高阶磁共振功能成像评估骨与软组织肿瘤价值初探

doi:10.3969/j.issn.1674-8115.2025.05.007

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (5): 585-596.doi: 10.3969/j.issn.1674-8115.2025.05.007

高阶磁共振功能成像评估骨与软组织肿瘤价值初探

张钲佳, 李小敏, 周鑫, 马海荣, 艾松涛()

上海交通大学医学院附属第九人民医院放射科，上海 200011

收稿日期:2024-12-30 接受日期:2025-02-26 出版日期:2025-05-28 发布日期:2025-05-21
通讯作者: 艾松涛，主任医师，博士；电子信箱： ai.songtao@qq.com。
作者简介:张钲佳（1999—），女，硕士生；电子信箱： GeorgiaZhang@sjtu.edu.cn。
基金资助:
国家自然科学基金(82171993);上海交通大学医学院生物材料与再生医学研究院联合攻关项目(2022LHB07);中央高校基本科研业务费专项资金(YG2023LC07);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ202122)

Preliminary study on the value of high-order functional magnetic resonance imaging in the evaluation of bone and soft tissue tumors

ZHANG Zhengjia, LI Xiaomin, ZHOU Xin, MA Hairong, AI Songtao()

Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2024-12-30 Accepted:2025-02-26 Online:2025-05-28 Published:2025-05-21
Contact: AI Songtao, E-mail: ai.songtao@qq.com.
Supported by:
National Natural Science Foundation of China(82171993);Biomaterials and Regenerative Medicine Institute Cooperative Research Project, Shanghai Jiao Tong University School of Medicine(2022LHB07);Fundamental Research Funds for the Central Universities(YG2023LC07);Clinical Research Program of Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ202122)

摘要/Abstract

摘要：

目的·初步探讨高阶磁共振功能成像在评估骨与软组织肿瘤良恶性及化学治疗（化疗）效果中的应用价值。方法·纳入2014年10月至2024年12月在上海交通大学医学院附属第九人民医院骨科接受治疗且临床确诊为骨与软组织肿瘤的患者，根据患者磁共振检查方法，分为常规组和酰胺质子转移加权成像（amide proton transfer-weighted imaging，APTw）组。所有患者术前均行常规磁共振成像（magnetic resonance imaging，MRI）、弥散加权成像（diffusion-weighted imaging，DWI）及动态增强成像（dynamic contrast-enhanced imaging，DCE），APTw组患者在此基础上额外接受APTw成像。2组患者根据病理结果各分为非恶性病变组和恶性病变组；APTw组中的恶性病变患者根据入组前是否接受化疗，进一步分为未化疗组和化疗组。收集患者临床信息、影像学资料，分析肿瘤最大截面的APT值、表观弥散系数（apparent diffusion coefficient，ADC）及时间信号强度曲线（time intensity curve，TIC），以比较磁共振APTw、DWI及DCE在肿瘤诊断及评估化疗后改变中的应用价值。结果·共入组85例患者（男性51例，女性34例），年龄10~84岁，平均（43.05±17.62）岁。常规组51例（非恶性病变16例，恶性病变35例），APTw组34例（非恶性病变5例，恶性病变29例；恶性病变患者中未化疗者23例，化疗者6例）。临床和影像学特征中，仅常规组的边界是否清楚与APTw组的肿瘤最大直径在各自的恶性与非恶性病变患者间差异具有统计学意义（ P<0.05）。在APTw组中，恶性病变与非恶性病变患者的APT值差异具有统计学意义（ P<0.001）；进一步分析，恶性病变未化疗组的APT值显著低于恶性病变化疗组（ P<0.001），但恶性病变化疗组与非恶性病变组的APT值差异无统计学意义（ P>0.05）。常规组与APTw组的ADC值及TIC分型在2组各自的恶性病变与非恶性病变组间差异均无统计学意义（ P>0.05）。APTw组诊断模型（常规MRI+DWI+DCE+APTw）对骨与软组织恶性与非恶性病变的诊断效能曲线下面积（area under curve，AUC）大于常规组诊断模型（常规MRI+DWI+DCE），差异具有统计学意义（ P<0.05），且APTw组诊断模型的约登指数及特异度均更高。结论·APTw成像作为一种高阶磁共振功能成像，可以评估骨与软组织肿瘤的良恶性及化疗后改变，是常规MRI、DWI及DCE成像评估的有益补充，为骨与软组织肿瘤的无创诊疗评估提供了新的临床工具。

关键词: 骨肿瘤, 软组织肿瘤, 酰胺质子转移, 扩散加权磁共振成像, 新辅助治疗

Abstract:

Objective ·To preliminarily investigate the value of high-order functional magnetic resonance imaging in the evaluation of benign and malignant bone and soft tissue tumors and the changes after chemotherapy. Methods ·Patients clinically diagnosed with bone and soft tissue tumors at the Department of Orthopaedics, Shanghai Ninth People 's Hospital, Shanghai Jiao Tong University School of Medicine, from October 2014 to December 2024 were enrolled. The patients were divided into a control group and an amide proton transfer-weighted imaging (APTw) group according to the imaging method. All patients underwent conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE) before surgery. Patients in the APTw group received additional APTw imaging. Both groups were divided into non-malignant and malignant lesion subgroups according to pathological results. According to whether the patients received chemotherapy before enrollment, the patients with malignant lesions in the APTw group were further divided into malignant group without chemotherapy and malignant group with chemotherapy. Clinical and imaging data, including APT values, apparent diffusion coefficient (ADC), and time-intensity curves (TICs) from the largest tumor section, were collected and analyzed to assess the diagnostic performance of APTw, DWI, and DCE, and to evaluate changes after chemotherapy. Results ·Eighty-five patients were enrolled, including 51 males and 34 females, with ages ranging from 10 to 84 years, and a mean age of (43.05±17.62) years. There were 51 patients in the control group (16 with non-malignant lesions and 35 with malignant lesions) and 34 patients in the APTw group (5 with non-malignant lesions and 29 with malignant lesions; 23 malignant lesions without chemotherapy and 6 malignant lesions with chemotherapy). The clinical and imaging data showed that only the tumor margin of the control group and the maximum tumor diameter of the APTw group had statistically significant differences in their malignant and non-malignant lesion groups ( P<0.05). In the APTw group, there was a statistically significant difference in APT values between the malignant lesion group and the non-malignant lesion group ( P<0.001). Further analysis showed that the APT values in the malignant group without chemotherapy were significantly lower than that in the malignant group with chemotherapy ( P<0.001). However, there were no statistically significant differences in APT values between the malignant group with chemotherapy and the non-malignant lesion group ( P>0.05). There were no significant differences in ADC values and TIC types between malignant and non-malignant lesion groups in the control group and the APTw group ( P>0.05). The area under the curve (AUC) of the diagnostic model in the APTw group (MRI+DWI+DCE+APTw) for distinguishing malignant from benign tumors was significantly higher than that of the control group (MRI+DWI+DCE) ( P<0.05). The Youden index and specificity of the diagnostic model in the APTw group were higher than those in the control group. Conclusion ·As a high-order functional MRI technique, APTw imaging is capable of evaluating the nature (benign or malignant) of bone and soft tissue tumors and detecting changes after chemotherapy. It serves as a valuable supplement to conventional MRI, DWI, and DCE imaging, providing a novel noninvasive tool for the diagnosis and treatment evaluation of bone and soft tissue tumors.

Key words: bone neoplasm, soft tissue neoplasm, amide proton transfer, diffusion magnetic resonance imaging, neoadjuvant therapy

中图分类号:

R445.2

张钲佳, 李小敏, 周鑫, 马海荣, 艾松涛. 高阶磁共振功能成像评估骨与软组织肿瘤价值初探[J]. 上海交通大学学报（医学版）, 2025, 45(5): 585-596.

ZHANG Zhengjia, LI Xiaomin, ZHOU Xin, MA Hairong, AI Songtao. Preliminary study on the value of high-order functional magnetic resonance imaging in the evaluation of bone and soft tissue tumors[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 585-596.

图/表 11

参考文献 49

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Parameter	T1WI	T2WI	T2-SPAIR	DWI	DCE	APTw
Sequence	TSE	TSE	TSE	EPI	TSE	TSE
Plane	Axial	Axial	Coronal	Axial	Axial	Axial
Fat saturation	NO	NO	SPAIR	SPAIR	NO	SPIR
Time to repeat/ms	672	3 000	3 200	3 048	638	7 300
Time to echo/ms	13	75	60	56	15	8.3
Thickness/mm	4	4	4	5	4	6
FOV/mm	250×400	300×379	280×350	300×450	300×379	230×180
Matrix	312×418	352×375	352×368	152×197	352×402	128×100
Slice gap/mm	0.4	0.4	0.4	0.5	0.4	0
NSA	1	1	1	1	1	1
b value/(s·mm ^-2)	‒	‒	‒	0, 1 000	‒	‒
Scan time	2 min 5 s	2 min 30 s	2 min 14 s	1 min 41 s	2 min 32 s	3 min 37 s

Parameter	T1WI	T2WI	T2-SPAIR	DWI	DCE	APTw
Sequence	TSE	TSE	TSE	EPI	TSE	TSE
Plane	Axial	Axial	Coronal	Axial	Axial	Axial
Fat saturation	NO	NO	SPAIR	SPAIR	NO	SPIR
Time to repeat/ms	672	3 000	3 200	3 048	638	7 300
Time to echo/ms	13	75	60	56	15	8.3
Thickness/mm	4	4	4	5	4	6
FOV/mm	250×400	300×379	280×350	300×450	300×379	230×180
Matrix	312×418	352×375	352×368	152×197	352×402	128×100
Slice gap/mm	0.4	0.4	0.4	0.5	0.4	0
NSA	1	1	1	1	1	1
b value/(s·mm ^-2)	‒	‒	‒	0, 1 000	‒	‒
Scan time	2 min 5 s	2 min 30 s	2 min 14 s	1 min 41 s	2 min 32 s	3 min 37 s

Variable	Control group ( n=51)			APTw group ( n=34)			P value
Variable	Non-malignant lesion ( n=16)	Malignant lesion ( n=35)	P value	Non-malignant lesion ( n=5)	Malignant lesion ( n=29)	P value	P value
Gender/ n(%)			0.068			0.618	0.119
Male	5 (31.3)	22 (62.9)		3 (60.0)	21 (72.4)
Female	11 (68.8)	13 (37.1)		2 (40.0)	8 (27.6)
Age/year	39.00±12.87	47.40±17.57	0.111	41.80±12.46	40.24±20.10	0.925	0.317
Maximum diameter/cm	4.80 (5.28)	7.69±3.13	0.082	4.24±0.83	8.14±4.33	0.038	0.986
Margin/ n(%)			0.001			0.146	0.509
Clear	14 (87.5)	13 (37.1)		4 (80.0)	11 (37.9)
Unclear	2 (12.5)	22 (62.9)		1 (20.0)	18 (62.1)
Signal/ n(%)			0.187			0.570	0.624
Homogeneous	7 (43.8)	8 (22.9)		2 (40.0)	6 (20.7)
Heterogeneous	9 (56.3)	27 (77.1)		3 (60.0)	23 (79.3)
Shape/ n(%)			0.157			0.205	0.595
Regular	6 (37.5)	6 (17.1)		2 (40.0)	4 (13.8)
Irregular	10 (62.5)	29 (82.9)		3 (60.0)	25 (86.2)
Peritumoral edema/ n(%)			0.115			0.591	0.632
No	8 (50.0)	9 (25.7)		2 (40.0)	7 (24.1)
Yes	8 (50.0)	26 (74.3)		3 (60.0)	22 (75.9)
Cortical bone destruction/ n(%)			1.000			1.000	0.257
No	1 (6.3)	2 (5.7)		1 (20.0)	4 (13.8)
Yes	15 (93.8)	33 (94.3)		4 (80.0)	25 (86.2)

Variable	Control group ( n=51)			APTw group ( n=34)			P value
Variable	Non-malignant lesion ( n=16)	Malignant lesion ( n=35)	P value	Non-malignant lesion ( n=5)	Malignant lesion ( n=29)	P value	P value
Gender/ n(%)			0.068			0.618	0.119
Male	5 (31.3)	22 (62.9)		3 (60.0)	21 (72.4)
Female	11 (68.8)	13 (37.1)		2 (40.0)	8 (27.6)
Age/year	39.00±12.87	47.40±17.57	0.111	41.80±12.46	40.24±20.10	0.925	0.317
Maximum diameter/cm	4.80 (5.28)	7.69±3.13	0.082	4.24±0.83	8.14±4.33	0.038	0.986
Margin/ n(%)			0.001			0.146	0.509
Clear	14 (87.5)	13 (37.1)		4 (80.0)	11 (37.9)
Unclear	2 (12.5)	22 (62.9)		1 (20.0)	18 (62.1)
Signal/ n(%)			0.187			0.570	0.624
Homogeneous	7 (43.8)	8 (22.9)		2 (40.0)	6 (20.7)
Heterogeneous	9 (56.3)	27 (77.1)		3 (60.0)	23 (79.3)
Shape/ n(%)			0.157			0.205	0.595
Regular	6 (37.5)	6 (17.1)		2 (40.0)	4 (13.8)
Irregular	10 (62.5)	29 (82.9)		3 (60.0)	25 (86.2)
Peritumoral edema/ n(%)			0.115			0.591	0.632
No	8 (50.0)	9 (25.7)		2 (40.0)	7 (24.1)
Yes	8 (50.0)	26 (74.3)		3 (60.0)	22 (75.9)
Cortical bone destruction/ n(%)			1.000			1.000	0.257
No	1 (6.3)	2 (5.7)		1 (20.0)	4 (13.8)
Yes	15 (93.8)	33 (94.3)		4 (80.0)	25 (86.2)

Variable	Radiologist 1	Radiologist 2	ICC/ κ	95% CI
APT	2.50% (1.23%)	2.63% (1.09%)	0.977	0.954‒0.988
ADC/(10 ^-3·mm ²·s ^-1)	1.01 (0.67)	1.08 (0.69)	0.964	0.929‒0.982
TIC (Ⅰ/Ⅱ/Ⅲ)/ n(%)	17 (50.0)/14 (41.2)/3 (8.8)	16 (47.1)/15 (44.1)/3 (8.8)	0.847	0.678‒1.000

高阶磁共振功能成像评估骨与软组织肿瘤价值初探

Preliminary study on the value of high-order functional magnetic resonance imaging in the evaluation of bone and soft tissue tumors

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Metrics

Variable	Non-malignant lesions group ( n=5)	Malignant lesions group ( n=29)	U/ χ²	P value
APT	4.52%±0.76%	2.47% (0.56%)	5.00	<0.001
ADC/(10 ^-3·mm ²·s ^-1)	1.37±0.52	1.03 (0.66)	44.00	0.527
TIC(Ⅰ/Ⅱ/Ⅲ)/ n(%)	3 (60.0)/1 (20.1)/1 (20.0)	14 (48.3)/13 (44.8)/2 (6.9)	1.59	0.453

Variable	Non-chemotherapy group ( n=23)	Chemotherapy group ( n=6)	U/ χ²	P value
APT	2.43%±0.23%	3.67%±0.24%	138.00	<0.001
ADC/(10 ^-3·mm ²·s ^-1)	1.00 (0.66)	1.31±0.65	75.00	0.643
TIC(Ⅰ/Ⅱ/Ⅲ)/ n(%)	13 (56.5)/9 (39.1)/1 (4.3)	1 (16.7)/4 (66.7)/1 (16.7)	3.42	0.181

Variable	Non-malignant lesions group ( n=16)	Malignant lesions group ( n=35)	U/ χ²	P value
ADC/(10 ^-3·mm ²·s ^-1)	1.33±0.55	1.00 (0.89)	260.50	0.690
TIC(Ⅰ/Ⅱ/Ⅲ)/ n(%)	10 (62.5)/4 (25.0)/2 (12.5)	17 (48.6)/13 (37.1)/5 (14.3)	0.91	0.633

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