磁共振扩散加权成像鉴别良恶性软组织肿瘤的价值  

Evaluation of Diffusion-weighted Imaging for the Differential Diagnosis of Soft-tissue Tumors

作　　者：王琦[1] 鲍润贤[1] 叶兆祥[1] 刘佩芳[1] 肖渤瀚[1] 汪沁[1] 

机构地区：[1]天津市肿瘤防治重点实验室,天津医科大学附属肿瘤医院放射科,天津市300060

出　　处：《中国肿瘤临床》2008年第23期1331-1334,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨磁共振扩散加权成像(DWI)鉴别良恶性软组织肿瘤的价值。方法:采用扩散加权成像分析43例软组织肿瘤,其中恶性25例,良性18例。所有病例均经手术病理证实。扩散加权成像的扩散敏感因子(b值)为0,500s/mm2。选取肿瘤实体部分最大感兴趣区,尽量避开坏死、出血、瘢痕及钙化等不均质成分。分析各病灶的扩散加权图像特点,比较良、恶性肿瘤表观扩散系数(apparent diffusion coefficient,ADC)的差异。3例恶性肿瘤患者化疗前、后进行DWI检查,分析ADC值的变化特点。结果:恶性肿瘤的ADC值(0.96±0.31×10-3)mm2/s明显低于良性肿瘤的ADC值(1.92±0.63×10-3)mm2/s和肌肉组织(1.69±0.47×10-3)mm2/s的ADC值,差异具有统计学意义(P<0.05),良性肿瘤与肌肉的ADC值无明显差异。ADC值为(1.38×10-3)mm2/s时,鉴别良恶性肿瘤的敏感性为92%,特异性为83%。3例恶性肿瘤患者化疗前、后进行DWI检查,其中2例化疗后ADC值升高,1例无ADC值的明显变化。结论:ADC值在软组织良恶性肿瘤的鉴别诊断中具有重要价值,ADC值对于化疗效果评价的作用需要进一步研究并与组织学对照加以证实。Objective： To explore the potential value of diffusion-weighted magnetic resonance imaging （MRI） in characterizing soft-tissue tumors. Methods： Diffusion-weighted MRI was performed in 43 histologically proven soft-tissue tumor cases using diffusion-weighted spin-echo sequences. Of the 43 soft-tissue tumor cases, there were 25 cases of sarcoma and 18 cases of benign tumor. The b values of diffusion were 0 and 500 s/ mm^2. The apparent diffusion coefficient （ADC） values of a large region with no necrosis, scar tissue, hemorrhage or calcification representing the lesion were measured. ADC values of benign tumors, malignant tumors and normal muscles were compared. ADC values of different histological malignancy （grade Ⅱ, Ⅲand Ⅳ） were compared. Three patients with malignant tumors （2 cases of primitive neuroectodermal tumor and 1 case of rhabdomyosarcoma） underwent diffusion weighted MRI before and after chemotherapy. We evaluated the changes in ADC values. Results： The ADC values of the malignant tumors （mean±SD, 0.96±0.31 ×10.3 mm^2/ s） were significantly lower than those of benign lesions （1.92±0.63× 10^-3 mm^2/s） and muscles （1.69＋0.47 × 10^-3 mm^2/s）. There was no significant difference in ADC values between benign lesions and muscles. High sensitivity （92%） and specificity （83%） were obtained when the ADC value was 1.38×103 mm^2/s in the differentiation of benign and malignant tumors. No significant difference was found in ADC values among groups of different histological grades of malignancy. In the 3 patients with malignant tumors who underwent diffusion-weighted MRI before and after chemotherapy, ADC values after treatment of 2 cases were increased due to micro-necrosis but there were no obvious changes in the other case. Conclusion： Diffusion-weighted MRI has po- tential value in differentiating benign soft-tissue tumors from malignant ones. The increase of ADC values of soft-tissue sarcoma after chemotherapy warrants further studies of diffusion wei

关 键 词：软组织肿瘤 磁共振成像 扩散加权成像 疗效观察 

分 类 号：R738[医药卫生—肿瘤]