肺结节的3T多b值磁共振扩散加权成像鉴别诊断  

Diffusion-weighted MR-imaging with Multiple b-values for Differentiation of Pulmonary Nodules at 3.0 Tesla

作　　者：潘江峰[1] 应明亮[1] 李惠民[2] 卢金花[1] 蒋杨[1] 潘勇浩[1] 舒锦尔[1] 

机构地区：[1]浙江金华市中心医院影像科 [2]上海交通大学医学院附属新华医院影像科,上海200092

出　　处：《中国医学计算机成像杂志》2015年第6期533-537,共5页Chinese Computed Medical Imaging

基　　金：浙江省金华市科技局重点项目No.2012-3-007~~

摘　　要：目的：探讨利用3.0T磁共振扩散加权成像（DWI）及其表观扩散系数（ADC）值鉴别诊断孤立性肺结节良恶性的效能,并优化b值。方法：收集2012年3月至2014年12月CT检查发现的孤立性肺结节患者71例,并经手术、穿刺活检或临床治疗随访证实。其中良性结节41例,恶性结节30例,全部行3.0T MRI胸部常规T1WI、T2WI和DWI检查,DWI采用附加三维容积匀场技术并减小相位方向视野,b值选择300、600、900和1200s/mm^2,测量各b值下肺结节的ADC值,并绘制各b值下ADC值诊断的受试者操作特性（ROC）曲线,得出相关诊断效能,依此获得合理的b值。结果：良恶性肺结节的ADC值均随b值增加而逐渐变小,各组中均显示恶性结节的ADC值显著低于良性结节（t=4.58～6.33,P〈0.01）。不同b值ROC曲线下面积（AUC）依次为0.800、0.839、0.878及0.873,均有诊断意义（AUC〉0.5）;b=900s/mm^2时获得的ADC值诊断效能最大,鉴别良恶性病变的最佳阈值为1.228×10^-3mm^2/s,其敏感性83.3%,特异性91.2%。结论：3.0T磁共振扩散加权成像对孤立性肺结节的定性诊断有较高价值,b值900s/mm^2时的ADC值诊断效能较高。Purpose： Using diffusion-weighted MR-imaging （DWI） and its apparent diffusion coefficient （ADC） for differentiation of pulmonary nodules at 3.0 Tesla, and consequently optimizing the b-value. Methods： Seventyone patients with solitary pulmonary nodule （SPN） （benign：41, malignant：30） detected on CT scan and confirmed with surgery, aspiration or follow-up results were enrolled in our study. All patients were undergone a routine chest MR imaging including T1WI, T2WI and DWI. Three-dimensional shimming and phase-reduced FOV were used in DWI and the b-value was set as 300, 600, 900, and 1200s/mm^2. The ADC values were calculated and their receiver-operating characteristic （ROC） curves were conducted. Results： The ADC values decreased with b-value. The ADC value of malignant PN was significantly smaller than that of benign one in all groups （t=4.58-6.33, P〈0.01）. The area under curve （AUC300-1200） was 0.800, 0.839, 0.878, and 0.873, respectively. The ADC value obtained with b=900s/mm^2 had the best diagnostic efficiency and the cutoff value was 1.228×10^-3mm^2/s with the sensitivity of 83.3%, specificity of 91.2%. Conclusion： DWI （3T） has high qualitative diagnostic value for pulmonary nodules and the reasonable b-value is 900 s/mm^2.

关 键 词：孤立性肺结节 磁共振成像 扩散加权成像 表观扩散系数 

分 类 号：R593.9[医药卫生—内科学] R445.2[医药卫生—临床医学]