显微镜高分辨率MRI鉴别皮肤良、恶性局灶隆起性结节

doi:10.6040/j.issn.1671-7554.0.2023.0654

摘要/Abstract

摘要： 目的探讨显微镜高分辨磁共振成像(MHR-MRI)在皮肤局灶隆起性结节良、恶性鉴别中的价值。方法对2020年4月至2023年4月于山东大学齐鲁医院就诊并行术前MHR-MRI检查的45例皮肤局灶隆起性结节进行前瞻性分析。根据术后病理结果将其分为良性组(n=19)和恶性组(n=26)。分别对两组病灶的MHR-MRI特征进行测量及评估,并对良、恶性组,以及基底细胞癌、隆突性皮肤纤维肉瘤和鳞癌三个类型之间的差异进行比较,计算其诊断恶性皮肤局灶隆起性结节的灵敏度、特异度、约登指数、受试者工作特征曲线下面积(AUC)及联合诊断效能。结果在恶性组,MHR-MRI显示病灶更易出现尖角楔入征(P<0.001)、累及表皮真皮(P<0.001)、边界不清(P=0.003),以及存在周围血管(P=0.003),综合影像指标(尖角楔入征阳性、侵犯表皮真皮、边界不清、T2WI高信号、合并周围血管)诊断恶性局灶隆起性结节的约登指数为0.909(灵敏度为0.962,特异度为0.947),AUC值为0.995。在基底细胞癌、隆突性皮肤纤维肉瘤、鳞癌之间,MHR-MRI显示基底细胞癌及隆突性皮肤纤维肉瘤的宽基底特征较鳞癌更多见(P=0.021),隆突性皮肤纤维肉瘤和鳞癌比基底细胞癌更常出现尖角楔入征(P=0.001)。结论 MHR-MRI作为一种新型的皮肤高清成像方法,有助于皮肤良、恶性局灶隆起性结节及常见恶性肿瘤的鉴别。

关键词: 皮肤局灶隆起性结节, 显微镜高分辨磁共振成像, 良恶性, 鉴别诊断

Abstract: Objective To explore the value of microscope high-resolution magnetic resonance imaging(MHR-MRI)in the differentiation of benign and malignant skin focal protuberant nodules. Methods A total of 45 patients with skin focal protuberant nodules admitted to Qilu Hospital of Shandong University during April 2020 and April 2023 and examined with preoperative MHR-MRI were prospectively analyzed. Based on pathological results, they were divided into benign group(n=19)and malignant group(n=26). The MHR-MRI characteristics of the lesions in the two groups were assessed. Differences between the benign and malignant groups, and among basal-cell carcinoma, protuberant skin fibrosarcoma and squamous cell carcinoma were compared. The sensitivity, specificity, Youden index and the area under the operating characteristic curve(AUC)and diagnostic efficiency of MHR-MRI were calculated. Results Lesions in the malignant group were more commonly characterized by sharp-angle-wedge sign(P<0.001), involvement of the epidermis and dermis(P<0.001), unclear boundaries(P=0.003), and the presence of surrounding vessels(P=0.003). The Youden index for a combined imaging parameters(sharp-angle-wedge sign, invasion of the epidermis and dermis, poorly defined borders, high signal intensity on T₂WI, and combination of peripheral vessels)was 0.909(sensitivity 0.962, specificity 0.947)with an AUC of 0.995. The basal-cell carcinoma and protuberant skin fibrosarcoma were more often characterized by a wide base of the focus than the squamous cell carcinoma on MHR-MRI(P=0.021). The protuberant skin fibrosarcoma and squamous cell carcinoma were more often associated with sharp-angle-wedge sign than basal-cell carcinoma(P=0.001). Conclusion MHR-MRI is helpful in the differentiation of benign and malignant skin focal protuberant nodules and common malignant tumors.

Key words: Skin focal protuberant nodules, Microscope high-resolution magnetic resonance imaging, Benign and malignant, Differential diagnosis

中图分类号:

R751

靳新娟,蔡大幸,范金蕾,邓展昊,李楠,于德新,李安宁. 显微镜高分辨率MRI鉴别皮肤良、恶性局灶隆起性结节[J]. 山东大学学报 (医学版), 2023, 61(12): 51-61.

JIN Xinjuan, CAI Daxing, FAN Jinlei, DENG Zhanhao, LI Nan, YU Dexin, LI Anning. Differentiation of benign and malignant skin focal protuberant nodules using microscope high-resolution MRI[J]. Journal of Shandong University (Health Sciences), 2023, 61(12): 51-61.

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