DCE-MRI联合高b值DWI对卵巢恶性肿瘤和纤维卵泡膜细胞肿瘤鉴别诊断价值  

DCE-MRI and High-b Value DWI for Differentiating Fibmtbecoma and Malignant Ovarian Tumor

作　　者：刘碧英[1] 何岩燕 兰鹏 张彩霞[1] 林晓南[1] 张小镇 钟群[1] LIU Biying;HE Yanyan;LAN Peng(Department of Radiology,the People's Hospital of Fujian Traditional Chinese Medicine University,Fuzhou,Fujian Province 350005,P.R.China)

机构地区：[1]福建中医药大学附属人民医院放射科,福州350005

出　　处：《临床放射学杂志》2023年第3期438-443,共6页Journal of Clinical Radiology

基　　金：福建省科技厅引导性项目(编号:2018Y0045)。

摘　　要：目的探讨DCE-MRI联合高b值DWI对卵巢恶性肿瘤和纤维卵泡膜细胞肿瘤鉴别诊断的价值。方法搜集术后经病理证实的卵巢肿瘤患者,26例恶性肿瘤,13例纤维卵泡膜细胞肿瘤.术前对肿瘤患者行常规MRI平扫及增强、高b值DWI、DCE-MRI检查,测量肿瘤实性区ADC值、定量参数(K^(trans)、K_(ep)、V_(e)),对照术后病理结果并统计分析,通过ROC曲线分析,获得最佳诊断阈值、敏感度、特异度和阳性预测值、阴性预测值、诊断准确率。结果卵巢恶性组和纤维卵泡膜细胞肿瘤组实性区ADC值、K^(trans)值、K_(ep)值两组间差异有统计学意义(P<0.05),而V_(e)值无统计学意义(P>0.05);分析ROC曲线,当b值=1200 s/mm2时,肿瘤实性部分ADC值的阈值为931 mm2/s,AUC为0.772,敏感度、特异度分别为73.1%、76.9%,阳性预测值86.4%,阴性预测值58.8%,诊断准确率74.4%;DCE-MRI定量参数K^(trans)值诊断效能最高,诊断阈值为0.0655 min-1,AUC为0.896,敏感度、特异度分别为92.3%、76.9%,阳性预测值及阴性预测值分别为88.9%、83.3%,诊断准确率87.2%。DCE-MRI、高b值DWI联合应用对两组肿瘤的诊断效能最高,敏感度、特异度、阳性预测值、阴性预测值、诊断准确率分别为92.6%、84.6%、92.6%、91.7%、92.3%。结论b值=1200 s/mm2及K^(trans)值联合应用在卵巢恶性肿瘤、纤维卵泡膜细胞肿瘤的鉴别诊断中具有重要价值,帮助临床医师术前制定最优化治疗方案。Objective To investigate the potential value of dynamic contrast enhanced-MR imaging(DCE-MRI)or high-b-value diffusion weighted imaging(DWI)in differential between fibmtbecoma and malignant ovarian tumor.Methods This retrospectively study enrolled 39 patients with ovarian tumor confirmed by pathology.All patients underwent conventional MR imaging,high-b value DWI and DCE-MRI.The apparent diffusion coefficient(ADC)values were obtained from solid portion of tumor,while K^(trans),K_(ep)and V_(e)values were obtained from the solid portion of tumor.Receiver operating characteristic(ROC)curve analysis were performed to determine optimal thresholds,sensitivity(Se),specificity(Sp),positive predictive value(PPV),negative predictive value(NPV)and accuracy(ACC)for ADC,K^(trans),K_(ep)and V_(e)values in the differentiation of fibmtbecoma and malignant ovarian tumor.Results There were significant differences in ADC,K^(trans)and K_(ep)values of solid portion between two groups(P<0.05).In ROC curve analysis,when b value=1200 s/mm2,ADC values provided a valuable diagnostic performance in differentiating fibmtbecoma from malignant ovarian tumor,AUC=0.772 of solid portion with optimal thresholds,Se,Sp,PPV,NPV and ACC of 931 mm2/s,73.1%,76.9%,86.4%,58.8%and 74.4%.Beside,the AUC of K^(trans)values(AUC=0.896)was higher than that of K_(ep)or V_(e)values,with optimal thresholds,Se,Sp,PPV,NPV and ACC of 0.0655 min-1、92.3%,76.9%,88.9%,83.3%and 87.2%.The combination of DCE-MRI and high-b-value DWI showed the best diagnostic performance in the discrimination of fibmtbecoma and malignant ovarian tumor with Se,Sp,PPV,NPV and ACC of 92.6%,84.6%,92.6%,91.7%,92.3%,respectively.Conclusion b=1200 s/mm2 for DWI and K^(trans)values derived from DCE-MRI are useful for differentiating fibmtbecoma from malignant ovarian tumors.The combination of DCE-MRI with high-b-value DWI can improve the preoperative diagnostic performance in the discrimination of fibmtbecoma and malignant ovarian tumors.

关 键 词：纤维卵泡膜细胞肿瘤 卵巢肿瘤 扩散加权成像 表观扩散系数 动态增强磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.31[医药卫生—诊断学]