常规MRI 与31P MR 波谱在骨及软组织肿块中的鉴别诊断价值

常规MRI 与31P MR 波谱在骨及软组织
肿块中的鉴别诊断价值
刘宏伟 杨贞振 李传亭 吕玉波
【摘要】 目的 探讨常规MRI 与31P MR 波谱( MRS) 对骨及软组织肿块的鉴别诊断价值。方法
在1. 5 T场强下, 对16 例健康志愿者及35 例骨及软组织肿块患者分别行常规MRI 与31P MRS 检查,
测定波谱中各代谢产物的峰下面积, 计算各代谢产物与β-三磷酸腺苷( β-ATP) 的比值, 以及根据无
机磷( Pi) 的化学位移相对于磷酸肌酸( PCr ) 的改变测定细胞内pH 值。结果 良恶性两组肿块在大
小、信号均匀性、境界及对周围结构的侵犯等方面差异无统计学意义( P 值均> 0. 05) , 其MRI 特征有
很大重叠性。对照组的磷酸单酯/β-三磷酸腺苷( PME/ β-ATP) 、磷酸二酯( PDE) / β-ATP、低能磷酸盐
( LEP) / β-ATP、PCr / β-ATP、细胞内pH 值分别为0. 33 ±0. 21、0. 64 ±0. 27、1. 62 ±0. 67、3. 12 ±0. 78、
7. 08 ±0. 16, 良性肿块组的PME/ β-ATP、PDE/ β-ATP、LEP/ β-ATP、PCr / β-ATP、pH 值分别为0. 55 ±
0. 31、0. 81 ±0. 31、2. 03 ±0. 87、1. 65 ±0. 65、7. 18 ±0. 23, 恶性肿块组的PME/ β-ATP、PDE / β-ATP、低
能磷酸盐( LEP) /β-ATP、PCr / β-ATP、pH 值分别为1. 73 ±0. 40、1. 73 ±0. 45、4. 31 ±1. 18、1. 44 ±0. 54、
7. 32 ±0. 29。与对照组比较, 恶性肿块组的PME / β-ATP( P < 0. 01) 、PDE /β-ATP ( P < 0. 01) 、LEP / β-
ATP( P < 0. 01) 、细胞内pH 值( P < 0. 05) 升高, 良性及恶性肿块组的PCr /β-ATP( P < 0. 01) 均降低, 差
异均具有统计学意义。与对照组比较, 良性肿块组PME/ β-ATP、PDE/ β-ATP、LEP/ β-ATP 、pH 值均有
所升高, 但差异无统计学意义( P 值均> 0. 05) 。与良性肿块组比较, 恶性肿块组的PME/ β-ATP、
PDE/ β-ATP、LEP/ β-ATP 升高, 差异有统计学意义( P 值均< 0. 01 ) ; 恶性肿块组的细胞内PH 值较良
性肿块组升高, 但差异无统计学意义( P > 0. 05) 。以良性肿块的PME /β-ATP 均值的1. 8 倍作为鉴别
良恶性肿块的标准, 则对肿块潜在恶性评估的敏感性为88. 89% , 特异性为94. 12% 。结论 31 P MRS
对骨及软组织肿块的诊断及鉴别诊断具有重要价值, 是1 种简单、无创、有效的补充检查手段。
【关键词】 骨肿瘤; 软组织肿瘤; 磁共振波谱学
The value of MRI and 31 P MRS in differentia l diagnosis of bone and soft tissue tumor s LIU
Hong-wei* , YANG Zhen-zhen, LI Chuan-ting, L􊙂Yu-bo. Shandong University Medical College, Shandong
Medical Imaging Resea rch Institute, Jinan 250012, China ( * Now in: 253000 Department of Ra diology,
Dezhou People′s Hospital, Sha ndong)
【Abstra ct 】 Objective To explore the value of MRI and 31P MRS in differential diagnosis of bone
and soft tissue tumors. Methods MRI and 31P MRS were performed in 35 bone and soft tissue tumor
patients and 16 healthy volunteers at 1. 5 T. The areas under the peak of various metabolite in spectra were
measured. The spectra were analyzed by taking peak areas relative to peak area of β-ATP and by calculating
the pH from the Pi shift relative to PCr. Results The differences of the size, signal intensity homogeneity,
border and involvement of surround structure between benign and malignant lesions had no statistically
significant differences ( P > 0. 05) . There was great overlap in the MR imaging characteristics of benign and
malignant lesions. The mean peak area rations of PME/ β-ATP、PDE /β-ATP、LEP / β-ATP、PCr / β-ATP、
intracellular pH in control group were 0. 33 ±0. 21、0. 64 ±0. 27、1. 62 ±0. 67、3. 12 ±0. 78、7. 08 ±0. 16.
The mean peak area rations of PME/ β-ATP、PDE / β-ATP、LEP / β-ATP、PCr / β-ATP、intracellular pH in
benign group were 0. 55 ±0. 31、0. 81 ±0. 31、2. 03 ±0. 87、1. 65 ±0. 65、7. 18 ±0. 23. The mean peak area
rations of PME/ β-ATP、PDE/ β-ATP、LEP / β-ATP、PCr / β-ATP、intracellular pH in malignant group were
1. 73 ±0. 40、1. 73 ±0. 45、4. 31 ±1. 18、1. 44 ±0. 54、7. 32 ±0. 29. Compared with control group, the mean
peak area rations of PME / β-ATP ( P < 0. 01 ) 、PDE / β-ATP ( P < 0. 01 ) 、LEP / β-ATP ( P < 0. 01 ) 、
intracellular pH( P < 0. 05) in malignant group increased significantly and PCr / β-ATP( P < 0. 01) in benign
and malignant group decreased significantly. The mean peak area rations of PME / β-ATP、PDE/ β-ATP、
LEP / β-ATP and intracellular pH in benign group were higher than that of the normal group but did not reach
statistical significance( P > 0. 05) . The mean peak area rations of PME/ β-ATP、PDE / β-ATP、LEP / β-ATP
in malignant group were significantly higher than that in benign group ( P < 0. 01 ) . Intracellular pH in
malignant group was higher than that in benign group but did not reach statistical significance ( P > 0. 05) .
If we set a standard at 1. 8 time of the mean of the PME/ β-ATP ration in the benign group, then the
sensitivity of this discrimination for diagnosing a malignancy was 88. 89% and the specificity was 94. 12%.
Conclusion 31P MRS has important value in diagnosis and differential diagnosis of bone and soft tissue
tumors. It should be a simple, non-invasively, effective diagnostic method.
【Key wor ds】 Bone neoplasms; Soft tissue neoplasms; Magnetic resonance spectroscopy

常规MRI 与31P MR 波谱在骨及软组织--骨格.rar