联合DWI和常规MRI征象在睾丸生殖细胞瘤中的诊断价值  

The diagnostic value of combining DWI and conventional MRI features in testicular germ cell tumor

作　　者：安丽华[1] 冯海霞[1] 王唯伟 李静[1] 陈月芹[1] 赵凡 AN Li-hua;FENG Hai-xia;WANG Wei-wei(Department of Imaging,Affiliated Hospital of Jining Medical University,Shandong 272029,China)

机构地区：[1]济宁医学院附属医院影像科,山东272029 [2]济宁医学院附属医院肿瘤科,山东272029

出　　处：《放射学实践》2022年第1期79-83,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DWI联合常规MRI征象对睾丸精原细胞瘤与非精原细胞瘤(NSGCT)的鉴别诊断价值。方法:搜集经病理证实的睾丸生殖细胞瘤患者46例,其中精原细胞瘤28例,非精原细胞瘤18例,46例患者均行MRI平扫及DWI扫描。两位医师采用双盲法行常规MRI征象观察及ADC值测量,并比较上述指标在睾丸精原细胞瘤与非精原细胞瘤间的差异;运用多因素logistic回归分析及受试者工作特征(ROC)曲线分析独立影响因素的诊断效能。结果:精原细胞瘤的平均ADC值小于NSGCT,差异有统计学意义(P<0.05);精原细胞瘤的T_(2)WI低信号征象、信号的均匀性及瘤内分隔征象较NSGCT多见,而NSGCT多见坏死/囊变,上述征象在两种肿瘤间的发生率差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示ADC值、坏死/囊变及瘤内分隔征象为鉴别诊断精原细胞瘤与NSGCT的独立影响因素。当ADC值≤0.90×10^(-3) mm^(2)/s时,倾向于诊断为精原细胞瘤,曲线下面积(AUC)为0.722,敏感度为72.2%,特异度为67.9%,准确度为67.4%。联合坏死/囊变与瘤内分隔征进行诊断的AUC为0.803,敏感度为83.3%,特异度为57.1%,准确度为76.1%。联合ADC值、坏死/囊变和瘤内分隔征的诊断效能最高,AUC为0.899,敏感度为77.8%、特异度为89.3%、准确度为89.1%。结论:当ADC值≤0.90×10^(-3) mm^(2)/s、瘤内分隔征象多见而少有囊变/坏死时倾向于诊断为精原细胞瘤,反之则诊断为NSGCT。将DWI与常规MRI征象相联合,可进一步提高诊断效能,对睾丸生殖细胞瘤的术前鉴别诊断有一定价值。Objective:To explore the diagnostic value of combining diffusion-weighted imaging(DWI)and conventional magnetic resonance imaging(MRI)features for differentiating seminoma and non-seminomatous germ cell tumor(NSGCT).Methods:A total of 46 patients with testicular germ cell tumors confirmed by pathology were collected,including 28 cases of seminoma and 18 cases of NSGCT.All the 48 cases underwent conventional MRI and DWI scans.The conventional MRI features and ADC values among different types of testicular tumors were recorded by two doctors and their differences were statistically analyzed.Multivariate logistic regression models and receiver operating characteristic(ROC)curves were used to analyze the diagnostic efficacy of independent predictors.Results:There were significant differences between seminoma and NSGCT in ADC value,T_(2)-hypointensity,T_(2)-homogeneity,cyst/necrosis,and intratumor septa(P<0.05).Binary Logistic regression analysis showed that ADC≤0.90×10^(-3) mm^(2)/s,cyst/necrosis,and intratumor septa were independent predictors for differentiating seminoma and NSGCT.The area under the ROC curve(AUC)of ADC value was 0.722.The sensitivity,specificity and accuracy were 72.2%,67.9%,67.4%,respectively.The AUC of combining cyst/necrosis with intratumor septa was 0.803,the sensitivity,specificity and accuracy were 83.3%,57.1%,and 76.1%,respectively.Combining ADC with cyst/necrosis,and intratumor septa showed a maximum AUC of 0.899,sensitivity of 77.8%,specificity of 89.3%,and accuracy of 89.1%.Conclusion:ADC≤0.90×10^(-3) mm^(2)/s and intratumor septa were independent predictors for seminoma.Cyst/necrosis were significant variables for predicting the NSGCT.The combination of ADC and could further improve the specificity in differentiating seminomas from NSGCT.

关 键 词：睾丸 生殖细胞肿瘤 精原细胞瘤 非精原细胞瘤 磁共振成像 扩散加权成像 表观扩散系数 

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