MR全身扩散加权成像探查小儿恶性肿瘤原发部位及转移灶的研究  

Preliminary study of whole body MR diffusion weighted imaging in detecting pediatric primary and metastatic malignant tumor

作　　者：张晓凡 马林[2] 秦阳 刘鑫春 徐守成 张旭 王志伟 

机构地区：[1]哈尔滨市儿童医院影像科,150010 [2]解放军总医院放射科

出　　处：《中华放射学杂志》2011年第8期752-756,共5页Chinese Journal of Radiology

基　　金：黑龙江省卫生厅科技项目（2009-537）

摘　　要：目的评价MR全身扩散加权成像（WB-DWI）探查小儿恶性肿瘤原发部位及转移灶的价值。方法回顾性分析行WB—DWI检查的62名健康体检儿及经CT、MRI及临床均确诊为恶性肿瘤的40例患儿资料。正常组按年龄分为0～12个月、12个月以上至5岁及5岁以上3组，分析正常组WB-DWI图像特点，并采用McNemar检验比较WB-DWI与WB—DWI结合MRI、CT两种方法对转移瘤的检出情况；采用配对t检验比较肿瘤组原发灶及转移灶与正常对照组对应部位ADC值的差异。结果WB-DWI图显示正常组小儿干骺端信号随年龄增加逐渐减低。WB—DWI检测原发灶的敏感度为100％（40／40），对全身转移灶诊断敏感度为89．2％（58／65），阳性预测值为90．6％（58／64）；WB-DWI结合MRI、CT对全身转移灶诊断的敏感度为95．4％（62／65），阳性预测值为95．4％（62／65），两方法间诊断的敏感度差异无统计学意义（Х^2=2．25，P〉0．05）。脑（5例）、肝（6例）、肾（8例）、肾上腺（11例）部位的原发肿瘤ADC值分别为（0．76±0．19）×^-3、（0．97±0．29）×10^-3、（0．81±0．12）×10^-3和（0．93±0．28）×10^-3mm^2／s，正常对照组对应部位ADC值分别为（1．02±0．11）×10^-3、（1．57±0．58）×10^-3、（1．19±0．15）×10^-3和（2．03±0．42）×10^-3mm^2／s，差异均有统计学意义（t值分别为3．54、3．84、7．02和12．57，P值均〈0．05）。脑（9例）、肝（13例）、肾（17例）、骨（7例）和淋巴结（6例）部位转移灶ADC值分别为（0．88±0．12）×10^-3、（0．98±0．10）×10^-3、（0．89±0．11）×10^-3、（0．96±0．15）×10^-3和（0．83±0．14）×10^-3mm^2／s，正常对照组对应部位ADC值分别为（1．01±0．09）×10^-3、（1．45±0．39）×10^-3、（1．31±0．27）×10^-3、（1．34±0．20）×10^-3和（0．99±0．08）×10^-3mm^2／s，差异均有统计学意义（t值分别为4．09、4Objective To assess the efficacy of whole body diffusion weighted imaging （WB-DWI） in detecting pediatric primary and metastatic malignant tumor. Methods WB-DWI was performed in 62 healthy pediatric volunteers and 40 pediatric patients with confirmed malignant tumors. The healthy volunteers were divided into three groups： 0 to 12 months, more than 12 months to 5 years and more than 5 to 15 years. The characteristics of WB-DWI imaging were analyzed. McNemar test was used to compare the difference of detection on metastasis between WB-DWI and WB-DWI combined with MRI, CT. The mean apparent diffusion coefficient （ADC） values of primary tumors and metastases were measured by using paired t test and compared with those of corresponding body regions of control group. Results WB-DWI imaging shows that signal intensity of metaphysis gradually reduces with increasing age in the normal pediatric group. On WB-DWI primary malignant tumors showed 100% （40/40） high signal intensity and metastases showed high signal intensity in 89. 2% （58/65） on WB-DWI, with a positive predictive value of 90. 6% （58/64）. The detecting rate for metastases increased to 95.4% （62/65） when WB-DWI was combined with MRIfCT, with a positive predictive value of 95.4% （62/65）there was no statistically significant difference（ Х^2 = 2. 25 ,P 〉 0. 05 ）. The ADC values of primary malignant tumor sites in head（ n = 5）, liver（n =6）, kidney（n =8）, adrenal（n = 11 ） were （0. 76 ±0. 19）×10^-3, （0. 97 ±0. 29） ×10^-3, （0. 81 ±0. 12）×10^-3 and （0. 93 ±0. 28） ×10^-3mm^2/s and those of corresponding body regions of control group were （1.02 ±0. 11） x 10-3, （1.57 ±0.58）×10^-3, （1.19 ±0. 15） ×10^-3 and （2.03 ±0.42） ×10^-3mm^2/s respectively, there were statistically significant difference（ t values were 3.54,3.84,7. 02 and 12. 57 ; P 〈 0.05 ）. The ADC values of metastases sites in head （ n = 9 ）, liver （ n = 13 ）, kidney （ n = 17 ）, bone（n =7） and ly

关 键 词：儿童 肿瘤 继发原发性 磁共振成像 

分 类 号：R730[医药卫生—肿瘤] R44[医药卫生—临床医学] R73