3.0T磁共振扩散加权成像表观扩散系数对泪腺肿瘤性病变的鉴别诊断价值  

Value of the apparent diffusion coefficient in diffusion weighted imaging at 3.0T MR for differentiating lacrimal gland tumors

作　　者：王永哲[1] 鲜军舫[1] 杨本涛[1] 郭健[1] 王新艳[1] 宋丽媛[1] Wang Yongzhe;Xian Junfang;Yang Bentao;Guo Jian;Wang Xinyan;Song Liyuan(Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《中华医学杂志》2019年第1期53-56,共4页National Medical Journal of China

基　　金：北京市医院管理局临床医学发展专项经费资助(ZYLX201704);北京市卫生系统高层次卫生技术学科带头人项目(2014-2-005).

摘　　要：目的 探讨3.0 T磁共振(MR)扩散加权成像(DWI)表观扩散系数在泪腺肿瘤性病变中的鉴别诊断价值。 方法 回顾性分析2011年1月至2016年4月间就诊于北京同仁医院经临床手术病理证实的73例泪腺肿瘤性病变的临床及影像资料,其中男36例、女37例,年龄14-81(44±15)岁,均行MR常规及DWI检查,测量病变实性部分感兴趣区内的表观扩散系数(ADC)值。根据手术病理结果将73例患者共分为良性肿瘤和恶性肿瘤两组,恶性肿瘤进一步分为上皮性及非上皮性恶性肿瘤两组,均采用独立样本t检验比较ADC值之间的差异;以泪腺不同良恶性肿瘤及不同恶性肿瘤的ADC值作为临界点分别绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),确定诊断阈值,分别评价其诊断效能。 结果 73例病例,单侧病变69例、双侧病变4例,共77个病灶。41个泪腺良性肿瘤和36个恶性肿瘤的平均ADC值分别为(1.36±0.16)和(0.90±0.30)×10^-3 mm^2/s,差异有统计学意义(t=-8.319,P<0.01)。24个上皮性恶性肿瘤和12个非上皮性恶性肿瘤的平均ADC值分别为(1.08±0.18)和(0.54±0.09)×10^-3 mm^2/s,差异有统计学意义(t=11.988,P<0.01)。以77个泪腺肿瘤性病变的ADC值作为临界点判断良恶性并绘制ROC,AUC为0.940,以ADC=1.275×10^-3 mm^2/s为诊断阈值预测恶性肿瘤的敏感度为94.4%(34/36),特异度为82.9%(34/41),准确度为88.3%(68/77)。以36个泪腺恶性肿瘤的ADC值作为临界点判断上皮性和非上皮性恶性肿瘤并绘制ROC,AUC为1.0,以ADC=0.736×10^-3 mm^2/s为诊断阈值预测非上皮性恶性肿瘤的敏感度为100%(12/12),特异度为100%(24/24),准确度为100%(36/36)。 结论 DWI的ADC值对泪腺肿瘤性病变的鉴别诊断具有一定的参考意义。Objective To investigate the diagnostic value of apparent diffusion coefficient in diffusion weighted imaging at 3.0 T MR for the differentiation in the larcrimal gland tumors. Methods A total of 73 cases, 36 males and 37 female;mean age 14-81(44±15)years, with lacrimal gland tumors confirmed by pathology in Beijing Tongren Hospital were retrospectively analyzed between January 2011 and April 2016.All cases underwent the preoperative routine MRI and DWI scan, the ADC values were measured in region of interest within the solid zone. The cases were divided into benign and malignant group by the histopathology, according the different pathological categories, the malignant cases were further divided into the epithelial and non-epithelial malignacy. 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 There were totally 77 lesions in 73 cases, of which 69 involved unilateral lacrimal gland,4 bilateral lacrimal glands. The mean ADC value of malignant and benign masses in lacrimal gland was (1.36±0.16) and (0.90±0.30)×10^-3 mm^2/s respectively. There was significantly statistical difference between the both(t=-8.319, P<0.01). The mean ADC value of epithelial and non-epithelial malignacy in lacrimal gland was (1.08±0.18) and (0.54±0.09)×10^-3 mm^2/s respectively. There was significantly statistical difference between the both(t=11.988, P<0.01). The area under the ROC for distinguishing malignant from benign lesions was 0.940. Using an ADC value of 1.275×10^-3 mm^2/s as the threshold value, the best result obtained had a sensitivity of 94.4%(34/36), specificity of 82.9%(34/41), accuracy of 88.3%(68/77). The area under the ROC for differentiating non-epithelial from epithelial malignacy was 1.0. Using an ADC value of 0.736×10^-3 mm^2/s as the threshold value, the best result obtained had a sensitivity of 100%, specificity of 100%, accuracy of 100%. Conclusio

关 键 词：泪器 磁共振成像 肿瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学]