多参数MRI预测舌癌颈部淋巴结转移的价值  

The value of multi-parameters MRI of tongue carcinoma in predicting cervical node metastases

作　　者：郭炜[1] 罗德红[1] 李琳[1] 林蒙[1] 赵燕风[1] 杨亮[1] 胡镭[1] 赵心明[1] 周纯武[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院影像诊断科,100021

出　　处：《中华放射学杂志》2016年第5期353-356,共4页Chinese Journal of Radiology

摘　　要：目的探讨多参数MRI预测舌癌颈部淋巴结转移的可行性和价值。方法回顾性分析经手术病理证实且临床、MRI资料完整的46例舌癌患者，根据病理结果分为颈部淋巴结转移组30例（单侧转移16例、双侧转移14例），无颈部淋巴结转移组16例。40例行头颈部MRI平扫及增强扫描，6例仅行MRI平扫；其中32例行DWI检查。测量和记录肿瘤ADC值、长径、厚度、距舌中线距离、距舌下间隙距离。采用独立样本t检验或Mann—WhitneyU检验比较颈部淋巴结转移组与无转移组间、单侧和双侧颈部淋巴结转移组间MRI测量参数的差异，采用ROC曲线分析有统计学意义的MRI参数预测颈部淋巴结转移的效能。结果有、无颈部淋巴结转移组患者间肿瘤距舌下间隙距离的差异无统计学意义（P〉0．05），肿瘤长径、厚度、距舌中线距离、ADC值的差异均有统计学意义（P均〈0．05）。单、双侧颈部淋巴结转移患者问的ADC值差异有统计学意义（P〈0．05），肿瘤长径、厚度及距舌中线距离的差异均无统计学意义（P均〉0．05）。肿瘤ADC值、长径、厚度及距舌中线距离预测颈部淋巴结转移的ROC下面积分别为0．878、0．822、0．834和0．794，分别以1．13×10^-3mm^2／s、31．08mm、17．33mm及-2．26mm为阈值预测颈部淋巴结转移的敏感度分别为90．9％、83．3％、86．7％和86．7％，特异度分别为90．O％、81．3％、81．3％和75．0％。肿瘤ADC值预测双侧颈部淋巴结转移的ROC下面积为0．806，以1．07×10^-3mm^2／s为阈值，预测双侧颈部淋巴结转移的敏感度和特异度分别为80．0％和75．0％。结论舌癌患者多参数MRI上，肿瘤ADC值、长径、厚度及距舌中线距离可作为独立因素预测颈部淋巴结转移，其中ADC值对预测双侧颈部淋巴结转移有一定帮助。Objective The aim of this study was to determine whether multi-parameters MRI of tongue carcinoma have the potential to predict cervical lymph node metastases. Methods A total of 46 patients with tongue carcinoma, who underwent MRI scan preoperatively, were investigated retrospectively and were divided into cervical lymph node （LN） metastases group （unilateral LN＋, n=16; bilateral LN＋, n= 14） and no cervical lymph node metastases group （LN-, n= 16） according to their pathological grading. Of the 40 patients with tongue carcinoma underwent plain and contrast MRI scan, 6 patients have plain MRI scan, and 32 have DWI examination.The ADC value, tumor length, tumor thickness, sublingual distance between tumor and sublingual space, and para-lingual distance between tumor and tongue midlinedetermined from MRI, were preoperatively estimated and compared with the pathological findings of cervical lymph nodes. A unpaired t test was used to analyze normal distributed continuous data, and a Mann-Whitney U test was used to analyze abnormally distributeddata. The ROC was used to evaluate the efficacy of MRI in predicting the metastasis of cervical lymph nodes. Results The indexes of ADC value, tumor length, tumor thickness, and para-lingual distance between tumor and tongue midline, which all showed significant difference between LN＋ group and LN- group （all P〈0.05）, and the index of sublingual distance between tumor and subfingual space showed no significantly association with LN ＋ （P〉0.05）. The index of ADC value showed significant difference between unilateral LN＋ group and bilateral LN＋ group （P〈0.05）, and the other indexes, which all showed no significantly association with bilateral LN ＋ （all P〉0.05）. The ROC curve analysis of the ADC value, tumor length, tumor thickness, and para-lingual distance between tumor and tongue midline of the neck lymph node metastasis were carried out, with the cutoff set as 1.13×10^-3mm^2/s, 31.08 mm, 17.33 mm and-2.26 mm. The corresponding

关 键 词：舌肿瘤 淋巴转移 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.86[医药卫生—诊断学]