Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI.
Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI.
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使用动态对比增强 MRI 鉴别脊柱结核和转移性癌症
DOI：
10.1007/s00586-015-3851-z
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Yuan H
中科院分区：
文献类型：
--
作者：
Lang N;Su MY;Yu HJ;Yuan H
探讨动态对比增强磁共振成像（DCE-MRI）检测脊柱结核（TB）与转移性癌影像学特征的差异。结核病在常规MRI上的表现可能不显示典型的结核病征象，并可能被误诊为恶性疾病。DCE-MRI可以提供额外的信息来帮助鉴别诊断。对24例结核和22例转移性肿瘤患者进行了DCE-MRI检查。DCE动力学模式被确定为“冲刷”、“平台”或“持续增强”。根据信号强度时间过程计算特征DCE参数。采用双室药代动力学模型得到与MR造影剂进入病变有关的参数Ktrans和与造影剂在病变内的分布和清除有关的参数keep。24 TB中，1例表现为冲蚀动力学模式，12例表现为平台模式，11例表现为持续增强模式。在22例转移性肿瘤中，12例表现为消退，7例表现为平台期，3例表现为持续增强模式。与转移癌组相比，TB组的保留时间较低（0.27±0.15 vs 0.49±0.23 min - 1， P<0.001）。ROC分析显示，曲线下面积为0.780。当常规影像学表现相似时，DCE-MRI可为鉴别脊柱结核和转移提供额外信息。
To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis. DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as “wash-out”, “plateau” or “persistent enhancement”. The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain Ktrans, which is the parameter associated with the delivery of MR contrast agents into the lesion, and kep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion. Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower kep (0.27±0.15 vs. 0.49±0.23 min−1, P<0.001). The ROC analysis showed that the area under the curve was 0.780 for kep. DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.