鼻腔鼻窦腺样囊性癌扩散加权成像特征及其诊断肿瘤浸润神经价值  

Diffusion-weighted imaging features of sinonasal adenoid cystic carcinoma and their value in diagnosis of neural involvement

作　　者：王新艳[1] 郝晖[1] 吴建兴[1] 胡凌[1] 郭健[1] 鲜军舫[1,2] 

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 [2]鼻病研究北京市重点实验室,北京100730

出　　处：《中国医学影像技术》2014年第7期974-977,共4页Chinese Journal of Medical Imaging Technology

基　　金：北京市优秀人才培养资助D类(2010D003034000033);北京市卫生系统高层次卫生技术人才学科骨干(2011-3-047);北京市自然科学基金(7112030)

摘　　要：目的探讨鼻腔鼻窦腺样囊性癌(ACC)DWI特征及DWI诊断肿瘤浸润神经的能力。方法回顾性分析19例经病理证实的鼻腔鼻窦腺ACC常规MRI及DWI资料,观察MRI及DWI特征,以病理结果为金标准,比较二者诊断肿瘤浸润神经的敏感度、特异度和准确率差异。结果平扫MRI:T1WI低信号5例(5/19,26.32%),等信号14例(14/19,73.68%),8例(8/19,42.11%)信号不均匀;T2WI高信号6例(6/19,31.58%),等信号13例(13/19,68.42%),15例(15/19,78.95%)不均匀;增强MRI:1例(1/19,5.26%)均匀强化、18例(18/19,94.74%)不均匀强化,中度强化11例(11/19,57.89%)、明显强化8例(8/19,42.11%)。DWI:等信号6例(6/19,31.58%),低信号12例(12/19,63.16%),略高信号1例(1/19,5.26%)。平扫和增强MRI诊断神经浸润的敏感度、特异度及准确率分别为54.55%(6/11)、87.50%(7/8)、68.42%(13/19)和90.91%(10/11)、87.50%(7/8)和89.47%(17/19),DWI诊断神经浸润的敏感度、特异度及准确率分别为81.82%(9/11)、75.00%(6/8)和78.95%(15/19),其准确率高于平扫MRI(P<0.05),低于增强MRI(P<0.05)。结论鼻腔鼻窦ACC的DWI表现具有一定特征,且对于诊断ACC神经浸润具有重要价值。Objective To investigate DWI findings of sinonasal adenoid cystic carcinoma （ACC）, and to explore the ability of DWI in diagnosis of neural involvement. Methods Data of MRI and DWI of 19 ACC patients confirmed by pathology were retrospectively analyzed. MRI and DWI features were observed, and the sensitivity, specificity and accuracy of MRI and DWI in diagnosing neural involvement were calculated and compared taken pathological results as gold standards. Results On plain MRI, sinonasal ACC showed hypointensity in 5 （5/19, 26.32%）, isointensity in 14 （14/19, 73.68%）, with 8 （8/19, 42.11%） being heterogeneous on T1WI, while hyperintensity in 6 （6/19, 31.58%）, isointensity in 13 （13/19, 68.42%）, with 15 being heterogeneous （15/19, 78.95%） on T2WI. After injection of contrast agent, 1 tumor （1/19, 5.26%） displayed homogenous enhancement and 18 （18/19, 94.74%） displayed heterogenous enhancement, 11 （11/19,57.89%） showed moderate enhancement and 8 （8/19, 42.11%） showed obvious enhancement. In DWI, the lesions showed isointensity in 6 （6/19, 31.58%）, hypointensity in 12 （12/19, 63.16%）, and slight hyperintensity in 1 （1/19, 5.26%） patient. The sensitivity, specificity and accuracy in diagnosis of neural involvement was 54.55% （6/11）, 87.50% （7/8）, 68.42%（13/19） for plain MRI, 90.91% （10/11）, 87.50% （7/8）, 89.47% （17/19） for enhanced MRI and 81.82% （9/11）, 75.00% （6/8）, 78.95% （15/19） for DWI. The accuracy of DWI was higher than that of plain MRI but lower than that of enhanced MRI （both P〈0.05）. Conclusion DWI features of sinonasal ACC have certain characteristics, which are valuable for diagnosis of neural involvement.

关 键 词：鼻肿瘤 癌 腺样囊性 扩散磁共振成像 

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