孤立性肺病灶的病理参数与表观扩散系数值的相关性及其定性诊断价值  

Correlation of apparent diffusion coefficient with histopathological parameters in solitary pulmonary lesions and its diagnostic value

作　　者：张凤[1] 路青[1] 赵子周[1] 张莹 华小兰[1] 吴华伟[1] ZHANG Feng;LU Qing;ZHAO Zi-zhou;ZHANG Ying;HUA Xiao-lan;WU Hua-wei(Dept. of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《同济大学学报（医学版）》2017年第5期46-51,57,共7页Journal of Tongji University(Medical Science)

基　　金：国家自然科学基金(81571670);上海市科委项目(14411968100)

摘　　要：目的探讨表观扩散系数(apparent diffusion coefficient,ADC)值与孤立性肺病灶(solitary pulmonary lesions,SPLs)病理参数的相关性及其对SPLs的定性诊断价值。方法该研究应用3.0T磁共振扩散加权成像(diffusion w eighted imaging,DWI),以手术切除65例SPLs(恶性52例,良性13例)为研究对象,定量SPLs的多种病理参数(细胞密度,核质比,坏死分数,黏液和病理分级),用多元线性回归分别分析良、恶性SPLs的ADC与多种病理参数的相关性。通过受试者工作曲线(receiver operating characteristic curve,ROC)评估ADC对SPLs的定性诊断效能。结果恶性SPLs的ADC与细胞密度(β=-0.40,P<0.001)和黏液(β=0.77,P<0.001)独立相关,良性SPLs的ADC与病理参数无相关性。恶性和良性SPLs的ADC分别为(1.10±0.24)×10^(-3)、(1.53±0.47)×10^(-3)m m^2/s,差异有统计学意义(P<0.001)。鳞癌、不含黏液腺癌和含黏液肺癌ADC分别为(0.98±0.11)×10^(-3)、(1.08±0.13)×10^(-3)、(1.69±0.18)×10^(-3)m m^2/s,两两差异均有统计学意义(P<0.05)。当ADC阈值为1.21×10^(-3)m m^2/s时,对SPLs的定性诊断价值最高,灵敏度为80.8%,特异度为77.0%,且对鳞癌、不含黏液腺癌和含黏液肺癌定性诊断准确率分别为100%(9/9)、82%(22/27)、0%(0/5)。鳞癌、不含黏液腺癌和含黏液肺癌的细胞密度分别为373±109、287±51、275±87(每×400高倍视野),其中仅鳞癌与不含黏液腺癌的细胞密度差异有统计学意义(P<0.001)。结论肺癌的ADC与细胞密度和黏液独立相关。ADC有助于SPLs的定性诊断,对肺鳞癌的定性诊断准确性较高,对低细胞密度腺癌及含黏液肺癌的定性诊断准确性不足。ObjectiveTo investigate the correlation of apparent diffusion coefficient(ADC)value with histopathological parameters in solitary pulmonary lesions(SPLs)and its diagnostic value.MethodsSixty five patients with SPLs undergoing MR diffusion weighted imaging(DWI)examination and receiving surgical treatment were enrolled in the study.Multiple histopathological parameters including cell density,nuclear to cytoplasm ratio,necrotic fraction,presence of mucus and grade of differentiation were quantified.The correlation of ADC values with histopathological parameters was analyzed by multiple linear regression in malignant and benign SPLs,The qualitative diagnosis value of ADC in SPLs was evaluated by receiver operating characteristic curve(ROC).ResultsCell density(β=-040,P<0001)and presence of mucus(β=077,P<0001)were independently correlated with ADC value in malignant SPLs.There was no significant correlation between histopathological parameters and ADC values in benign SPLs.ADC value of malignant and benign SPLs was(110±024)×10-3and(153±047)×10-3mm2/s,respectively(P<0001).ADC value of squamous carcinomas,adenocarcinomas without mucus and malignant tumors with mucus were(098±011)×10-3,(108±013)×10-3and(169±018)×10-3mm2/s,respectively(P<005).At optimal cut off value of121×10-3mm2/s,ADC value could best distinguish malignant and benign SPLs with sensitivity of808%and specificity of77%;and the accurate diagnosis rate of squamous carcinomas,adenocarcinomas without mucus and malignant tumors with mucus were1000%(9/9),820%(22/27)and0%(0/5),respectively.The cell density of squamous carcinomas,adenocarcinomas without mucus and malignant tumors with mucus were373±109,287±51and275±87(×400high power field of vision),respectively;the significant difference was found between squamous cell carcinoma and adenocarcinomas without mucus(P<0001).ConclusionADC value is independently correlated with cell density and presence of mucus in malignant SPLs.Squamous carcinoma may be more accurately diagnosed as malignancy by ADC v

关 键 词：孤立性肺病灶 磁共振扩散加权成像 表观扩散系数 病理参数 相关性分析 定性诊断 

分 类 号：R445[医药卫生—影像医学与核医学]