磁共振扩散加权成像对睾丸肿块的鉴别诊断价值  

The value of diffusion-weighted imaging in the differential diagnosis of testicular masses

作　　者：王皆欢[1] 王唯伟 赵凡 陈月芹[1] WANG Jie-huan;WANG Wei-wei;ZHAO Fan(Department of Imaging,Affiliated Hospital of Jining Medical University,Shandong 270029,China)

机构地区：[1]济宁医学院附属医院影像科,山东272029

出　　处：《放射学实践》2021年第9期1122-1126,共5页Radiologic Practice

基　　金：2019年山东省研究生教育优质课程立项建设项目(SDYKC19213)。

摘　　要：目的:探讨扩散加权成像(DWI)对睾丸肿块的定量鉴别诊断价值。方法:搜集经病理证实的睾丸占位患者47例,其中恶性病变33例,良性病变14例,47例患者均行MRI平扫及DWI检查,其中27例行增强MRI检查。两位医师采用双盲法进行ADC值测量,一致性分析运用组内/组间相关系数,采用独立样本t检验及单因素方差分析比较不同病变的ADC值差异,ADC值对睾丸良恶性病变以及生殖细胞瘤的鉴别诊断效能采用受试者工作特性(ROC)曲线进行评价。结果:DWI图上13例病变呈均匀高信号,30例呈不均匀高信号,4例呈稍低信号;ADC图上37例病变呈均匀或混杂低信号,10例呈稍高或高信号;睾丸良、恶性病变之间的ADC值差异有统计学意义(P<0.05);性索-间质细胞瘤、炎性肉芽肿与恶性非精原细胞瘤两两之间的ADC值差异不具有统计学意义(P>0.05),精原细胞瘤、淋巴瘤与性索-间质细胞瘤、炎性肉芽肿、恶性非精原细胞瘤两两之间的ADC值差异具有统计学意义(P<0.05);以ADC值=0.79×10-3 mm 2/s为阈值鉴别诊断睾丸病变的良、恶性并绘制ROC曲线,曲线下面积(AUC)为0.826,敏感度为100%,特异度为67.0%,准确度为76.6%;以ADC值=0.75×10-3 mm 2/s为阈值鉴别诊断精原细胞瘤与恶性非精原细胞瘤,曲线下面积(AUC)为0.706,敏感度为75.0%,特异度为75.0%,准确度为75.0%。结论:DWI及其ADC值对睾丸病变的术前鉴别诊断有一定价值。Objective:To explore the value of diffusion weighted imaging(DWI)in quantitative differential diagnosis of testicular masses.Methods:47 cases of testicular masses confirmed by pathology were collected,including 33 malignant cases and 14 benign cases.All cases underwent conventional MRI and DWI,and 27 patients underwent enhanced MRI.Two physicians measured the apparent diffusion coefficient(ADC)in a double-blind manner.Intra-class and inter-class correlation coefficients(ICCs)were used to analyze the consistency of the two measurements.The independent sample t test and one-way ANOVA were used to analyze the difference of ADC value between different lesions.The receiver operating characteristic(ROC)curves was used to evaluate the differential diagnosis efficacy of ADC value.Results:On DWI,13 cases showed homogeneous hyper-intensity,30 cases showed inhomogeneous hyperintensity,and 4 cases showed slightly hypo-intensity.37 cases showed homogeneous or inhomogeneous hypo-intensity and 10 cases showed slightly high or high signal intensity on ADC images.The difference of ADC values between benign and malignant testicular masses was statistically significant(P<0.05).There was no statistically significant difference in ADC value between sex cord-stromal tumor,inflammatory granuloma and malignant non-seminomas(P>0.05).But there was statistically significant difference in ADC value between seminomas,lymphoma and sex cord-stromal tumor,inflammatory granuloma and malignant non-seminomas(P<0.05).The area under the ROC curve of ADC value for differential diagnosis of the benign and malignant testicular masses was 0.826 with optimal cut-off value of 0.79×10-3 mm 2/s.The sensitivity,specificity and accuracy were 100%,67.0%and 76.6%,respectively.The area under the ROC curve of ADC value for differential diagnosis of seminomas and non-seminomas was 0.877 with optimal cut-off values of 0.75×10-3 mm 2/s.The sensitivity,specificity and accuracy were 75.0%,75.0%and 75.0%,respectively.Conclusion:DWI showed certain value in preoperativ

关 键 词：睾丸 肿块 扩散加权成像 表观扩散系数 诊断 鉴别 

分 类 号：R737.21[医药卫生—肿瘤] R445.2[医药卫生—临床医学]