磁共振DWI检查在肺内良恶性病变鉴别诊断中的价值  

Differential Diagnosis of Benign and Malignant Pulmonary Lesions by Diffusion Weighted MRI

作　　者：翁静飞 曾奇虎 姚丁华 韩福刚 陈光祥 唐光才 陆笑非 何其舟 WENG Jing-fei;ZENG Qi-hu;YAO Ding-hua;HAN Fu-gang;CHEN Guang-xiang;TANG Guang-cai;LU Xiao-fei;HE Qi-zhou(Department of Radiology,Affiliated Hospital of Southwest Medical University,Luzhou 646000;Department of Radiology,Affiliated Hospital of Traditional Chinese Medicine,Southwestern Medical University)

机构地区：[1]西南医科大学附属中医医院放射科,庐州646000 [2]西南医科大学附属医院放射科

出　　处：《中国医学计算机成像杂志》2020年第1期23-28,共6页Chinese Computed Medical Imaging

摘　　要：目的:探讨磁共振DWI检查中ADC值和LSR值对肺内良恶性病变的鉴别诊断价值。方法:收集经肺部CT检查发现肺部大于1cm结节或肿块的55名患者,所有患者均行磁共振常规检查和DWI(b=600s/mm^2)扫描,分析肺内良恶性病变ADC值和LSR值的特点。结果 :ADC值和LSR值诊断肺内良恶性病变ROC曲线下面积为0.787和0.783,最佳诊断阈值为1.53×10^-3mm^2/s和1.075。ADC值和LSR值诊断肺内良恶性病变的灵敏度分别为79.1%和72.1%,特异度分别为73.3%和86.7%,两者之间灵敏度与特异度差异没有统计学意义(P=0.44,0.48);将ADC值和LSR值联合诊断肺内良恶性病变的灵敏度为93.0%,高于任何单一的诊断方法(P=0.04,0.0077);特异度为73.3%,与单一诊断之间比较,差异没有统计学意义(P=1,0.48)。ADC值、LSR值以及ADC值联合LSR值诊断肺内良恶性病变的阳性预测值、阴性预测值、阳性似然比、阴性似然比、约登指数和准确率分别为87.2%,57.9%,2.96,0.29,52.4%,77.6%;93.9%,52.0%,5.4,0.32,58.8%,75.9%;90.9%,78.6%,3.48,0.23,66.3%,87.9%。结论:磁共振DWI检查对鉴别肺内良恶性病变具有诊断价值,将ADC值和LSR值联合起来诊断的灵敏度高于单一诊断方式。Purpose:To evaluate the diagnostic performance of ADC values and LSR values in the differentiation of benign and malignant pulmonary lesions by the diffusion weighted MRI.Methods:A total of 55 patients were identified with the diameter of nodules or masses larger than 1cm by CT.All patients underwent routine magnetic resonance examination and DWI(b=600s/mm^2)examination.And the characteristics of ADC values and LSR of benign and malignant pulmonary lesions were analyzed.Results:Sensitivity,specificity,optimal threshold and area under the ROC curve demonstrated by linear regression formula generated by ADC values in differentiating benign and malignant lesions were 79.1%,73.3%,1.53×10^-3mm^2/s and 0.787,respectively.Sensitivity,specificity,optimal threshold and area under the ROC curve demonstrated by linear regression formula generated by LSR values in differentiating benign and malignant lesions were 72.1%,86.7%,1.075 and 0.783.There was no statistical significant difference of sensitivity and specificity between the ADC values and LSR.When combined ADC values with LSR,the sensitivity for diagnosing malignant pulmonary nodules was 93.0%,higher than any single diagnostic method(P=0.04,0.0077),the specificity was 73.3%,and compared with single diagnosis method,the difference was with no statistical significant(P=1,0.48).The positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,Yoden index,accuracy for diagnosing malignant pulmonary nodules by ADC values,LSR and ADC values combined with LSR were 87.2%,57.9%,2.96,0.29,52.4%,77.6%;93.9%,52.0%,5.4,0.32,58.8%,75.9%;90.9%,78.6%,3.48,0.23,66.3%,87.9%.Conclusion:The diffusion weighted MRI has diagnostic values for the differentiation of benign and malignant pulmonary lesions,when combined ADC values with LSR,the sensitivity is higher than that of single diagnosis method.

关 键 词：肺良恶性病变 MRI 扩散加散成像 ADC值 LSR值 

分 类 号：R445.2[医药卫生—影像医学与核医学]