动态增强扫描磁共振及扩散加权成像对泪腺淋巴瘤和炎性假瘤的鉴别诊断价值  

Value of DCE-MRI and DWI in the differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland

作　　者：冯莉莉[1] 鲜军舫[1] 燕飞[1] 付琳[1] 周红悦[1] 

机构地区：[1]首都医科大学附属北京同仁医院放射科,100730

出　　处：《中华医学杂志》2017年第7期487-491,共5页National Medical Journal of China

基　　金：北京市自然科学基金（7112030）;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）;北京市“百千万”人才工程（2014001）

摘　　要：目的评估动态增强扫描磁共振成像（DCE-MRI）及扩散加权成像（DWI）对泪腺炎性假瘤和淋巴瘤的鉴别诊断价值。方法回顾性分析比较2010年1月至2015年1月来北京同仁医院就诊的经病理组织学证实的24例泪腺炎性假瘤及22例淋巴瘤患者的临床及MR资料。比较二者的DCE-MRI及DWI表现，获取时间-信号强度曲线（TIC）、测量峰值强化指数（CIpeak）、最大强化率（ERmax）和流出率（WR）；DWI b值取0、1 000 s/mm^2，测量病灶的表观扩散系数（ADC）值。绘制受试者工作特征（ROC）曲线评价以上参数的诊断价值。结果DCE-MRI参数CIpeak、WR、ERmax、TIC类型及ADC值在泪腺炎性假瘤与淋巴瘤之间差异均有统计学意义（均P〈0.05）。炎性假瘤的ERmax、CIpeak及ADC值的均值〉淋巴瘤，WR均值〈淋巴瘤。绘制ROC曲线，CIpeak、WR、ERmax及ADC值的ROC曲线下面积分别为0.68±0.08、0.70±0.08、0.70±0.08及0.84±0.81。以ADC值=1.005×10^-3 mm^2/s为临界值，其鉴别诊断泪腺炎性假瘤和淋巴瘤的灵敏度、特异度及准确率分别为84.2%、65.0%及75.0%。DWI联合DCE-MRI鉴别泪腺炎性假瘤及淋巴瘤的准确率高于DCE-MRI（P=0.000）或DWI（P=0.008）单独应用，二者联合鉴别泪腺炎性假瘤及淋巴瘤的灵敏度、特异度及准确率分别为86.3%、87.5%和86.9%。结论CIpeak、WR、ERmax、TIC类型及ADC值均有助于泪腺炎性假瘤及淋巴瘤的诊断和鉴别诊断，可以提高诊断正确率。Objective To evaluate the value of dynamic contrast-enhanced MR （DCE-MRI） and diffusion weighted MR （DWI） in differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland. Methods In this retrospective study, a total of 24 cases of inflammatory pseudotumor and 22 cases of lymphoma in the lacrimal gland at Beijing Tongren Hospital confirmed by histological results were enrolled from January 2010 to January 2015. DCE-MRI and DWI were performed in these cases, and the type of time-signal intensity curve （time-intensity curve, TIC）, the peak contrast index （CIpeak）, maximum enhancement ratio （ ERmax）, washout ratio （WR） and ADC value were analyzed. Differences of these parameters between inflammatory pseudotumor and lymphoma in the lacrimal gland was evaluated by independent samples t test or Mann-Whitney U test. The receiver operating characteristic analysis was used to evaluate the utility of these parameters in discriminating the two diseases. Results Type of TIC, CIpeak, WR, ERmax and ADC values were statistically different （all P 〈 0. 05 ） between the inflammatory pseudotumor and lymphoma in the lacrimal gland. ERmax, CIpeak and ADC values of inflammatory pseudotumor were greater than those of lymphoma, but the WR values of inflammatory pseudotumor was less than those of lymphoma. The area under the ROC of the CIpeak, WR, ERmax and ADC values was 0. 68 ±0. 08, 0. 70 ±0. 08, 0. 70 ± 0. 08, 0. 84 ±0. 81 respectively. Using an ADCb =0.1000 value of 1. 005 × 10^ -3mm^2/s as the diagnostic threshold, the sensitivity, specificity and accuracy to differentiate benign lesions from malignant lesions were 84. 2%, 65.0% and 75.0% respectively. The diagnostic ability of DWI combined with DCE-MRI was superior to that of DCE-MRI （ P = 0. 000 ） or DWI alone （ P = 0. 008 ） with overall sensitivity, specificity and accuracy of 86. 3% , 87. 5% and 86. 9%. Conclusion DCE-MRI and DWI may improve the diagnostic accuracy in differentiation of the inflammatory pseudotu

关 键 词：泪腺 淋巴瘤 炎性假瘤 扩散加权成像 磁共振成像 动态增强扫描 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.7[医药卫生—诊断学]