DCE-MRI及多b值DWI对卵巢上皮源性肿瘤良恶性的鉴别诊断价值  

DCE-MRI and multi-b-value DWI for differentiating benign from malignant ovarian epithelial tumor

作　　者：刘碧英[1] 林晓南[1] 张小镇 张彩霞[1] 兰鹏 何岩燕 戚婉[1] LIU Bi-ying;LIN Xiao-nan;ZHANG Xiao-zhen(Department of Radiology,the People's Hospital of Fujian Traditional Chinese Medicine University,Fuzhou 350005,China)

机构地区：[1]福建中医药大学附属人民医院放射科,福州350005

出　　处：《放射学实践》2021年第2期216-221,共6页Radiologic Practice

基　　金：福建省科技厅引导性项目(2018Y0045)。

摘　　要：目的:探讨动态对比增强MRI(DCE-MRI)及多b值DWI对卵巢上皮源性肿瘤良恶性的鉴别诊断价值。方法:搜集经术后病理证实为卵巢上皮源性肿瘤的39例患者,术前行常规MRI平扫及增强、多b值DWI及DCE-MRI检查,与术后病理结果进行对照,分别测量卵巢肿瘤实性区域及囊性区域的ADC值及DCE-MRI定量参数。采用ROC曲线分析良恶性肿瘤的最佳诊断阈值及相对应的诊断敏感度、特异度、阳性预测值、阴性预测值和诊断符合率(ACC)。结果:卵巢良、恶性上皮源性肿瘤实性部分各组间ADC值及囊性部分各组间ADC值差异均有统计学意义(P<0.05);DCE-MRI定量参数转移常数(Ktrans)值、速率常数(Kep)值及血管外细胞外间隙容积比(Ve)值在卵巢良、恶性上皮源性肿瘤实性部分中差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,当b值=1200 s/mm 2时具有最佳诊断效能,肿瘤实性部分ADC值的最佳诊断阈值为1149.9 mm 2/s,AUC为0.874,诊断敏感度、特异度为88.2%、86.4%;肿瘤囊性部分ADC值的最佳诊断阈值为2640.2 mm 2/s,AUC为0.893,诊断敏感度、特异度为73.7%、88.2%;DCE-MRI定量参数Ktrans值在3个定量参数中具有最高诊断效能,其最佳诊断阈值为0.0925min-1,AUC为0.840,诊断敏感度、特异度为77.3%、82.4%。联合DCE-MRI、多b值DWI可明显提高卵巢上皮源性肿瘤的诊断效能,敏感度、特异度、阳性预测值、阴性预测值、诊断符合率分别为95.7%、100%、94.1%、100%、97.4%。结论:b值=1200 s/mm 2时的ADC值及Ktrans值对良、恶性卵巢上皮源性肿瘤具有较高的鉴别诊断效能,联合DCE-MRI及多b值DWI可明显提高卵巢上皮源性肿瘤的术前诊断符合率。Objective:To investigate the value of dynamic contrast enhanced-MR imaging(DCE-MRI)and mulit-b-value diffusion weighted imaging(DWI)in differentiating malignant from benign ovarian epithelial tumor.Methods:39 patients with ovarian epithelial tumor confirmed by postoperative pathology were collected.All patients underwent mulit-b-value DWI and DCE-MRI.The apparent diffusion coefficient(ADC),and DCE-MRI quantitative parameters(Ktrans,Kep and Ve values)were measured on solid and cystic portion of ovarian tumor,respectively.Receiver operating characteristic(ROC)curve was performed to determine diagnostic performance.Results:There were statistically significant differences in ADC values between benign and malignant ovarian epithelial tumor in both the solid and the cystic portion(P<0.05).DCE-MRI quantitative parameters had statistically significant differences in the solid portion of benign and malignant ovarian epithelial tumors(P<0.05).With b value of 1200s/mm 2 and thresholds of 1149.9mm 2/s for ADC of solid portion,DWI had AUC,Se and Sp of 0.874,88.2%and 86.4%,respectively;with thresholds of 2640.2mm 2/s for ADC of cystic portion,DWI had AUC,Se and Sp of 0.893,73.7%and 88.2%,respectively.For DCE-MRI,Ktrans values achieved the highest diagnostic efficiency among three quantitative parameters.With thresholds of 0.0925min-1 for Ktrans,DWI had AUC,Se and Sp of,0.840,77.3%and 82.4%,respectively.The combination of DCE-MRI and mulit-b-value DWI showed the best diagnostic performance for discrimination malignant from benign ovarian epithelial tumor with Se,Sp,PPV,NPV and ACC of 95.7%,100%,94.1%,100%and 97.4%,respectively.Conclusion:ADC(b=1200s/mm 2)and Ktrans values may be valuable for differentiation of malignant from benign ovarian epithelial tumors.The combination of DCE-MRI with mulit-b-value DWI can further improve the diagnostic performance.

关 键 词：卵巢上皮源性肿瘤 卵巢肿瘤 扩散加权成像 DCE-MRI 磁共振成像 ADC值 

分 类 号：R737.11[医药卫生—肿瘤] R445.2[医药卫生—临床医学]