磁共振扩散加权成像对肾上腺良恶性病变的鉴别诊断价值  

Value of Diffusion-Weighted Imaging in the Diagnosis of Benign and Malignant Adrenal Lesions

作　　者：邹飞[1] 胡利平[1] 方常练[1] 王索宇[1] 刘岚[1] 孙美[1] 易波[1] 刘敏知[1] 彭德新[1] 文庆怡[1] 

机构地区：[1]江西省肿瘤医院,330029

出　　处：《实用癌症杂志》2017年第12期2002-2005,共4页The Practical Journal of Cancer

摘　　要：目的研究不同b值肾上腺病变的扩散加权成像(diffusion weighted imaging,DWI)表现,比较不同b值组表观扩散系数(apparent diffusion coefficient,ADC)之间的差异,探讨最佳b值的选择并尝试寻找鉴别肾上腺良、恶性病灶的ADC值阈值。方法对32例经手术病理或临床证实的单个肾上腺病变患者行MRI检查和DWI扫描,b值分别取0、400、800、1 000 s/mm^2,观察不同b值下病灶的信号差异,同时分别测量ADC值并做统计学分析。结果(1)b为0 s/mm^2时,所有病灶的信号和T2WI信号一致,当b值为400、800和1 000 s/mm^2时,随着b值升高,良性病变的信号下降程度较恶性病变明显,囊变、坏死区信号减低明显,实性部分信号变化不明显;(2)3个b值组肾上腺病变的平均ADC值有显著差异(F=23.092,P<0.05),随着b值的增大,平均ADC值逐渐减小;(3)肾上腺良、恶性病变平均ADC值在b值为400 s/mm^2时无统计学意义(t=-1.932,P=0.063),b值为800、1 000 s/mm^2时有显著差异(t=-2.290,P=0.029;t=-2.257,P=0.031);(4)对b值取800 s/mm^2时得出的ADC值进行受试者工作特性曲线(ROC)分析,曲线下面积为0.736,诊断阈值为1.52×10^(-3)mm^2/s。结论肾上腺病变的DWI扫描b值取800为较佳选择,此时良性病变的平均ADC值为(1.56±0.49)×10^(-3)mm^2/s,恶性病变的平均ADC值为(1.25±0.24)×10^(-3)mm^2/s,DWI对肾上腺肿瘤性质的判断有一定补充的作用,在未来的研究中将更趋完善。Objective To study the manifestations of MR diffusion-weighted imaging（DWI）and to compare the differences of apparent diffusion coefficient（ADC）values of adrenal lesions in different b factors,so as to investigate the selection of optimal b factor as well as threshold of ADC value of benign and malignant adrenal lesions.Methods A total of 32 patients with pathology or clinical proven adrenal lesion underwent MR imaging and DWI scanning.Various b factors were set as 0,400,800and 1 000 s/mm^2.The signal of different lesions were observed,the ADC values with different b factors were measured and statistically analyzed.Results（1）When b factor was 0 s/mm^2the signal intensities of lesion was the same as T2WI.With b factor increased the ADC values of benign lesions declined more markedly than malignant lesions,meanwhile the signal intensity was lower in area of cystic degeneration and necrosis,compared with solid area.（2）Of the 3 groups of adrenal lesions with different b factors,the mean ADC value reduced following the increased of b factor with significant statistical difference（F=23.092,P0.05）.（3）There was no statistical difference in the ADC value between benign and malignant adrenal lesions with b factor=400s/mm^2（t=-1.932,P=0.063）,there had statistical difference when b factor was 800 s/mm^2and 1000 s/mm^2（t=-2.290,P=0.029;t=-2.257,P=0.031）.（4）Using the ADC value with b=800 s/mm^2group for ROC curve analysis,the AUC was0.736 and the diagnosis threshold was 1.52×10^（-3）mm^2/s.Conclusion It is the best choice as b=800 s/mm^2for the diagnosis of adrenal lesions.In the mean time the ADC value of benign lesion is（1.56±0.49）×10^（-3）mm^2/s,which of malignant lesion is（1.25±0.24）×10^（-3）mm^2/s.DWI is supplement for conventional MRI to some extent to differentiate adrenal lesions and will become more perfect in the near future.

关 键 词：肾上腺病变 扩散加权成像 ADC值 

分 类 号：R736.6[医药卫生—肿瘤]