高场MR扩散加权成像在小细胞肺癌及非小细胞肺癌鉴别诊断中的应用与b值优化  

Differentiation of small cell lung cancer and non-small cell lung cancer with diffusion-weighted MR imaging at 3.0 Tesla and optimization of b values

作　　者：彭俊琴[1] 汤日杰[1] 张海南[1] 周建伟[2] 

机构地区：[1]广州医科大学附属肿瘤医院放射科,广州市510095 [2]南方医科大学南方医院影像中心,广州市510515

出　　处：《实用医学杂志》2015年第6期969-972,共4页The Journal of Practical Medicine

摘　　要：目的:探讨扩散加权磁共振成像(diffusion-weighted imaging,DWI)在小细胞肺癌(small cell lung cancer,SCLC)及非小细胞肺癌(non-small cell lung cancer,NSCLC)鉴别诊断中的价值,并优化最佳b值。方法:收集36例经病理证实的肺癌患者,比较不同b值DWI扫描(b=400,600和800 s/mm2)下不同组织学类型NSCLC间表观扩散系数(apparent diffusion coefficient,ADC)的差异。结果:b=600 s/mm2时获得的ADC值的诊断效能ROC曲线下面积(area under curve,AUC)最大(0.892)。结论:b=600 s/mm2时,DWI对SCLC和NSCLC的鉴别诊断有较高的临床应用价值。Objective To investigate the feasibility of diffusion-weighted imaging（DWI） for differentiation of small cell lung cancer（SCLC） and non-small cell lung cancer（NSCLC） at 3.0 T MRI. This study also aims to optimize b values. Methods Thirty-six patients with lung cancer proved by pathology were examined by T2 WI and DWI（b = 400, 600 and 800 s / mm2） and apparent diffusion coefficient（ADC） values of each lesion were calculated among different b values. The receiver operating characteristic（ROC） curves were used to calculate the difference between the ADC of SCLC and NSCLC and to evaluate the diagnostic capability. Analysis of variance was used to determine difference in ADC of NSCLC histological types at the optimal b values. Results The ADC values of SCLC and NSCLC decreased with increasing b values, and the differences were statistically significant（P = 0.002, P 0.001）. ROC analysis showed that the area under curve（AUC） values were 0.775 、0.892、0.804（b = 400, 600, 800 s / mm2, respectively）. The AUC with a b value of 600 s / mm2 was the largest.When an ADC of 1.296 × 10^-3mm2/ s was considered as a threshold, the sensitivity, and specificity were 76.9%,and 90.0%, respectively. Conclusion DWI reflects the diffusion motion of water protons in lung carcinoma and it has moderate diagnosis potency in differentiating SCLC and NSCLC. The optimal b value is 600 s / mm2.

关 键 词：癌 非小细胞肺 肺癌 小细胞 扩散加权成像 磁共振成像 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学]