单、双指数模型DWI与PET-CT在肺孤立性病变诊断效能的对比研究  

Differentiation of Solitary Pulmonary Lesions with Bi-Exponential and Mono-Exponential Model of Diffusion Weighted Imaging Versus PET-CT

作　　者：刘利姗 邓义[1] 雷强[1] LIU Lishan;DENG Yi;LEI Qiang(Department of Medical Imaging,Fifth Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province 510700,P.R.China)

机构地区：[1]广州医科大学附属第五医院医学影像科,510700

出　　处：《临床放射学杂志》2020年第1期201-205,共5页Journal of Clinical Radiology

摘　　要：目的探讨单、双指数模型DWI及18F-脱氧葡萄糖(FDG)PET-CT对肺孤立性病变(SPLs)良、恶性鉴别的诊断效能。方法搜集经病理证实的36例SPLs(恶性肿瘤26例,良性病变10例),术前均行胸部多b值DWI(b=0、5、10、15、20、25、50、80、150、300、600、800及1000 s/mm2)及18F-FDG PET-CT扫描。所有病灶的MRI原始图像根据单、双指数模型测量得到的参数包括ADC total值、D值、D star值、f值及PET-CT最大标准化摄取值(SUVmax)。应用Mann-Whitney U检验比较SPLs良、恶性之间各参数的差异,同时应用受试者工作特征(ROC)曲线分析进一步评估其诊断效能。结果恶性肿瘤ADC total值、D值、f值及D star值分别为(1.01±0.21)×10^-3mm^2/s、(1.01±0.25)×10^-3mm^2/s、(17±12)%及(44.6±28.0)×10^-3mm^2/s,而良性病变对应参数分别为(1.31±0.23)×10^-3mm^2/s、(1.28±0.30)×10^-3mm^2/s、(22±10)%及(41.0±23.2)×10^-3mm^2/s,其中参数ADC total值、D值及f值在两组间的差异有统计学意义(Z=-3.285、-2.861和-2.420,P<0.05)。恶性肿瘤与良性病变的SUVmax值分别为(13.27±5.77)和(5.77±4.08),两组间的差异有统计学意义(Z=-3.056,P<0.05)。SUVmax、ADC total值、D值及f值四个参数的AUC分别为0.833、0.860、0.815和0.765,对应敏感性分别为96.15%、65.38%、69.23%和57.69%,特异性分别为70%、100%、90%和100%。结论单、双指数模型DWI的参数ADC total值、D值及f值在SPLs中都具有较好的诊断价值,其中ADC total值与D值的诊断效能较高,与SUVmax相当。Objective To quantitatively compare the potential of intravoxel incoherent motion(IVIM)-derived parameters as well as apparent diffusion coefficient(ADC)with that of combined positron emission tomography and CT(PET-CT)in differentiating solitary pulmonary lesions.Methods Thirty-six patients with solitary pulmonary lesions(26 cases of malignant tumors,10 cases of benign lesions)proven by pathological results underwent DWI(b=0,5,10,15,20,25,50,80,150,300,500,800,1000 s/mm2),PET/CT.The quantitative DWI parameters including ADC total、D、f and D star and SUVmax were measured.These parameters of the two groups were statistically compared using Mann-Whitney U test.Receiver operating characteristic(ROC)analyses were used to compare the diagnostic capability of the DWI and PET/CT indexes.Results The mean ADC total、D、f and D star of malignant tumors were(1.01±0.21)×10^-3mm^2/s、(1.01±0.25)×10^-3mm^2/s、(17±12)%and(44.6±28.0)×10^-3mm^2/s,that of benign lesions were(1.31±0.23)×10^-3mm^2/s、(1.28±0.30)×10^-3mm^2/s、(22±10)%and(41.0±23.2)×10^-3mm^2/s respectively.There were significant differences between malignant tumors and benign lesions in ADC total、D and f(Z=-3.285、-2.861 and-2.420,respectively,P<0.05).SUVmax of lung cancer was significantly higher than that of benign lesions(13.27±5.77 versus 5.77±4.08;Z=-3.056,P<0.05).The areas under the ROC curve(AUC)of SUVmax、ADC total、D and f between malignant and benign lesions were 0.833、0.860、0.815 and 0.765,respectively.The sensitivity of these four parameters were 96.15%、65.38%、69.23%and 57.69%and specificity were 70%、100%、90%and 100%for the differential diagnosis of solitary pulmonary lesions if the maximum Youden index is taken as cut-off.Conclusion The ADC total value,D value,and f value of the single and dual exponential models of DWI have good diagnostic value in SPLs.Among them,the ADC total value and D value have higher diagnostic efficacy and are equivalent to SUVmax.

关 键 词：肺孤立性病变 扩散加权成像 体层摄影术 X线计算机 敏感性 特异性 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2