【摘要】 目的　研究对比剂增强MR灌注成像技术在骨骼 软组织肿瘤良恶性鉴别诊断中的应用价值。方法　对骨骼 软组织肿瘤 39例 41个病灶进行对比剂增强MR灌注成像检查。分别计算肿瘤最高灌注区域信号强度 时间 (SI T)曲线的最大线性斜率 (SSmax)和肿瘤边缘 中心灌注差异率(Rrim cen)。对肿瘤作病理学检查 ,确定其良恶性 ,并计数肿瘤最高灌注区的微血管密度 (MVD)。结果SSmax和MVD在良恶性肿瘤之间的差异均无显著性意义 (P >0 0 5 ) ,而MVD和SSmax之间有良好的相关性。良、恶性肿瘤Rrim cen的中位数分别为 0 0 0 0和 0 2 78,在良恶性肿瘤之间的差异具有显著性意义(z=- 4 175 ,P <0 0 1) ,恶性肿瘤的Rrim cen值大于良性肿瘤。以 0 115作为区分良恶性肿瘤的阈值 ,则诊断恶性肿瘤的灵敏性、特异性、准确性分别可达 82 6 %、10 0 %和 90 2 %。结论　Rrim cen对鉴别良恶性骨骼 软组织肿瘤具有较高的准确性 ,尤其用于鉴别较大的恶性肿瘤 ,具有很高的特异性。SI T曲线的最大线性斜率 (SS)能够准确地反映组织的血管化情况 ,但SSmax在良恶性骨软组织肿瘤之间存在较多重叠 ,还不能用作鉴别良恶性的指标更多还原

【Abstract】 Objective To assess the diagnostic value of contrast enhanced perfusion weighted MR imaging technique in differential diagnosis between benign and malignant musculoskeletal neoplasms. Methods 39 patients with 41 musculoskeletal neoplasms underwent contrast enhanced perfusion weighted MR imaging. The steepest slope of the SI T curve of the highest perfusion area (SS max ) and rim to center differential perfusion ratio (R rim cen ) were calculated. Pathological analysis was performed not only to determine weather a neoplasm was benign or malignant but also to count the microvessel density under microscopy. Results The difference in either SS max or density of microvascularity between malignant and benign musculoskeletal neoplasms had no statistically significance( P >0.05). However, a statistically significant correlation existed between density of microvascularity and SS max . The median of R rim cen of benign musculoskeletal neoplasms was 0.000, as compared with 0.278 in malignant ones. R rim cen of benign and malignant musculoskeletal neoplasms differed significantly( z =-4 175, P < 0 01), R rim cen of malignant neoplasms tend to be larger than that of benign ones. Using a threshold of 0.115, the malignant potential can be predicted with a sensitivity of 82.6%, a specificity of 100% and an accuracy of 90 2%. Conclusion R rim cen could be used as an accurate quantitative parameter to differentiate between benign and malignant musculoskeletal neoplasms, especially when it is used for larger neoplasms. SS can reflect the vascularity of tissue accuratly. Nevertheless with extensive overlap between benign and malignant musculoskeletal neoplasms, SS max can′t be used as a parameter to distinguish benign from malignant.更多还原