적수체미선류유일정적감별진단개치.
Objective To evaluate the diagnostic value of quantitative Dynamic Contrast Enhanced MRI analysis on pituitary adenoma.Methods With the standard of pathology and follow-up results,67 cases of microadenoma,20 cases of macroadenoma and 15 cases of normal pituitary were selected and taken routine scanning,meanwhile the dynamic contrast-enhanced scanning was performed,then the characteristics of lesions on conventional images were analyzed,and the mean permeability parameters were measured,including transfer rate (Ktrans),back flux rate (Kep),fractional EES volume (Ve) using Tofts model,which were compared with each other among those three groups and between prolactinoma and somatotroph adenoma;finally,the areas under the ROC curve of permeability parameters were compared.Results 61 cases of 67 cases of pituitary adenoma could be diagnosed by conventional methods,therefore the diagnostic accuracy was 91.1％.The Ktrans,Kep and Ve values were(0.90 ±0.23)/min,(1.14 ±0.58)/min,1.02 ± 0.51 respectively in normal pituitary,and (0.46 ± 0.23)/min,(0.80 ± 0.27)/min,0.73 ± 0.32 in microadenoma and (0.41 ±0.25)/min,(0.71 ±0.48)/min,0.66 ±0.40 in macroadenoma.The Ktrans and Kep in normal adenoma were respectively higher than in microadenoma and macroadenoma,and the difference had statistical significance (P ＜ 0.05),while the Ve value among these three groups had no statistical significance;the Ktrans in prolactinoma was higher than in somatotroph adenoma,and the difference had statistical significance (P ＜ 0.05),while the difference of Kep and Ve between prolactinoma and somatotroph adenoma had no statistical significance.The area under the ROC curve in finding the microadenoma,Ktrans,Kep were 0.915 and 0.738,and the sensitivity of Ktrans and Kep were 92.3％ and 53.8％,and the specificity of Ktrans and Kep were 85％ and 100％.Conclusion Dynamic contrast-enhanced quantitative parameters,Ktrans and Kep are help to the diagnosis of pituitary adenoma,and K exhibits a relatively high diagnostic efficacy,and the value of diagnosis in Kt is higher than which in MRI conventional method;while Ktrans can differentiate certain secreting type of pituitary microadenoma.
