【摘要】 目的 探讨MRI动态增强扫描的时间-密度曲线(TIC)对肌骨肿瘤与瘤样病变的诊断价值。方法 回顾性分析2022年1月至2023年12月在我院接受手术治疗的84例肌骨肿瘤与瘤样病变患者的临床资料。纳入患者均在术前完成常规MRI以及MRI动态增强扫描，统计其形态学特征、信号征象、TIC曲线类型以及相关参数。以手术病理结果为“金标准”，使用Kappa一致性分析MRI动态增强扫描诊断肌骨肿瘤与瘤样病变与金标准的一致性。以手术病理结果将84例肌骨肿瘤与瘤样病变患者分为恶性组(n=51)与良性组(n=33)。比较两组患者的形态学特征、信号征象、TIC曲线类型以及MRI动态增强扫描参数。使用受试者工作特征(ROC)曲线分析各参数对肌骨肿瘤与瘤样病变的诊断价值。结果 恶性组与良性组边缘、边界、强化比较，差异有统计学意义(P<0.05)；以手术病理结果为金标准，MRI动态增强扫描诊断肌骨肿瘤与瘤样病变与金标准的Kappa值为0.730，说明诊断一致性较高(P<0.05)。其敏感度、特异度、准确率、良性预测值、恶性预测值分别为86.27%、87.88%、86.90%、80.56%、91.67%。秩和检验发现恶性组与良性组MRI动态增强扫描TIC曲线类型比较有极显著差异(P<0.05)。恶性组TIC曲线最大上升率大于良性组，峰值时间短于良性组(P<0.05)。TIC曲线最大上升率、峰值时间、二者联合诊断肌骨肿瘤与瘤样病变病灶良恶性的ROC曲线下面积分别为0.756、0.805、0.846(P<0.05)。结论 MRI动态增强扫描诊断肌骨肿瘤与瘤样病变与手术结果一致性高，MRI动态增强扫描的TIC曲线对肌骨肿瘤与瘤样病变诊断具有一定价值，TIC曲线最大上升率、峰值时间可作为辅助评估指标。更多还原

【Abstract】 Objective To explore the diagnostic value of time-signal intensity curve(TIC) under dynamic contrast-enhanced MRI(DEC-MRI) in musculoskeletal tumors and tumor-like lesions.Methods A retrospective analysis was performed on the clinical data of 84 patients with musculoskeletal tumors and tumor-like lesions who underwent surgical treatment in the hospital between January 2022 and December 2023.All patients underwent routine MRI and DEC-MRI examinations befo re surgery to statistically analyze morphological chara cteristics,signal signs,TIC types and related parameters.Taking results of surgical pathology as the golden standard,the consistency between DEC-MRI and the golden standard in the diagnosis of musculoskeletal tumors and tumor-like lesions was analyzed by Kappa consistency test.According to results of surgical pathology,84 patients were divided into malignant group(n=51) and benign group(n=33),morphological characteristics,signal signs,TIC types and DEC-MRI parameters in the two groups were compared,and the diagnostic value of different parameters for musculoskeletal tumors and tumor-like lesions was analyzed by receiver operating characteristic(ROC) curves.Results There were significant differences in edge,boundary and reinforcement between malignant group and benign group(P<0.05).Taking results of surgical pathology as the golden standard,Kappa value between DEC-MRI and the golden standard in the diagnosis of musculoskeletal tumors and tumor-like lesions was 0.730,showing high consistency(P<0.05),and its sensitivity,specificity,accuracy,benign predictive value and malignant predictive value were 86.27%,87.88%,86.90%,80.56% and 91.67%,respectively.The rank sum test showed that there were extremely significant differences in TIC types under DEC-MRI between malignant group and benign group(P<0.05).The maximum rise rate of TIC in malignant group was higher than that in benign group,and time to peak was shorter than that in benign group(P<0.05).The area under ROC curve(AUC) values of maximum rise rate,time to peak and combined detection in the diagnosis of benign and malignant musculoskeletal tumors and tumor-like lesions were0.756,0.805 and 0.846,respectively(P<0.05).Conclusion DEC-MRI has high consistency with surgical pathology in the diagnosis of musculoskeletal tumors and tumor-like lesions.TIC under DEC-MRI has certain diagnostic value in musculoskeletal tumors and tumor-like lesions,the maximum rise rate of TIC and time to peak can be applied as auxiliary evaluation indexes.更多还原