Value of 3T magnetic resonance dynamic contrast-enhanced and diffusion-weighted imaging in differential diagnosis of musculoskeletal tumors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the value of magnetic resonance dynamic contrast-enhanced (MR-DCE) and magnetic resonance diffusion-weighted imaging (MR-DWI) in the differentiation of benign and malignant musculoskeletal tumors.</p><p><b>METHODS</b>Sixty-three patients with pathologically confirmed musculoskeletal tumors were examined with MR-DCE and MR-DWI. Using single shot spin echo planar imaging sequence and different b values of 400, 600, 800 and 1000 s/mm(2), we obtained the apparent diffusion coefficient (ADC) of the lesions. ADC values were measured before and after MR-DCE, with a b value of 600 s/mm(2). The 3D fast acquired multiple phase enhanced fast spoiled gradient recalled echo sequence was obtained for multi-slice of the entire lesion. The time-signal intensity curve (TIC), dynamic contrast-enhanced parameters, maximum slope of increase (MSI), positive enhancement integral, signal enhancement ratio, and time to peak (T(peak)) were also recorded.</p><p><b>RESULTS</b>ADC showed no significant difference between benign and malignant tumors when the b value was 400, 600, 800, or 1000 s/mm(2), and it was not significantly different between benign and malignant tumors in both pre-MR-DCE and post-MR-DCE with b value of 600 s/mm(2). TIC were classified into four types type1 showed rapid progression and gradual drainage; type2 showed rapid progression but had no or slight progression; type 3 showed gradual progression; and type 4 had no or slight progression. Most lesions of type1 or type2 were malignant, whereas most lesions of type 3 or type 4 were benign. When using type1 and type 2 as the standards of malignancy, the diagnostic sensitivity and specificity was 87.23% and 50.00%, respectively. The types of TIC showed significant difference between benign and malignant musculoskeletal tumors(χ(2)=17.009,P=0.001). When using MSI 366.62 ± 174.84 as the standard of malignancy, the diagnostic sensitivity and specificity was 86.78% and 78.67%, respectively. When using T(peak)≤70s as the standard of malignancy, the diagnostic sensitivity and specificity was 82.89%and 85.78%, respectively. Positive enhancement integral and signal enhancement ratio showed no significant difference between benign and malignant musculoskeletal tumors.</p><p><b>CONCLUSIONS</b>TIC, MSI and T(peak) of MR-DCE are valuable in differentiating benign from malignant musculoskeletal tumors. T(peak) has the highest diagnostic specificity, and TIC has the highest diagnostic sensitivity. The mean ADC value are no significant difference between benign and malignant tumors.</p>

Application value of 3T 1H-magnetic resonance spectroscopy in diagnosing tumors of bone and soft tissue / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study benign and malignant bone and soft tissue tumors with 1H-magnetic resonance spectroscopy (1H-MRS) at 3 Tesla MR scanner and assess the value of 1H-MRS in diagnosing bone and soft tissue tumors and distinguishing benign from malignant tumors. METHODS; Totally 49 patients with clinically and pathologically confirmed bone and soft tissue tumors were enrolled in this study. 1H-MRS was performed before treatment with point-resolved spectroscopy sequence. The imaging characteristics of 1H-MRS for bone and soft tissue tumors were observed and the possible differences between benign and malignant tumors was compared. Since spectra were directly found under single-voxel proton MRS brain examination, the peak height of choline containing compounds (Cho) opposite to the creatine (Cr) and the Cho peak were observed, and then the malignancies of the tumors were judged. Cho/Cr value was calculated and used to distinguishing benign tumors from malignancies.</p><p><b>RESULTS</b>1H-MRS spectra of bone and soft tissue tumors were different from those of the normal muscles, and such difference also existed between benign and malignant tumors. The Cho peak disappeared or was extremely low among benign tumors. The Cho/Cr values of malignant tumors and benign tumors were 3.13 +/- 0.9 and 1.34 +/- 1.02, respectively (P = 0.02). Using 1.79 as the threshold value, the Cho/Cr value had sensitivity, specificity, and accuracy of 94%, 80%, and 90%, respectively, in diagnosing malignancies.</p><p><b>CONCLUSIONS</b>The increased Cho level, as measured by 1H-MRS, is related with the bone and soft tissue malignant tumor. Cho/Cr value is useful in distinguishing benign tumors from malignancies. 1H-MRS can be an important supplement to the conventional magnetic resonance imaging.</p>

Changes of 3-tesla 31P-MR spectroscopy of bone and soft tissue tumors / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the characteristic changes of 31P-MR spectroscopy of bone and soft tissue tumors.</p><p><b>METHODS</b>41 patients were examined by phosphorus surface coil of 3 tesla MR machine, including 18 benign tumor foci and 28 malignant foci, and adjacent normal muscles. The areas under the peaks of various metabolites in the spectra were measured, including phosphomonoester (PME), inorganic phosphours (Pi), phosphodiester (PDE), phosphocreatine (Pcr), adenosine triphosphate (ATP) gamma, alpha, beta. The ratios of the metabolites to beta-ATP, NTP and Pcr were calculated. Intracellular pH was calculated according to the chemical shift change of Pi relative to Pcr.</p><p><b>RESULTS</b>The ratios of Pcr/PME and PME/NTP in benign and malignant tumor groups were significantly different from those of the normal group (P<0.05). Between benign and malignant tumor groups, the ratios of PME/beta-ATP and PME/NTP were significantly different (P<0.05).</p><p><b>CONCLUSION</b>Pcr/PME and PME/NTP are potential diagnostic indexes of bone and soft tissue tumors. PME/beta-ATP and PME/NTP are potential indexes of differential diagnosis of bone and soft tissue tumors.</p>

Preliminary study of 3T 1H MR spectroscopy in bone and soft tissue tumors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Magnetic resonance spectroscopy (MRS) is one method that can examine noninvasively the alive specimen of the organ, metabolism of the organ and cell, and the biochemistry change. MRS provides the biochemistry information that may be used to diagnose tumors or differentiate the malignant tumor from benign. The objective of this study is to investigate the benign and malignant bone and soft tissue tumors by 1H-MR spectroscopy ((1)H-MRS) on a 3 Tesla MR scanner, then to assess the usefulness of (1)H-MRS in diagnosing bone and soft tissue tumors and distinguishing benign from malignant tumors.</p><p><b>METHODS</b>Fifty-six patients with bone and soft tissue tumors proved clinically and pathologically were examined with (1)H-MRS. (1)H-MRS was performed to study malignant musculoskeletal tumors, benign tumors and normal muscle adjacent to lesions to analyze the characteristics, and single-voxel point-resolved spectroscopy sequence was used. Proton brain exam-single voxel of (1)H-MRS which directly appeared in the spectrum, was observed to find the peak height of choline compounds (Cho) opposite to the creatine (Cr), and whether there was a Cho peak. Metabolite values were calculated automatically from the area under each metabolite peak by the Functool 3.1 software. Metabolite ratios of Cho/Cr were manually calculated. Then according to the results, it was judged whether there existed benign or malignant tumors. The Kappa statistical test was used to analyze the MRS results, the histopathology data and the surgical situation. Statistics processing was performed using the software package SPSS11.5 for Windows.</p><p><b>RESULTS</b>(1)H-MRS spectra style of bone and soft tissue tumors was different from that of normal muscle, and differences also existed between benign and malignant tumors. Choline level in malignant tumor was markedly higher than that in benign tumors. Cho/Cr in malignant tumor was higher than in benign tumor significantly (P < 0.05). The true positive rate of bone and soft tissue between benign and malignant tumors was 34/36, the true negative rate was 15/18, the false positive rate was 3/18 and the false negative rate was 2/36. Therefore in the group, sensitivity of the (1)H-MRS was 94% (34/36), specificity was 83% (15/18), positive predictive value was 92% (34/37), negative predictive value was 88% (15/17) and the accuracy rate was 91% (49/54). The MRS results and the histopathology inspection conclusions had very good uniformity. The kappa value was 0.76 +/- 0.10 (P < 0.01).</p><p><b>CONCLUSIONS</b>The increase of Cho level measured by (1)H-MRS is related to the bone and soft tissue malignant tumor. Cho/Cr in malignant tumor was higher than in benign tumor, so they will play a vital role in the diagnosis and differential diagnosis of bone and soft tissue tumors.</p>