The Study Of Differential Diagnosis Of Benign And Malignant Musculoskeletal Tumors With Energy-spectrum CT And BOLD-fMRI Perfusion In P30 Model

Part One Comparing the Benign and Malignant Musculoskele-tal Tumors using Energy-spectrum CTObjective: The purpose of this study was to prospectively evaluate the value of dual-energy CT computed tomography(DECT)in the differential diagnosis of musculoskeletal(MSK)tumors,the optimal time point of energy-spectrum CT in differentiating benign from malignant musculoskeletal tumors(bone and soft tissue tumors)was further evaluated.Methods: 34 patients with musculoskeletal tumors(bone and soft tissue tumors)were included in this study.They were divided into benign tumor group(N = 13)and malignant tumor group(N = 21).Six phases in enhanced CT were performed on IQon Spectral CT(Philips Healthcare,The Netherlands).Iodine concentrations(IC),normalized iodine concentrations(NIC)and the slope of the energy spectrum(λHU)were measured and calculated of the six phases at the largest axial MSK tumors.The NIC value andλHU between benign and malignant tumors were compared,and then the NIC value between the central and peripheral regions in benign tumors and malignant tumors were compared,respectively.Receiver operator charac-teristic(ROC)curves were analyzed for data with statistically significant differences between two groups.Results:1.The NIC values of each region in the malignant MSK tumors were larger than that of benign tumors on all six phases(P<0.001).The NIC values of peripheral region in first phase enhanced scan was the most effective in differentiating benign from malignant MSK tumors.The area under the ROC curve was 0.949,and the sensitivity and specificity were 90.5% and 84.6%,respectively;2.The λHU of malignant MSK tumors was larger than that of benign ones on six phases enhanced scan(P < 0.001).The λHU in first phase was the most effective in differentiating benign from malignant MSK tumors.The area under the ROC curve was 0.956,and the sensitivity and specificity of λHU in the phase I were 90.5% and 94.1%,respectively;3.The NIC values in the peripheral area of malignant MSK tumors on six phase enhanced scanning were higher than those in the central area,and the difference was statistically significant(P<0.001);In the sixth phase of enhanced scanning,the P value of the NIC values in each area of the fourth phase of benign MSK tumor was 0.019.After pairwise comparison,there was no statistically significant difference in the central and peripheral areas of the tumor(P>0.05)in the fourth phase,while the NIC values in the central and peripheral areas of the other five phases of benign tumors were not statistically significant,with P values of 0.169,0.452,0.169,0.097,and 0.717,respectively.Conclusions: Dual-energy CT can be used to differentiate benign and malignant MSK tumors,and the first phase is the best time point to differentiate benign and malignant MSK tumors.Part Two Study on the Time Point NIC Curve of Energy Spec-trum CT for Benign and Malignant Musculoskeletal TumorsObjective: This study aims to explore the differences between benign and malignant tumors,as well as the differences between different regions of the same tumor,by observing the time point NIC curve characteristics of energy spectrum CT scans of 34 cases of musculoskeletal tumors,in order to provide certain differential diagnostic ideas for clinical applications.Methods: This study included 34 patients with musculoskeletal tumors,divided into 13 benign tumor groups and 21 malignant tumor groups based on pathological results.Perform enhanced CT scans at six time points using energy spectrum CT.The first scan time is the peak time of the tumor.After the first scan,delay for 16 s,33s,49 s,66s,and 91 s in sequence to set the II,III,IV,V,and VI scans,for a total of six scans,which means six time points.Measure and calculate the normalized iodine concentrations(NIC)at the maximum level of the tumor at six time points,and plot the NIC values at the six time points into a time point NIC curve.Use Cox-Stuart trend test to analyze the trend of the obtained time point NIC curve;Further explore and summarize the time point NIC curve characteristics of benign and malignant tumors,as well as different regions of the same tumor.Results:1.The Cox-Stuart trend test results showed that there was no increasing or decreasing trend in the time point NIC curves of benign and malignant tumors in each region(P>0.05).2.Inter group observation of benign and malignant tumors: In benign tumors,there were more cases(6/13 cases,46.2%)where the time point NIC curve showed an upward trend in each region.There were 5 cases(4/13 cases,30.8%)where the time point NIC curve trend differed in each region.In addition,3 cases(3/13 cases,23.1%)did not detect clear iodine density values.In malignant tumors,the NIC curves of all cases at different time points showed an upward trend(21/21 cases,100%).In addition,the amplitude of the time points NIC curve in malignant tumors is higher than that in the benign tumors.3.Intra group observation of benign and malignant tumors: In benign tumors,the dispersion of the time point NIC curves in the central and peripheral regions is relatively small,and in some cases,the time point NIC curves in the central and peripheral regions basically overlap(6/13 cases,46.2%).In malignant tumors,the time point NIC curves of the central and peripheral regions have a greater degree of dispersion,and only 2 cases(2/21 cases,9.5%)have the time point NIC curves of the central and peripheral regions basically overlapping.Conclusions: The time point NIC curve of musculoskeletal tumor energy spectrum CT shows differences between benign and malignant tumors,as well as between different regions of the same tumor,providing a certain diagnostic approach for clinical application.Part Three Differentiation of Benign and Malignant Musculos-keletal Tumors Using BOLD-f MRI Perfusion Para-meters under the P30Objective: This study aims to perform BOLD-f MRI imaging in patients with musculoskeletal tumor in lower limb under the P30 model(i.e.,the pressure of the tourniquet is equal to the systolic pressure of the ipsilateral brachial artery plus 30 mm Hg),and to explore whether there will be differences in BOLD-f MRI perfusion parameter between benign and malignant musculoskeletal tumors under this model,as well as whether there are differences in perfusion parameters between different regions of the tumor.In order to find a reliable imaging technique to reflect the perfusion of microcirculation in benign and malignant musculoskeletal tumors,and provide a certain basis for clinical treatment plan selection and efficacy evaluation.Methods: Under the P30 model,BOLD-f MRI imaging was performed on 32 patients with bone and soft tissue musculoskeletal tumors(22 benign tumors and 10 malignant tumors).The standardized BOLD time signal curves of the tumor center area,tumor peripheral area,and surrounding normal muscles were obtained,and the following 4 relevant parameters of the BOLD time signal curves were calculated: minimum ischemic phase(MIV),maximum reactive hyperemia phase(PHV),and peak time(TTP)The average slope of reactive congestion period(Shyp).The comparison of parameters between different regions and muscle regions within benign and malignant tumors conforms to the randomized block design,and the parameter data between each region shows a non normal distribution(P<0.1).Therefore,the non parametric test of the randomized block design,Friedman test,is used.If the results show statistically significant differences(P<0.05),further post hoc multiple comparisons can be conducted to explore which specific regions have statistically significant differences.For the comparison of parameters between benign and malignant tumors,it is consistent with a completely randomized design between two independent samples.For parameter data that satisfies a normal distribution(P>0.1),a two independent sample t-test is used,and for parameter data that does not satisfy a normal distribution(P<0.1),a two independent sample Wilcoxon rank sum test is used.Results:1.In malignant tumors,there is a significant difference in TTP and Shyp between the central and peripheral regions(P<0.05);There were significant differences in TTP and Shyp between the central area and surrounding normal muscles(P<0.05).2.In benign tumors,there is no significant difference in perfusion parameters between different regions of the tumor and surrounding normal muscles.3.There is no significant difference in perfusion parameters between benign and malignant tumors in different regions of the tumor and between surrounding normal muscles.Conclusions: In P30 model,there were significant differences in BOLD perfusion parameters(TTP and Shyp)between central and peripheral regions of malignant MSK tumors,but there were no significant differences between central and peripheral regions of benign MSK tumors,this difference in perfusion parameters between benign and malignant MSK tumors provides a new basis for reflecting the functional information of MSK tumors,it may be of potential value in the diagnosis and treatment of benign and malignant MSK tumors in the future.