扩散加权成像对良、恶性肺实性结节的诊断价值  

Diagnostic value of diffusion weighted imaging in pulmonary solid benign and malignant lesions

作　　者：赖海辉[1,2] 雷强 肖俊强[1] 黄旭东 陈惠茹[1] LAI Haihui;LEI Qiang;XIAO Junqiang;HUANG Xudong;CHEN Huiru(Department of Radiology,Huizhou First People's Hospital,Huizhou,Guangdong Province 516001,China;Department of Radiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Radiology,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]惠州市第一人民医院放射科,广东惠州516001 [2]广州医科大学附属第一医院放射科,广东广州510120 [3]广东省第二人民医院影像科,广东广州510317

出　　处：《实用放射学杂志》2021年第12期1959-1962,2005,共5页Journal of Practical Radiology

基　　金：惠州市医疗卫生类科技计划项目(2020Y074)。

摘　　要：目的探讨快速自旋回波扩散加权成像(DWI)对良、恶性肺实性结节的诊断价值。方法选取经病理证实的肺恶性肿瘤75例和肺良性结节21例,96例患者术前均行胸部常规MRI平扫及DWI(b=0、20、40、200、800 s/mm^(2)),测量所有病灶的参数,包括表观扩散系数(ADC)(0,800)、病灶与胸髓信号强度比(LSR800)、总表观扩散系数(ADCtotal)、单纯扩散系数(D)、灌注相关扩散系数(Dstar)及灌注分数(f)值。结果75例肺恶性肿瘤和21例良性结节的ADC(0,800)值分别为(1.19±0.27)×10^(-3)mm^(2)/s和(1.41±0.22)×10^(-3)mm^(2)/s(Z=-3.909,P<0.05);LSR800值为1.19±0.57和0.74±0.34(Z=-3.700,P<0.05);ADCtotal为(1.05±0.22)×10^(-3)mm^(2)/s和(1.27±0.36)×10^(-3)mm^(2)/s(Z=-2.451,P<0.05);D值为(1.13±0.26)×10^(-3)mm^(2)/s和(1.45±0.35)×10^(-3)mm^(2)/s(Z=-3.643,P<0.05)。ADC(0,800)值的曲线下面积(AUC)为0.779,最佳阈值为1.26×10^(-3)mm^(2)/s,敏感性和特异性分别为65.33%和85.71%;LSR800值的AUC为0.767,最佳阈值为0.99,敏感性和特异性分别为62.67%和80.95%;ADCtotal值的AUC为0.676,最佳阈值为1.26×10^(-3)mm^(2)/s,敏感性和特异性分别为73.33%和57.14%;D值的AUC为0.758,最佳阈值为1.16×10^(-3)mm^(2)/s,敏感性和特异性分别为54.67%和85.71%。结论ADC(0,800)值、ADCtotal值、D值及LSR800值可为肺实性结节良、恶性鉴别诊断提供重要的定量依据,诊断效能依次为ADC(0,800)>LSR800>D>ADCtotal。Objective To evaluate the diagnostic value of turbo spin echo diffusion weighted imaging(DWI)in differentiating pulmonary solid benign and malignant lesions.Methods A total of 96 patients were prospectively enrolled in the present study,including 75 malignant tumors and 21 benign lesions confirmed by histopathologic diagnosis.All patients underwent chest MRI scans before surgery,including conventional sequences and DWI(b=0,20,40,200,800 s/mm^(2)).The parameters of all lesions including apparent diffusion coefficient(ADC)(0,800),LSR800,total apparent diffusion coefficient(ADCtotal),D,Dstar and f value were measured.Results The ADC(0,800)of the malignant tumors and benign nodules were(1.19±0.27)×10^(-3)mm^(2)/s and(1.41±0.22)×10^(-3)mm^(2)/s,respectively,and there was significant difference between the two groups(Z=-3.909,P<0.05).LSR8O0 of the malignant tumors and benign lesions were 1.19±0.57 and 0.74±0.34,respectively,and there was significant difference between the two groups(Z=-3.700,P<0.05).ADCtotal of the malignant tumors and benign lesions were(1.05±0.22)× 10-3 mm^(2)/s and(1.27±0.36)×10^(-3)mm^(2)/s,respectively,and there was significant difference between the two groups(Z=-2.451,P<0.05).D value of the malignant tumors and benign lesions were(1.13±0.26)×10^(-3)mm^(2)/s and(1.45±0.35)×10^(-3)mm^(2)/s,respectively,and there was significant difference between the two groups(Z=-3.643,P<C0.05).The area under the curve(AUC)of the ADC(0,800)was 0.779,the optimal threshold was 1.26×10^(-3)mm^(2)/s,the sensitivity and specificity was 65.33%and 85.71%,respectively.The AUC of the LSRs。。was 0.767,the optimal threshold was 0.99,the sensitivity and specificity was 62.67%and 80.95%,respectively.The AUC of the ADCto,„was 0.676,the optimal threshold was 1.26×10^(-3)mm^(2)/s,the sensitivity and specificity was 73.33%and 57.14%,respectively.The AUC of the D value was 0.758,the optimal threshold was 1.16×10^(-3)mm^(2)/s,the sensitivity and specificity was 54.67%and 85.71%,respectively.Conclusion ADC(0,80

关 键 词：肺实性结节 扩散加权成像 磁共振成像 

分 类 号：R563[医药卫生—呼吸系统] R445.2[医药卫生—内科学]