연부 조직 종양과 전이암에 대한 확산 강조영상과 역동적 조영증강 검사의 유용성 고찰 : Ktrans, Kep, Ve와 TCC 중심으로

Purpose : It is the purpose of the study to confirm whether it would be useful to diagnose malignant and benign lesion by analyzing the parameters’ values and the time-concentration curve (TCC) graphs drawn according to DWI and DCE MRI on patients who are suspected cases of soft tissue mass and metastasis cancer before and after the operation. Materials and Methods : The research was conducted as a retrospective study by the acknowledgement of the Institutional Review Board (IRB), and a total of 51 patients took part in it from February 1, 2015 to July 31, 2016 who were required to have MRI examination for the accurate diagnosis of lesions after the nuclear medicine and the computed tomography. The protocol used in the study were the optimized examination technique of DCE MRI, which is being practiced in the hospital,and DWI. quantitative evaluation was performed by using Tissue 4D to derive from the parameters, in the diffusion weighted image, the regions of interest were determined by setting the regions of interest in the lesion that showed signal drop in the diffusion restriction area and the apparent diffusion coefficient (ADC). The independent sample t-test and the pearson correlation were used in the statistic analysis. Results : The measured parameters’ average values are as followings : In the soft tissue mass each of Ktrans, Kep, Ve, ADCminimal, ADCmaximal, ADCmean, TCCpattern/type is have the average values of 0.161 ± 0.012, 0.661 ± 0.041, 0.268 ± 0.003, 0.828 ± 0.393, 1.218 ± 0.502, 1.304 ± 0.435, 2.675 ± 0.674, 5.500 ± 1.874, and in case of the patients who were estimated to have metastasis cancer the average values are 0.126 ± 0.019, 0.711 ± 0.012, 0.219 ± 0.024, 0.879 ± 0.392, 1.285 ± 0.412, 1.074 ± 0.393, 2.787 ± 0.606, 5.590 ± 1.161 (p>0.05). Eight patients among twenty who had soft tissue mass belonged to the case that showed diffusion restriction, hyperpefusion, signal drop of ADC at the same time owing to hypercellularity ; And the average values of Ktrans, Kep, Ve, ADC showed 0.176 ± 0.121, 0.655 ± 0.297, 0.274 ± 0.146, 0.701 ± 0.203. In case of metastasis cancer, the average values acquired from nine patients among 31 were like this : each of Ktrans, Kep, Ve, ADC showed 0.133 ± 0.083, 0.698 ± 0.202, 0.187 ± 0.111, 0.889 ± 0.283. Diffusion restriction and hyperperfusion were not found in case of hemangioma, elastofibroma, chondrosarcoma, and enchondroma at the same time. Conclusions : The parameters’ criterion values in malignant tumor were 0.14 ± 0.09, 0.73 ± 0.47, 0.22 ± 0.11, 0.84 ± 0.40, 1.02 ± 0.40, 1.21 ± 0.43 in the order of Ktrans, Kep, Ve, ADCminimal, ADCmaximal, ADCmean and their TCC pattern was the third stage, which belonged to the fifth, sixth, and seventh types. In case of malignant tumor, diffusion restriction and hyper-perfusion were simultaneously appeared owing to hypercellularity and as the values of Ktrans, Kep, Ve drawn from DCE MRI and the pattern analysis of TCC graphs were complementarily applied the possibility of the accurate diagnosis grew higher than that of the conventional MRI. In addition, it is thought that it would be very useful for estimating the tumor remnant in lesions before and after the operation and its developments after chemotherapy.