摘要/Abstract

摘要： 目的·探讨动态增强磁共振成像（dynamic contrast-enhanced magnetic resonance imaging，DCE-MRI）用于静脉畸形患者血管内泡沫硬化剂治疗的效果预测和硬化剂选择的价值。方法·回顾性分析了2018年1月—2019年6月在上海交通大学医学院附属第九人民医院行血管内硬化治疗并接受DCE-MRI检查的初治静脉畸形患者56例。所有患者术中均首先使用泡沫硬化剂治疗，根据术中疗效判断是否换用无水乙醇硬化剂治疗，最终分为单纯泡沫硬化剂组40例和无水乙醇组16例。比较2组患者基本资料和DCE-MRI参数的差异，Logistic回归分析选用不同硬化剂的相关因素，受试者工作特征曲线分析这些相关因素用于确定不同硬化剂的效能。结果·单纯泡沫硬化剂组与无水乙醇组间患者性别、年龄、病灶部位、治疗前病灶体积及有无静脉石比较，差异无统计学意义。病灶分型、最大强度时间率（maximum intensity time ratio，MITR）及增强百分比的差异有统计学意义。多因素Logistic回归分析显示，病灶分型和MITR是硬化剂选择的独立相关因素。MITR的曲线下面积（area under curve，AUC）为0.947，病灶分型的AUC为0.844；两者联合后AUC为0.969，敏感度为93.8%，特异度为90.0%。结论·DCE-MRI可以辅助临床在静脉畸形血管内治疗时选用适当的硬化剂，提高治疗的有效性。
关键词: 动态增强磁共振成像, 静脉畸形, 硬化治疗, 硬化剂
Abstract:
Objective · To evaluate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the efficacy of foam sclerotherapy and selecting sclerosants for endovascular sclerosis of venous malformations. Methods · A retrospective analysis was conducted for 56 patients with venous malformations who underwent intravascular sclerotherapy and DCE-MRI examination from January 2018 to June 2019 in Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine. All the patients were firstly treated with foam sclerotherapy. During the surgery, the surgeons determined whether to subsequently use ethanol, depending on the immediate therapeutic effect of foam sclerotherapy. Among them the 40 cases were treated with foam sclerotherapy only (foam sclerotherapy group) and the other 16 cases (ethanol group) with subsequent ethanol. The basic characteristics and DCE-MRI parameters of the two groups were compared. Logistic regression was used to analyze the risk factors of selecting different sclerosing agents, and the receiver operator characteristic curve was applied to assess the efficacy of these risk factors. Results · There were no significant differences in the gender, age, lesion location, pre-treatment volume and presence or absence of phleboliths between foam sclerotherapy group and ethanol group. The lesion classification, maximum intensity time ratio (MITR) and peak enhancement percentage showed significant differences between the two groups. Multivariate Logistic regression analysis showed that the lesion classification and MITR were two independent factors for the selection of sclerosing agents. The area under curve (AUC) of MITR was 0.947, while the AUC of lesion classification was 0.844. After the combination of these two parameters, the AUC was 0.969 with the sensitivity of 93.8% and the specificity of 90.0%. Conclusion · DCE-MRI can be helpful for clinical selection of appropriate sclerosing agents to improve the effectiveness of venous malformations treatment.
Key words: dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), venous malformations (VMs), sclerotherapy, sclerosant


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