MR扩散加权成像表观扩散系数鉴别鼻腔鼻窦实性肿块的价值  

The value of the apparent diffusion coefficient in MR diffusion weighted imaging for the differential diagnosis of sinonasal masses

作　　者：王永哲[1] 杨本涛[1] 鲜军舫[1] 李静[1] 陈光利[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730

出　　处：《中华放射学杂志》2014年第3期207-210,共4页Chinese Journal of Radiology

基　　金：北京卫生高层次人才学科骨干资助（2011-3-048）

摘　　要：目的 探讨ADC值对鼻腔鼻窦实性肿块良恶性的鉴别诊断价值.方法 回顾性分析经临床手术病理证实,肿块为实性且直径＞1 cm的67例鼻腔鼻窦肿块患者资料,均行MR DWI检查,测量病变实性部分ROI内的ADC值.根据手术病理结果将67个患者分为良性组和恶性组,再根据肿块病理类型进一步分为淋巴造血系统肿块、恶性上皮及间叶组织肿块、良性上皮及间叶组织肿块及血管源性肿块4组.采用t检验及单因素方差分析分别比较良、恶性及不同病理类型病变ADC值之间的差异；以鼻腔鼻窦不同肿块的ADC值作为临界点绘制出ROC曲线,计算曲线下面积（Az）,确定诊断阈值,评价其诊断效能.结果 67例患者肿瘤均为单发,恶性肿块22个,其中淋巴造血系统肿瘤6个、上皮及间叶组织来源恶性肿瘤16个；良性肿块45个,其中上皮及间叶组织来源良性肿瘤22个、血管源性病变23个.恶性肿块和良性肿块的ADC值分别为（0.88 ±0.26）×10-3和（1.54±0.41） ×10-3 mm2/s,差异有统计学意义（t值=6.897,P值＜0.01）.淋巴造血系统肿块、恶性上皮及间叶组织肿块、良性上皮及间叶组织肿块和血管源性肿块的ADC值分别为（0.63±0.10） ×10-3、（0.97±0.24） ×10-3、（1.38±0.23）×10-3和（1.68 ±0.49）×10-3mm2/s,差异有统计学意义（F=22.788,P＜0.01）,组内两两比较差异也均有统计学意义（P值＜0.05）.以鼻腔鼻窦不同肿块的ADC值作为临界点判断其良恶性并绘制ROC,曲线下面积为0.945.以ADC=1.08×10-3 mm2/s作为诊断阈值,诊断恶性肿瘤的敏感度为81.8％（18/22）,特异度为97.8％ （44/45）,准确度为92.5％（62/67）.结论 ADC值对鼻腔鼻窦良、恶性及不同病理类型病变的鉴别诊断具有一定的参考价值.Objective To investigate the diagnostic value of apparent diffusion coefficient in the evaluation of sinonasal masses.Methods Sixty-seven sinonasal solid masses over 1 cm in diameter confirmed by pathology were retrospectively analyzed,all patients underwent preoperative routine MRI with DWI,the ADC values were measured in ROI within the solid mass.The patients were divided into benign and malignant groups by the histopathology,according to pathological findings,the patients were further divided into the hematolymphoid tumors,the malignancy of epithelium and mesenchymal tissue,the benign tumors of epithelial and mesenchymal tissue,and vasogenic masses.ANOVA test and t test were used to compare the ADC values of different groups.The receiver operating characteristic curve （ROC） was constructed using various cut points of ADC for different parameters to confirm the diagnostic threshold value and evaluate the diagnostic efficacy.Results All lesions were solitary.There were 22 malignant tumors,of which 6 lesions were hematolymphoid tumors and 16 lesions malignancy from epithelium and mesenchymal tissue.There were 45 benign tumors,of which 22 lesions were benign tumors from epithelium and mesenchymal tissue and 23 lesions vasogenic masses.The mean ADC value of malignant and benign masses was（0.88 ± 0.26） × 10-3 mm2/s and （1.54 ± 0.41） × 10-3 mm2/s respectively.There was statistically significant differences between them （t =6.897,P 〈 0.01）.The mean ADC value was（0.63 ± 0.10） × 10-3 mm2/s in hematolymphoid tumors,（0.97 ±0.24） × 10 3 mm2/s in malignancy from epithelium and mesenchymal tissue,（1.38 ± 0.23） × 10-3 mm2/s in benign tumors from epithelium and mesenchymal tissue,（1.68 ± 0.49） × 10-3 mm2/s in vasogenic masses respectively.There was statistically significant difference among all 4 groups（F =22.788,P 〈 0.01）,and the differences between any 2 groups were still statistically significant（P 〈 0.05）.The area under the ROC calculated was 0.945.Using an ADC valu

关 键 词：鼻肿瘤 磁共振成像 弥散 对比研究 

分 类 号：R739.62[医药卫生—肿瘤] R445.2[医药卫生—临床医学]