CAJ | 학술논문

目的：探讨动态增强磁共振半定量及定量分析方法在卵巢良、恶性肿瘤中的应用价值。材料与方法收集首诊经病理证实为卵巢恶性肿瘤组17例(包括原发卵巢腺癌9例、卵巢转移腺癌6例、卵巢淋巴瘤2例)，良性肿瘤或正常对照组15例(包括卵巢囊腺瘤5例、正常卵巢8例、卵巢囊肿2例)。均行3.0T 磁共振动态增强扫描，绘制时间强度曲线(time intensity curve，TIC)；并使用SIEMENS TISSUE 4D软件进行图像后处理，测得感兴趣区的Ktrans、Kep、Ve值。对良、恶性组的TIC曲线及定量灌注参数值进行统计学分析。结果卵巢良、恶性组TIC曲线形态存在明显不同(P＜0.05)；良性组均为I型曲线(100%)，恶性组中II型曲线所占比例最高(71%)。以I型曲线作为诊断良性标准，II型曲线作为诊断恶性标准，ROC曲线分析得出曲线下面积AUC为0.856。定量灌注参数值： Ktrans值分别是恶性组(0.166±0.077) min-1、良性组(0.071±0.025) min-1；Kep值分别是(0.455±0.172) min-1、(0.363±0.242) min-1；Ve值分别是(0.438±0.137)、(0.426±0.154)。恶性组平均Ktrans值比良性病变组高，且差异有统计学意义(P=0.000)；恶性组与良性组的平均Kep及Ve值比较差异无有统计学意义(P=0.218、P=0.821)。结论动态增强磁共振成像方法对卵巢良、恶性肿瘤有重要的鉴别诊断价值。良性肿瘤/组织多表现为I型曲线，恶性肿瘤多表现为II型曲线。定量参数Ktrans值对卵巢良、恶性肿瘤具有重要的鉴别诊断意义。
목적：탐토동태증강자공진반정량급정량분석방법재란소량、악성종류중적응용개치。재료여방법수집수진경병리증실위란소악성종류조17례(포괄원발란소선암9례、란소전이선암6례、란소림파류2례)，량성종류혹정상대조조15례(포괄란소낭선류5례、정상란소8례、란소낭종2례)。균행3.0T 자공진동태증강소묘，회제시간강도곡선(time intensity curve，TIC)；병사용SIEMENS TISSUE 4D연건진행도상후처리，측득감흥취구적Ktrans、Kep、Ve치。대량、악성조적TIC곡선급정량관주삼수치진행통계학분석。결과란소량、악성조TIC곡선형태존재명현불동(P＜0.05)；량성조균위I형곡선(100%)，악성조중II형곡선소점비례최고(71%)。이I형곡선작위진단량성표준，II형곡선작위진단악성표준，ROC곡선분석득출곡선하면적AUC위0.856。정량관주삼수치： Ktrans치분별시악성조(0.166±0.077) min-1、량성조(0.071±0.025) min-1；Kep치분별시(0.455±0.172) min-1、(0.363±0.242) min-1；Ve치분별시(0.438±0.137)、(0.426±0.154)。악성조평균Ktrans치비량성병변조고，차차이유통계학의의(P=0.000)；악성조여량성조적평균Kep급Ve치비교차이무유통계학의의(P=0.218、P=0.821)。결론동태증강자공진성상방법대란소량、악성종류유중요적감별진단개치。량성종류/조직다표현위I형곡선，악성종류다표현위II형곡선。정량삼수Ktrans치대란소량、악성종류구유중요적감별진단의의。
Objective:To evaluate the value of 3.0 T DCE-MR in diagnosing tumors of ovary.Materials and Methods:Thirty-two cases of ovarian lesions (17 were malignant, 15 were benign) were evaluated in our study. All cases were received dynamic contrast-enhanced scanning on 3.0 T MR. The raw data was processed by SIEMENS TISSUE 4D software and the signal intensity time curve (TIC) was obtained and analyzed. Pharmacokinetic modeling of Tofts with a modeled vascular input function was used for the quantitative measurements volume: transfer constant (Ktrans), reverse volume transfer constant (Kep), the extravascular extracellular space volume per unit volume of tissue (Ve). The correlation of these measurements at each groups were investigated. Compare TIC curve and the data of perfusion parameters of each groups.Results:Among 17 malignant tumors, 9 were cystadenocarcinoma and 6 were metastatic adenocarcinoma, 2 were lymphoma. 15 benign lesions included 5 cystadenomas, 8 normal ovaries and 2 ovarian cysts. 100% cases of benign lesions belong to Type I curve and 71% cases of malignant tumors belong to Type II curve. There was statistically significant difference in TIC curve between benign and malignant groups (P<0.05). If Type I curve was used as diagnostic criteria for benign and Type II for malignant, ROC resulted the AUC was 0.856. The mean value of perfusion parameters of the two groups were: Ktrans was (0.166±0.077) min-1 in malignant group and (0.071±0.025)min-1 in benign group, Kep was(0.455±0.172)min-1 in malignant group and (0.363±0.242) min-1 in benign group. Ve was(0.438±0.137) in malignant and (0.426±0.154)in benign group. Ktrans was signiifcantly difference between the malignant group and benign group(P=0.000).Conclusion:The Types of TIC and Ktrans value were important criterion in differentiating benign and malignant ovarian tumors in dynamic enhanced MR imaging. These parameters were important supplement for conventional morphology MR diagnosis.