DWI在鉴别中心型肺癌与阻塞性肺不张中的应用  

The application of DWI in the differentiation of central bronchogenic carcinomas from obstructive atelectasis

作　　者：乔香梅 陆锐 马苗[3] 史敏科[4] 苗立云[3] 何健[5] 周正扬[5] 周科峰[1,5] QIAO Xiangmei;LU Rui;MA Miao;SHI Mingke;MIAO Liyun;HE Jian;ZHOU Zhengyang;ZHOU Kefeng(Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing 210008, P.R.China;Department of Radiology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, P.R.China;Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R.China;Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R.China;Department of Radiology, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R.China)

机构地区：[1]南京医科大学鼓楼临床医学院医学影像科,江苏南京210008 [2]南京医科大学附属儿童医院医学影像科,江苏南京210008 [3]南京大学医学院附属鼓楼医院呼吸与重症医学科,江苏南京210008 [4]南京大学医学院附属鼓楼医院心胸外科,江苏南京210008 [5]南京大学医学院附属鼓楼医院医学影像科,江苏南京210008

出　　处：《医学影像学杂志》2020年第8期1376-1379,共4页Journal of Medical Imaging

基　　金：江苏省南京市卫健委医学科技发展项目(编号:YKK17073);十三五南京市卫生青年人才培养工程第二层次项目(编号:QRX17056)。

摘　　要：目的探讨3.0T磁共振DWI技术在CT难以鉴别的中心型肺癌与阻塞性肺不张中的应用价值。方法对33例CT疑似中心型肺癌合并阻塞性肺不张患者(由临床或PET-CT确诊)行磁共振T1WI-FFE、T2WI-TSE及DWI-EPI扫描,观察中心型肺癌与肺不张在各序列的信号特征,并于b=800s/mm2的DWI图像上测量中心型肺癌与阻塞性肺不张区域的表观弥散系数(ADC)及二者的信号强度(SI)并进行比较。结果T1WI、T2WI、DWI和T2WI+DWI能区分中心型肺癌与阻塞性肺不张的比例分别为12例(36.36%)、24例(72.73%)、30例(90.91%)、30例(90.91%)。在鉴别能力上,DWI>T2WI>T1WI(P<0.05);联合应用DWI+T2WI鉴别能力与单独运用DWI无显著性差异(P>0.05)。中心型肺癌的ADC值低于阻塞性肺不张(P<0.05),二者分别为(1.15±0.14)10-3s/mm2、(1.74±0.15)10-3s/mm2,在DWI相,中心型肺癌信号强度高于阻塞性肺不张(P<0.05)。结论3.0T MRI DWI技术在鉴别中心型肺癌与阻塞性肺不张鉴别中具有重要价值,可鉴别常规CT及T1WI及T2WI无法鉴别的部分病例。Objective To investigate the value of 3.0T MR Diffusion Weighted Imaging in the differentiation of central bronchogenic carcinomas from obstructive atelectasis which is difficult to identify by CT.Methods 33 patients with suspected central bronchogenic carcinomas complicated with obstructive atelectasis on CT(confirmed by clinical or PET-CT)underwent MR T1WI,T2WI and DWI-EPI scan.The signal characteristics of the central bronchogenic carcinomas and atelectasis in each sequence were observed.The apparent diffusion coefficient(ADC)and signal intensity(SI)of the central bronchogenic carcinomas and the obstructive atelectasis areas were measured and compared on the DWI images(b=800 s/mm2).Results 12 cases(36.36%),24 cases(72.73%),30 cases(90.91%)and 30 cases(90.91%)could be distinguished between central bronchogenic carcinomas and obstructive atelectasis by T1WI,T2WI,DWI and T2WI+DWI respectively.The ADC value of the central bronchogenic carcinomas was lower than that of the obstructive atelectasis(P<0.05).(1.15±0.14)×10-3 s/mm2 vs(1.74±0.15)×10-3 s/mm2,the signal intensity of the central bronchogenic carcinomas was higher than that of the obstructive atelectasis(P<0.05).Conclusion 3.0T MR DWI is of great value in differentiating central bronchogenic carcinomas from obstructive atelecta-sis.It can differentiate some cases which cannot be differentiated by conventional CT,T1WI and T2WI.

关 键 词：磁共振成像 弥散加权成像 中心型肺癌 肺不张 体层摄影术 X线计算机 

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