DWI对鼻咽癌颈部小淋巴结转移瘤的诊断价值及其对放疗靶区的优化  

Diagnostic Value of DWI for Small Cervical Lymph Node Metastases in Nasopharyngeal Carcinoma and its Optimization of Radiotherapy Target Area

作　　者：林灿洁 唐爽 文小芝 何明盛 LIN Can-jie;TANG Shuang;WEN Xiao-zhi(Department of Tumor Radiotherapy,The Second Affiliated Hospital of Guangxi University of Science and Technology,Liuzhou545006,China)

机构地区：[1]广西科技大学第二附属医院肿瘤放射治疗科,广西柳州545006 [2]广西科技大学第二附属医院放射科,广西柳州545006

出　　处：《中国实验诊断学》2021年第9期1272-1275,共4页Chinese Journal of Laboratory Diagnosis

基　　金：广西壮族自治区卫健委基金项目(Z20180138)。

摘　　要：目的探讨磁共振扩散加权成像(DWI)对鼻咽癌(NPC)小淋巴结转移瘤的诊断价值和NPC小淋巴结转移瘤表观扩散系数(ADC)的诊断阈值,及其对放疗靶区的优化。方法选取2017年9月至2019年12月广西科技大学第二附属医院收治的72例NPC患者,按检查方法分为对照组和观察组。对照组常规扫描确定放疗靶区,观察组DWI确定放疗靶区。测量颈部小淋巴结转移瘤、大淋巴结转移瘤和良性淋巴结ADC值,绘制受试者工作特征(ROC)曲线,确定诊断NPC颈部小淋巴结转移瘤的ADC诊断阈值和效能。比较两组放疗靶区勾画面积。结果对照组常规检测检出率83.33%(95/114),低于观察组DWI检出率99.32%(290/292)(P<0.05)。观察组颈部小淋巴结转移瘤ADC值(0.72±0.14)×10^(-3)mm^(2)/s与大淋巴结转移瘤ADC值(0.74±0.16)×10^(-3)mm^(2)/s比较无统计学差异(P>0.05);良性淋巴结ADC值(1.08±0.19)×10^(-3)mm^(2)/s高于颈部小淋巴结转移瘤、大淋巴结转移瘤(P<0.05)。当颈部小淋巴结转移瘤ADC诊断阈值为0.908×10^(-3)mm^(2)/s时,其ROC曲线下面积为0.919,诊断敏感性和特异性分别为95.30%、83.10%。观察组勾画NPC肿瘤原发灶和颈部淋巴结转移瘤面积均低于对照组(P<0.05)。结论DWI对NPC小淋巴结转移瘤具有较高诊断价值,诊断阈值为0.908×10^(-3)mm^(2)/s时,诊断价值最高。DWI可缩小靶区勾画面积,减少周围组织损伤,可用于NPC小淋巴结转移瘤的筛查、治疗。Objective To investigate the diagnostic value of diffusion-weighted imaging(DWI)for nasopharyngeal carcinoma(NPC)small lymph node metastasis,the diagnostic threshold of apparent diffusion coefficient(ADC)for NPC small lymph node metastasis and effect of DWI on optimization of radiotherapy targets zone.Methods Retrospective analysis of 72 patients in our hospital who were diagnosed with NPC were divided into control group(n=20)and observation group(n=52)according to their examination methods.Routine scanning was used to determine the radiotherapy target area of control group,and DWI was used to determine the radiotherapy target area of observation group.Measured ADC values of small cervical lymph node metastasis,large lymph node metastasis,and benign lymph nodes,draw receiver operating characteristic(ROC)curve,determine the diagnostic threshold and diagnostic efficiency of ADC for diagnosing NPC small cervical lymph node metastases.Compare the delineated area of the radiotherapy target area between the control group and the observation group.Results The detection rate of the control group(83.33% 95/114)was lower than that of the observation group(99.32% 290/292)(P<0.05).The ADC value of small cervical lymph node metastasis in the observation group was(0.72±0.14)×10-3 mm2/s and the ADC value of large lymph node metastases was(0.74±0.16)×10-3 mm2/s,there was no statistically significant difference(P>0.05),the ADC value of benign lymph nodes was(1.08±0.19)×10-3 mm2/s,which was higher than that of small cervical lymph node metastases and large lymph node metastases(P<0.05).When the ADC diagnostic threshold of cervical small lymph node metastasis was 0.908×10-3 mm2/s,the area under the ROC curve was 0.919,and the diagnostic sensitivity and specificity were 95.30% and 83.10%.The areas of primary NPC tumors and lymph node metastases in the observation group were lower than those in the control group(P<0.05).Conclusion DWI has high diagnostic value for NPC small metastatic lymphoma.When the diagnostic threshold is

关 键 词：鼻咽癌 颈部小淋巴结转移瘤 磁共振扩散加权成像 表观扩散系数 

分 类 号：R739.63[医药卫生—肿瘤]