| Objective: We used magnetic resonance enhanced T2 star weighted angiography(MR-ESWAN) to analyze the value of classification diagnosis in intramuscular hemangioma.Materials and methods:1. Case data: 36 cases of IMHs for surgical treatment were recruited from October 2013 to March 2015 in First Affiliated Hospital of Dalian Medical University. 13 male, 23 female, average age, 38.4 years. All cases were manifested by surgical pathology with 10 cases of capillary hemangiomas, 9 cavernous hemangiomas, and 17 mixed hemangiomas.2. MR equipment and technology:(1) Scanning parameters: GE Signa HDxt 3.0T MR was selected for all patients with conventional MR image and ESWAN image, which was performed before the Dynamic Contrast Enhanced-MRI, and the site of the lesion was fixed in case of the movement influence on the ESWAN image;(2) ESWAN post-processing and data collection: ESWAN images were sent to the GE-ADW 4.4 workstation. Functool functional software was used to automatic establish the phase diagram, R2* map and 3D-MIP imaging. Regions of Interest(ROI) was placed on the parenchyma of each types of intramuscular hemangioma in ESWAN image. Fat, calcification and thrombus were excluded. The mean ROI area was about 20mm2. Three ROIs in each image and totally 9 ROIs in 3 consecutive images of ESWAN were measured for each tumor and muscle on the same level, and caculated the ratio between tumors and muscles. The low signal in hemangiom on Min IP image was defined as intertumoral susceptibility signal(ITSS). All the numbers of ITSS in hemangioma and the percentage of ITSS were calculated.3. Observational indexes:(1) The morphology, size and signal characteristics of three types of intramuscular hemangioma;(2) The phase value ratio, R2* value ratio and the percentage of ITSS of three types of intramuscular hemangioma;(3) The cut-off value, diagnostic sensitivity and specificity of phase value ratio, R2* value ratio and the percentage of ITSS were uesd to identify capillary hemangiomas from cavernous hemangiomas, capillary hemangiomas from mixed hemangiomas, cavernous hemangiomas from mixed hemangiomas.4. Statistical Analysis:(1) The tumor size of three types of intramuscular hemangioma were described using x±s;(2) The rank-sum test was used for assessing whether phase value ratio, R2* value ratio, the percentage of ITSS on MR-ESWAN image could identify different types of intramuscular hemangioma;(3) ROC curve was used for analyzing the cut-off value, diagnostic sensitivity and specificity.Results:1. Different types of intramuscular hemangioma have various shapes such as: most of cavernous hemangiomas and capillary hemangiomas round, most of mixed hemangiomas irregular. The tumor size of capillary hemangiomas were 6.998±2.739 cm3, cavernous hemangiomas 34.472±26.637cm3 and mixed hemangiomas 38.445±24.626 cm3; MRI signal was not uniform, the capillary hemangiomas with T2 WI showed slightly high signal, cavernous hemangiomas and mixed hemangiomas with T2 WI showed high signal intensity; cavernous hemangioma in ESWAN 3D-MIP image showed mixed signal with uneven thickness of blood vessels and patchy low signal of hemorrhage.2. There were significant differences for phase value ratio, R2* value ratio and the percentage of ITSS on MR-ESWAN image among cavernous hemangiomas, capillary hemangiomas and mixed hemangiomas(p=0.008, p=0.006, p=0.000):(1) There were significant differences of phase value ratio, R2* value ratio and the percentage of ITSS for capillary hemangiomas and cavernous hemangiomas(p=0.004, p=0.004, p=0.000). The cut-off value were 0.842、0.836、31.443%, sensitivity 88.9%、100%、100% and specificity 90%、80%、100% respectively;(2) There were significant differences of phase value ratio and the percentage of ITSS for capillary hemangiomas and mixed hemangiomas(p=0.009, p=0.000). There was no significant difference of R2* value ratio for capillary hemangiomas and mixed hemangiomas(p=0.243). The cut-off value of phase value ratio and the percentage of ITSS were 0.371、13.170%, sensitivity76.5%、100%, and specificity 90%、100% respectively;(3) There was significant difference of R2* value ratio for cavernous hemangiomas and mixed hemangiomas(p=0.006). There was no significant difference of phase value ratio and the percentage of ITSS for cavernous hemangiomas and mixed hemangiomas(p=0.491, p=0.085). The cut-off value of R2* value ratio was 1.689, sensitivity 66.7% and specificity 94.1%.Conclusions:1. It is useful to identify cavernous hemangioms according to the low signal of uneven thickness of blood vessels and patchy in ESWAN 3D-MIP image.2. Phase value ratio, R2* value ratio and the percentage of ITSS can be used to distinguish three types of intramuscular hemangioma with good sensitivity and high specificity:(1) Capillary hemangiomas should be considered when the phase value ratio is less than 0.371, the ratio of R2* less than 0.836, the percentage of ITSS less than 13.17%;(2) Cavernous hemangiomas should be considered when the phase value ratio is greater than 0.842, the ratio of R2* greater than 1.689, the percentage of ITSS more than 31.443%;(3) Mixed hemangiomas should be considered when the phase value ratio is greater than 0.371, the ratio of R2* less than1.689, the percentage of ITSS more than13.17%. |
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