弥散加权成像对隆突性皮肤纤维肉瘤术前规划的价值初探

doi:10.3969/j.issn.1674-8115.2022.08.014

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (8): 1095-1102.doi: 10.3969/j.issn.1674-8115.2022.08.014

• 论著 · 临床研究 • 上一篇

弥散加权成像对隆突性皮肤纤维肉瘤术前规划的价值初探

柳思宇¹(), 吴兵¹, 李小敏¹, 赵露露¹, 陈骏², 艾松涛¹()

^1.上海交通大学医学院附属第九人民医院放射科，上海 200011
^2.上海交通大学医学院附属第九人民医院皮肤科，上海 200011

收稿日期:2022-06-30 接受日期:2022-08-08 出版日期:2022-08-28 发布日期:2022-10-08
通讯作者: 艾松涛 E-mail:liuye0326@126.com;ai.songtao@qq.com
作者简介:柳思宇（1997—），女，住院医师，硕士；电子信箱： liuye0326@126.com。
基金资助:
上海申康医院发展中心促进市级医院临床技能与临床创新三年行动计划(SHDC2020CR3083B);上海交通大学医学院附属第九人民医院临床研究型MDT项目(201901);上海交通大学医学院附属第九人民医院学科特色疾病生物样本库(YBKB202116)

Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans

LIU Siyu¹(), WU Bing¹, LI Xiaomin¹, ZHAO Lulu¹, CHEN Jun², AI Songtao¹()

^1.Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
^2.Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2022-06-30 Accepted:2022-08-08 Online:2022-08-28 Published:2022-10-08
Contact: AI Songtao E-mail:liuye0326@126.com;ai.songtao@qq.com
Supported by:
Clinical Research Plan of Shanghai Hospital Development Center(SHDC2020CR3083B);Clinical Research Project of Multi-Disciplinary Team, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(201901);Project of Biobank from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine(YBKB202116)

摘要/Abstract

摘要：

目的·探讨弥散加权成像（diffusion-weighted imaging，DWI）在隆突性皮肤纤维肉瘤（dermatofibrosarcoma protuberans，DFSP）术前规划中的应用价值。方法·招募2018年5月至2022年3月于上海交通大学医学院附属第九人民医院就诊的DFSP患者。所有患者术前均行CT和MRI检查，且随机分为MRI功能成像组（影像资料包含CT平扫＋增强、MRI平扫＋增强、DWI）与MRI常规成像组（影像资料包含CT平扫＋增强、MRI平扫＋增强）；2组均借助计算机辅助设计软件Medraw，通过CT与对应MRI图像配准［MRI功能成像组与DWI图像配准，MRI常规成像组与动态增强磁共振成像（dynamic contrast-enhanced magnetic resonance imaging，DCE）图像配准］，进行肿瘤边界勾画，形成DFSP三维肿瘤模型，完成皮肤肿瘤三维可视化报告，辅助设计手术切除方案。收集2组患者基本临床资料、随访复发率及术区美观满意度评价情况，并进行组间比较。结果·共招募临床资料及影像资料完善的DFSP患者34例，平均年龄（36.56±13.07）岁，肿瘤发生部位包括腹壁10例、胸壁9例、颌面部4例、大腿及肩部各3例、臀部及腰部各2例、足部1例，肿瘤平均直径为（2.25±0.92）cm。MRI功能成像组和MRI常规成像组各纳入17例患者，2组患者基本临床特征间差异均无统计学意义（均 P>0.05）。所有病例平均随访（9.97±7.82）个月，MRI功能成像组患者肿瘤复发率（0）显著低于MRI常规成像组（29.4%），且MRI功能成像组的术区美观满意率（100%）显著高于MRI常规成像组（70.6%），差异均有统计学意义（均 P<0.05）。结论·DWI对于DFSP肿瘤边界判断较常规MRI更有优势，基于DWI的术前影像规划对降低DFSP复发率及提高术区美观度有一定价值。

关键词: 隆突性皮肤纤维肉瘤, 磁共振成像, 弥散加权成像, 术前规划

Abstract:

Objective ·To explore the value of diffusion-weighted imaging (DWI) in pre-surgical planning of dermatofibrosarcoma protuberans (DFSP). Methods ·The cases with DFSP in Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine from May 2018 to March 2022 were enrolled. CT and MRI were conducted before surgery as a routine procedure. All the patients were randomly divided into MRI functional imaging group (CT plain scan and enhanced scan, MRI plain scan and enhanced scan, and DWI) and MRI conventional imaging group (CT plain scan and enhanced scan, and MRI plain scan and enhanced scan). The tumor boundaries of the two groups were outlined respectively by aligning CT with corresponding MRI images with computer- aided design software Medraw [alignment of CT images with DWI images in MRI functional imaging group and alignment of CT images with dynamic contrast-enhanced magnetic resonance imaging (DCE) images in MRI conventional imaging group] in order to complete the DFSP 3D tumor models and the 3D visualization reports, and to design surgical plans. The clinical characteristics of the two groups were completely collected. The recurrence rate and postoperative satisfaction evaluation of the two groups were compared. Results ·A total of 34 cases with DFSP having completed clinical and imaging information were enrolled in this research with an average age of (36.56±13.07) years. The tumor location of occurrence included 10 cases in the abdominal walls, 9 cases in the chest walls, 4 cases in the maxillofacial regions, 3 cases in the thighs, 3 cases in the shoulders, 2 cases in the hips, 2 cases in the waists, and 1 case in the feet. The average tumor diameter was (2.25±0.92) cm. Seventeen patients were included in the MRI functional imaging group and MRI conventional imaging group respectively with an average follow-up of (9.97±7.82) months. There were no significant differences in the basic clinical information between the two groups ( P>0.05). The recurrence rate of the MRI functional imaging group (0) was lower than that of the MRI conventional imaging group (29.4%), and the postoperative aesthetic satisfaction rate in the former group (100%) was higher than that in the latter group (70.6%). There were statistically significant differences in these results between the two groups ( P<0.05). Conclusion ·DWI is more advantageous for tumor boundary determination compared with conventional MRI; DWI-based preoperative image planning can reduce DFSP recurrence rate and improve aesthetics of the operative area to some extent.

Key words: dermatofibrosarcoma protuberans (DFSP), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), pre-surgical planning

中图分类号:

R445.2

柳思宇, 吴兵, 李小敏, 赵露露, 陈骏, 艾松涛. 弥散加权成像对隆突性皮肤纤维肉瘤术前规划的价值初探[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1095-1102.

LIU Siyu, WU Bing, LI Xiaomin, ZHAO Lulu, CHEN Jun, AI Songtao. Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(8): 1095-1102.

图/表 6

表1 患者临床基本信息

Tab 1 Clinical characteristics of the two groups

Clinical characteristic	MRI functional imaging group （ n＝17）	MRI conventional imaging group （ n＝17）	P value
Age/year	38.76±12.63	34.35±13.51	0.333
Gender/ n（%）			1.000
Male	9 （52.9）	9 （52.9）
Female	8 （47.1）	8 （47.1）
Lesion location/ n（%）			0.562
Trunk	12 （70.6）	14 （82.4）
Limbs	3 （17.6）	1 （5.8）
Head and neck	2 （11.8）	2 （11.8）
Diameter/cm	2.37±0.81	2.13±1.02	0.452
Number of episodes/ n（%）			0.080
First onset	7 （41.2）	13 （76.5）
Recurrence	10 （58.8）	4 （23.5）

表2 不同医师判断 2组患者肿瘤边界累及筋膜情况的一致性评价

Tab 2 Consistency evaluation of different doctors ' judgment of fascia involvement in tumor boundary in the two groups of patients

Radiologist 1	MRI functional imaging group			MRI conventional imaging group
	Radiologist 2		κ value	Radiologist 2		κ value
	Yes/ n	No/ n	κ value	Yes/ n	No/ n	κ value
Yes/ n	5	1	0.866	5	2	0.514
No/ n	0	11		2	8

表3 不同医师判断 2组患者肿瘤边界累及肌肉情况的一致性评价

Tab 3 Consistency evaluation of different doctors ' judgment of muscles involvement in tumor boundary in the two groups of patients

Radiologist 1	MRI functional imaging group			MRI conventional imaging group
	Radiologist 2		κ value	Radiologist 2		κ value
	Yes/ n	No/ n	κ value	Yes/ n	No/ n	κ value
Yes/ n	5	1	0.742	3	1	0.549
No/ n	1	10		2	11

表4 患者术后美观满意度评价比较

Tab 4 Comparison of post-operative aesthetic satisfaction evaluation

Group	n	Very satisfied/ n（%）	Satisfied/ n（%）	Unsatisfied/ n（%）	Total satisfaction rate/%
MRI functional imaging group	17	13 （76.5）	4 （23.5）	0 （0）	100.0
MRI conventional imaging group	17	8 （47.1）	4 （23.5）	5 （29.4）	70.6
χ² value					14.815
P value					0.001

图1 患者肿瘤影像图像示例Note：A. Preoperative CT scan of soft tissue window image. B. Homogeneously hypointensity on T1WI. C. Hyperintensity on FS-T2WI. D. The tumor area indicated by the long arrow was mildly enhanced, while the tumor area indicated by the short arrow was less enhanced than the former on DCE. E. Hyperintensity on DWI. F. Outlined tumor boundary by Medraw software.

Fig 1 Example of a patient 's tumor images

图2 影像规划辅助手术过程示例Note：A. 3D image of DFSP. B. Measurement of the extent of soft tissue defect around the tumor. C. Solid image. D. Actual resection. E. General pathology. F. Flap plasty.

Fig 2 Example of image-assisted surgical procedure planning

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弥散加权成像对隆突性皮肤纤维肉瘤术前规划的价值初探

Preliminary exploration of diffusion-weighted imaging in pre-surgical planning of dermatofibrosarcoma protuberans

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