张函光

【摘要】 目的：探讨动态增强MRI对良恶性骨肿瘤的鉴别诊断价值。方法：选取2018年2月-2019年

12月本院收治的67例骨肿瘤患者作为研究对象，按肿瘤性质分为良性组（n=31）和恶性组（n=36）。所有患者均在术前行动态增强MRI（DCE-MRI）检查，以术后病理检查结果作为金标准，计算DCE-MRI对骨肿瘤良恶性诊断准确度、灵敏度、特异度和Kappa值;比较两组DCE-MRI定量参数容量转运常数（Ktrans）、速率常数（Kep）、血管外细胞外容积分数（Ve）和初始曲线下面积（iAUC）;计算ROC曲线下面积与各定量参数指标对骨肿瘤良恶性诊断准确度、灵敏度、特异度和Kappa值。结果：DCE-MRI对骨肿瘤良恶诊断灵敏度、特异度、准确度和Kappa值分别为90.32%、94.44%、92.54%、0.85。良性组Ktrans、Kep、iAUC均明显低于恶性组（P<0.05）;两组Ve水平比较，差异无统计学意义（P>0.05）。Ktrans、Kep、iAUC的最佳诊断切断点分别为1.245/min、3.325/min、21.69，ROC曲线下面积分别为0.823、0.855、0.769。Ktrans对骨肿瘤良恶诊断灵敏度、特异度、准确度和Kappa值分别为93.55%、86.11%、89.55%、0.791;Kep对骨肿瘤良恶诊断灵敏度、特异度、准确度和Kappa值分別为96.77%、83.33%、89.55%、0.792;iAUC对骨肿瘤良恶诊断灵敏度、特异度、准确度和Kappa值分别为90.32%、77.78%、83.58%、0.673。结论：DCE-MRI鉴别诊断骨肿瘤良恶性准确度高，一致性极强，Ktrans、Kep、iAUC等定量参数作为辅助诊断指标具有较高的诊断价值。

【关键词】 动态增强MRI 骨肿瘤 良性 恶性

Value Research of Dynamic-enhanced MRI in the Differential Diagnosis of Benign and Malignant Bone Tumors/ZHANG Hanguang. //Medical Innovation of China， 2021， 18（07）： -170

[Abstract] Objective： To explore the value of dynamic-enhanced MRI in the differential diagnosis of benign and malignant bone tumors. Method： A total of 67 patients with bone tumor admitted to our hospital from February 2018 to December 2019 were selected as the research subjects， they were divided into benign group （n=31） and malignant group （n=36） according to tumor nature. All patients were examined with dynamic contrast-enhanced MRI （DCE-MRI） before operation， the results of postoperative pathological examination were taken as the gold standard， the accuracy， sensitivity， specificity and Kappa of DCE-MRI were calculated， the quantitative parameters of DCE-MRI for volume transport constant （Ktrans）， rate constant （Kep）， extracellular volume fraction （Ve） and area under initial curve （iAUC） were compared between the two groups. The area under the ROC curve and the diagnostic accuracy， sensitivity， specificity and Kappa value of various quantitative parameters for benign and malignant bone tumors were calculated. Result： The sensitivity， specificity， accuracy and Kappa values of DCE-MRI in benign and malignant bone tumors were 90.32%， 94.44%， 92.54% and 0.85， respectively. Ktrans， KEP and iAUC in benign group were significantly lower than those in malignant group （P<0.05）， there was no significant difference in Ve level between the two groups （P>0.05）. The optimal diagnostic cut-off points for Ktrans， Kep and iAUC were 1.245/min，

3.325/min and 21.69， respectively， the areas under the ROC curve were 0.823， 0.855 and 0.769， respectively. The sensitivity， specificity， accuracy and Kappa values of Ktrans for benign and malignant bone tumors were 93.55%， 86.11%， 89.55% and 0.791， respectively. The sensitivity， specificity， accuracy and Kappa values of Kep for benign and malignant bone tumors were 96.77%， 83.33%， 89.55% and 0.792， respectively. The sensitivity， specificity， accuracy and Kappa values of iAUC for benign and malignant bone tumors were 90.32%， 77.78%， 83.58% and 0.673， respectively. Conclusion： DCE-MRI has a high accuracy and consistency in the differential diagnosis of bone tumors. Quantitative parameters such as Ktrans， Kep and iAUC have a high diagnostic value as auxiliary diagnostic index.

[Key words] Dynamic enhanced MRI Bone tumor Benign Malignant

First-authors address： Heilongjiang Jiamusi Maternal and Child Health Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.07.040

骨肿瘤是指发生在骨骼及附属组织的肿瘤，在全身肿瘤中占2%～3%[1]，且近年来发病率不断上升，发病年龄则呈现低龄化[2]。临床上需要对肿瘤性质进行明确后在给予有效治疗，良性骨肿瘤易根治且预后较好，恶性骨肿瘤则预后较差，且易复发[3]。因此，鉴别诊断良恶性肿瘤是诊治过程中的关键步骤。当前对于骨肿瘤的影像学诊断方法主要有……