DWI单指数和双指数模型在肺癌与肺炎鉴别诊断中的应用价值  

Application of monoexponential and biexponential model of DWI in the differential diagnosis of lung cancer and pneumonia

作　　者：耿广[1] 侯桂英[2] 李臻[3] 吴新娟[3] 郭海荣 康若琛 李雯[1] 纪俊雨[1] 张莹[1] 孙梅花[2] GENG Guang;HOU Guiying;LI Zhen(Hebei Provincial Chest Hospital,Hebi,Shijiazhuang 050041,China;不详)

机构地区：[1]河北省胸科医院,石家庄市050041 [2]河北省石家庄市第五医院 [3]河北省石家庄市第二医院 [4]河北省石家庄市妇幼保健院 [5]河北大学

出　　处：《河北医药》2021年第10期1538-1541,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20200830)。

摘　　要：目的评价单指数与IVIM模型(体素内不相干运动模型,或双指数模型)弥散加权成像(DWI)在肺癌与肺炎鉴别诊断中的应用价值。方法收集包含较大实性成分的肺癌患者28例与肺炎患者25例。所有患者均在治疗前接受肺部弥散加权成像(DWI)检查,包括10个b值,b=0、25、50、100、150、200、400、600、800和1000 s/mm^(2)。分别以单指数和IVIM模型对所有b值的DWI图像进行计算,得到ADC值、纯扩散系数D、灌注相关扩散系数D*和灌注分数f。分析肺癌与肺炎组间各参数有无显著差异,绘制有显著差异参数的受试者工作特征曲线(ROC曲线),计算曲线下面积(AUC),并筛选出诊断效能最高的参数;再根据肺癌不同病理亚型将肺癌患者分为4组,比较组间各参数有无显著差异。结果肺癌组的ADC值与D值均显著低于肺炎组(P<0.05),肺癌与肺炎组间D*值与f值差异均无统计学意义(P>0.05);当ADC值阈值为1.44×10^(-3) mm^(2)/s时,其鉴别诊断的敏感度、特异度、准确度分别为75.0%、76.0%和75.4%;当D值阈值为1.23×10^(-3) mm^(2)/s时,其敏感度、特异度、准确度分别为75.0%、92.0%和88.0%;4组肺癌亚型间各参数差异均无统计学意义(P>0.05)。结论DWI单指数模型和IVIM模型可用于肺癌与肺炎的鉴别诊断,其中肺癌组的ADC与D值均显著低于肺炎组,且D值的诊断效能更高。Objective To evaluate the application value of monoexponential and IVIM model(incoherent motion model,or biexponential model)of diffusion weighted imaging(DWI)in the differential diagnosis of lung cancer and pneumonia.Methods A total of 28 patients with lung cancer and 25 patients with pneumonia with solid components were enrolled in the study.All the patients underwent pulmonary DWI examination before treatment,including 10 b-values,namely,b=0,25,50,100,150,200,400,600,800,and 1,000 s/mm^(2).The monoexponential and IVIM models were used to calculate b-value DWI images,and the ADC value,pure diffusion coefficient D,perfusion-related diffusion coefficient D*and perfusion fraction f were obtained.The differences of parameters between lung cancer group and pneumonia group were analyzed.Receiver operating characteristic curve(ROC curve)of significantly different parameters was delineated,the area under the ROC curve(AUC)was calculated,and the parameters with the highest diagnostic efficiency were screened.The patients with lung cancer were divided into four groups based on different pathological subtypes of lung cancer,and the differences of indexes were compared among the four groups.Results The ADC value and D value in lung cancer group were significantly lower than those in pneumonia group(P<0.05),however,there were no significant differences in the D*value and f value between the two groups(P>0.05).When the threshold value of ADC was 1.44×10^(-3) mm^(2)/s,the sensitivity,specificity,and accuracy of the differential diagnosis were 75.0%,76.0%and 75.4%,respectively;when the D value threshold was 1.23×10^(-3) mm^(2)/s,which were 75.0%,92.0%and 88.0%,respectively.There were no significant differences in these indexes between the four lung cancer subtype groups(P>0.05).Conclusion The DWI monoexponential and IVIM model can be used for the differential diagnosis of lung cancer and pneumonia.The ADC and D values in lung cancer group are significantly lower than those in pneumonia group,and the diagnostic efficiency of

关 键 词：肺癌 肺炎 弥散加权成像(DWI) 

分 类 号：R445.2[医药卫生—影像医学与核医学]