| Part 1The ADC value of DWI in differentiating diagnostic value of histopathological subtypes in lung carcinomasObjective:To observe and analyze the characteristics of the map of MRI,DWI,ADC in different histopathological Subtypes of lung carcinomas.To explore the ADC values in patients with different subtypes of lung carcinomas. To provide an radiological reference for clinical diagnosis and treatment of lung carcinomas.Methods:Totally 33 cases of patients with different subtypes of lung carcinomas (20 males, 13 females,age from 30 to 86,mean age 62) who had been confirmed by pathological diagnosis by prospectively collected from May 2014 to January 2015 in our hospital.All patients were obtained pathological results by puncture, bronchoscopic biopsy or surgical.Including 18 cases of adenocarcinomas,8 cases of squamous cell carcinomas,7 cases of small cell lung carcinomas.All patients were underwent routine MRI and DWI examinations with Siemens Aera 1.5T superconductive MRI scanner,by using different b values (50,500,1000 s/mm2).After the examinations were completed,the ADC values of all patients were measured on Siemens Syngo MRD13 by post processing to a workstation,the measurement of ADC value was the corresponding with the hyperintensity of lesion on the map of DWI. The three regions of interest (ROI)) were plotted around the tumor by the freehand.Try to avoid the areas of hemorrhage, necrosis and cystic. To observe the lesion sites,numbers and morphologies,and to analyze the signal characteristics of the maps of T1WI,T2WI and DWI,ADC.Grouped by according to the different subtypes of lung carcinomas,a normality distribution test by the method Komogorov-Smirnov test,a test of homogeneity of variance by the Leneve law test,if they meet the normal distribution and homogeneity of variance,the difference in the ADC value of small-cell lung carcinomas and non-small cell lung carcinomas was compared by the t test,if they do not meet the normal distribution,by the nonparametric Mann-Whitney U test. The difference of ADC value among groups was compared by Single factor analysis of variance (one-way ANOVA).Homogeneity of variance by the least significant difference (LSD) or the heterogeneity of variance by DunettT3 test.P<0.05 was considered statistically significant. Statistical analysis was performed with SPSS for windows.Version 18.0.Results:(1) Most of the solid components of lung carcinomas showed equal or slightly low signal on T1WI map,equal or high signal on T2WI map; the obstructive pneumonia and postobstructive atelectasis showed high signal on T2WI map, low or slightly low signal on DWI map and high signal on ADC map;the adenocarcinomas showed equal or high signal on DWI map,the map of ADC showed heterogeneous low signal;squamous cell carcinomas and small-cell lung carcinomas showed high signal on the DWI map,the map of ADC showed low signal,if they were accompanied with the areas of necrosis,cystic degeneration,the necrotic showed the lower signal on DWI map or higher signal on ADC map; (2)In the b value=1000s/mm2,the mean ADC values of adenocarcinoma,squamous cell carcinoma,small cell carcinomas were:(1.151±0.074)×10-3mm2/s;(0.807±0.127)×10-3mm2/s;(1.006±0.057)× 10-3mm2/s;(4)Different pathological subtypes of lung adenocarcinomas,squamous cell carcinoma,small cell carcinoma of the (F=44.415, P=0.000,P<0.05),the mean ADC values of adenocarcinomas were higher than the squamous cellcarcinomas and small cell lung carcinomas (P=0.000,0.001,P<0.05), the mean ADC values of squamous cell carcinoma were lower than small cell carcinoma (P=0.000, P<0.05),the mean ADC values between central and peripheral lung carcinomas were no significantly different (t=1.365,P=0.182,P>0.05),the mean ADC values between small cell lung carcinomas and no-small cell lung carcinomas were no significantly different (t=0.925,P=0.362,P> 0.05).Conclusion:1. The maps of T2WI and DWI have some helpful in differentiating diagnostic of the tumor tissues from obstructive pneumonia and postobstructive atelectasis.2. When selecting the b value of 1000s/mm2.The ADC values has important value in differential diagnosis of different types of pathological lung carcinomas; the ADC values of adenocarcinomas were higher than small cell lung carcinomas and squamous cell carcinomas.Part 2The quantitative parameters on dynamic contrast-enhanced MRI in differentiating diagnostic value of histopathological subtypes in lung carcinomasObjective:To observe and analyze the characteristics of the Ktrans map and TIC curve types in different histopathological Subtypes of lung carcinomas.To explore the quantitative parameters on dynamic contrast-enhanced MRI in patients with different subtypes of lung carcinomas.To explore the value and effectiveness of differential diagnostic in different types of pathological lung carcinomas by the quantitative parameters on dynamic contrast-enhanced MRI.To provide the radiological references for clinical diagnosis and treatment of lung carcinomas.Methods:Totally 33 cases of patients with different subtypes of lung carcinomas (20 males, 13 females,age from 30 to 86,mean age 62) who had been confirmed by pathological diagnosis by prospectively collecting from May 2014 to January 2015 in our hospital.All patients were obtained pathological results by puncture, bronchoscopic biopsy or surgical.Inc-luding 18 cases of adenocarcinomas,8 cases of squamous cell carcinomas,7 cases of small cell lung carcinomas. All patients were underwent routine MRI and DCE-MRI examinations with Siemens Aera 1.5T superconductive MRI scanner, After the examinations were completed, the DCE-MR images were transferred for postprocessing to a workstation running commercially available software for tissue perfusion estimation (Tissue 4D, Siemens Medical Systems).After motion correction and registration of the pre-and post-contrast acquisitions,Tl mapping was automatically performed and a freehand region of interest (ROI) was plotted around the tumor.Given the possible breathing artifacts,the outlier time point was discarded according to the fitting curve.The pharmacokinetic modeling was based on the Tofts two-compartment model that allowed for the calculation of Ktrans,Ve,Kep. To anlyze the characteristics of the curve type of TIC and Ktrans map.Grouped by according to the different subtypes of lung carcinomas,a normality distribution test by the method Komogorov-Smirnov test,a test of homogeneity of variance by the Leneve law test,if they meet the normal distribution and homogeneity of variance,the difference in quantitative parameters on DCE-MRI between small-cell lung carcinomas and non-small cell lung carcinomas were compared by the t test,if they do not meet the normal distribution,by the nonparametric Mann-Whitney U test.The difference of DCE-MRI quantitative parameters among groups was compared by Single factor analysis of variance (one-way ANOVA).Homo geneity of variance by the least significant difference (LSD) or the heterogeneity of variance by DunettT3 test.Meanwhile,the receiver operating characteristic (ROC) curves and the area under the curve (area under curve,AUC) were used to analyze the differential diagnostic efficacies of Ktrans,Kep,Ve values of small cell lung carcinomas and non-small carcinomas,and then confirm the optimal diagnostic threshold value by according to the most Youden index (Youden index=sensitivity+specificity-1).P<0.05 was considered statistically significant. Statistical analysis was performed with SPSS for windows.Version 18.0.Results:(1)The types of TIC showed outflowing curve (typeA) in the 14 cases of adenocarcinomas,platform (typeB) in the 3 cases of adenocarcinomas and inflowing curve (typeC) in the 1 case of adenocarcinoma.The types of TIC showed outflowing curve in the 8 cases of squamous cell carcinomas,outflowing curve in the 5 cases of small cell carcinomas,platform (type B) in the 2 cases of small cell carcinomas; (2) Most of the Ktrans maps that were obtained from DCE-MRI revealed that the perfusion function of tumor microvessels was higher in the rim than core region;(3)The Ktrans values of adenocarcinomas,squamous cell carcinomas and small-cell carcinomas were:0.123±0.047 (min-1),0.075±0.033(min-1),0.078±0.026(min-1) respectively;the Kep values were 0.406±0.174 (min-1),0.371±0.136 (min-1),0.377±0.124 (min-1) respectively;the Ve values were:0.303 ±0.018,0.201 ± 0.011;0.207±0.017 respectively;(4)The Ktrans,Kep,and Ve,values of the different pathological types of lung carcinomas were significantly different (F and P values are values 195.839,72.650,146.033,P<0.05);(5)The Ktrans,Kep,Ve values of adenocarcinom-as were higher than squamous cell carcinomas and small cell carcinomas,and the difference was statistically significant(P values were:0.000,P<0.05 respectively),but the Ktrans,Kep,Ve values between squamous cell carcinomas and small cell carcinomas were not significantly different(P values were:0.824,0.120,0.908,P>0..05 respectively);(6) the Ktrans,Kep,Ve Val-ues of non-small cell carcinomas were:0.108±0.024(min-1);0.396±0.018(min-1),0.271±0.051; the Ktrans,Kep,Ve values of non-small cell carcinomas were are higher than small cell carcinomas,and the Ktrans,Kep,Ve values were significantly different (Z and P values were:-2.578,-2.182,-2.642;0.010,0.029,0.008, P<0.05 respectively);(7)The Ktrans, Kep,Ve values have better differential diagnosis efficiency to differentiate small cell lung carcinomas and non-small cell carcinomas,area under the curve AUC) values were:0.821,0.772,0.830 respectively,when the threshold of Ktrans was set 0.084min-1,diagnostic sensitivity 73.1%, specificity of 85.7%;When the Kep threshold was set 0.388min-1,diagnostic sensitivity 69.2%,specificity of 84.3%;the Ve threshold was set to 0.253,the diagnostic sensitivity degree of 69.2%,and a specificity of 100%.Conclusion:1.The types of TIC have a certain value in differentiating diagnostic of different types of pathological lung carcinomas,there are a limit in a certain.2.The colour map of Ktrans can indirectly reflect the perfusion of tumor in lung carcinomas, and provide some help for clinical treatment and prognosis.3.Dynamic contrast-enhanced quantitative parameters (Ktrans,Kep,Ve values) are an importa-nt hepful in differential diagnosis of different types of pathological lung carcinomas.4. Ktrans,Kep and Ve values all have better differential diagnostic efficiency between small cell lung carcinomas and non-small cells carcinomas... |
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