定量IVIM参数对肾脏乏脂性错构瘤与乳头状细胞癌的鉴别诊断价值  

Value of intravoxel incoherent motion parameters in the differential diagnosis of angiomyolipoma with minimal fat tissue and papillary cell carcinoma of kidney

作　　者：李浩杰[1] 梁丽丽[1] 李安琴[1] 胡瑶[1] 胡道予[1] 李震[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030

出　　处：《放射学实践》2017年第7期715-718,共4页Radiologic Practice

基　　金：国家自然科学基金(81271529);国家自然科学青年基金(81501447)

摘　　要：目的:评价定量IVIM参数对肾乏脂性错构瘤与乳头状肾细胞癌的鉴别诊断价值。方法:47例经手术病理证实的肾脏乏脂性错构瘤(n=21)与肾乳头状细胞癌(n=26)患者术前采用3.0T MR进行多b值DWI(b值为0~1700s/mm2)扫描。基于双指数模型计算相应的IVIM参数:纯扩散系数(D),假扩散系数(D*),灌注分数(f)。采用独立样本t检验或Mann-Whitney U检验进行分析两组肿瘤的IVIM参数,采用受试者工作特征曲线分析IVIM参数对两组肿瘤的鉴别价值。结果:乳头状肾细胞癌f值明显低于肾乏脂性错构瘤(0.227±0.077vs 0.417±0.117,P<0.001);D值明显高于肾乏脂性错构瘤[(0.745±0.197)×10-3 mm2/s vs(0.610±0.117)×10-3 mm2/s,P<0.05],D*在两种肿瘤间差异无统计学意义(P=0.085)。IVIM参数值鉴别两者的AUC、敏感度、特异度和诊断阈值分别为f:0.918、91.3%、85.2%和0.312,D:0.684、51.9%、95.7%和0.789×10-3 mm2/s。结论:肾乏脂性错构瘤与乳头状肾细胞癌的定量IVIM扩散与灌注参数值具有一定差异。灌注分数f可用于术前两者的鉴别诊断。Objective：To assess the value of intravoxel incoherent motion （/VIM） parameters in the differential diagnosis of angiomyolipoma with minimal fat tissue （MFAML） and papillary cell carcinoma （PRCC） of kidney. Methods：47 pa- tients with pathology confirmed MFAML （n = 21） and PRCC （n = 26） were recruited. Multi-b values DWI （0 1700s/mm^2） was used on a 3. 0T MR scan before surgery. Their respective IVIM parameters （D, pure diffusion; D ＊ , pseudodiffusion coefficient;f,perfusion fraction） were obtained by using a biexponential model. Student＇s t test or Mann-Whitney U test was used for analysis,to compare the parameters between MFAML and PRCC. Receiver operating charac- teristic was used for statistical evaluation. Results：f value of PRCC was significantly lowe than that of MFAML （0. 227±0. 077 vs 0. 417±0. 117 ,P〈0. 001） ,while D value of PRCC was significantly higher than of MFAML [ （0. 745±0. 197）×10^-3 mm^2 / s vs （0.610±0.117 ）×10^-3 mm^2 / s, P《0.05 ]. No significant difference could be revealed in the mean D ＊ value between the two groups （P = 0. 085）. The AUC, sensitivity, specificity and the cutoff value for differentiating MFAML and PRCC for f value and D value was as follows： f value, 0. 918,91. 3%, 85. 2% and 0. 312 respectively; D value, 0. 684, 51.9% ,95.7%, and 0. 789×10^-3 mm^2/s respectively. Conclusion： Certain distinctive differences could be assessed in the IVIM parameters of PRCC and MFAML, f value could be used for the differential diagnosis before surgery.

关 键 词：体素不相干运动 肾肿瘤 乏脂性错构瘤 乳头状肾细胞癌 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.11[医药卫生—诊断学]