快速自旋回波弥散加权成像在视网膜母细胞瘤患儿病灶活动性评估中的价值  

The value of fast spin-echo diffusion-weighted imaging in the evaluation of focus activity in children with retinoblastoma

作　　者：李林[1] 李方元 赵建设[1] 崔若棣[1] 孙志群[3] LI Lin;LI Fangyuan;ZHAO Jianshe;CUI Ruodi;SUN Zhiqun(The Center of Medical Imaging,Children’s Hospital Affiliated to Shandong University,Jinan Children’s Hospital,Jinan 250022,Shangdong Province,China;Department of Imaging,Southern Suburb Hospital of Jinan,Jinan 250003,Shangdong Province,China;Department of Neonatology,People’s Hospital of Weifang City,Shandong Province,Weifang 261041,Shangdong Province,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)医学影像中心,山东济南250022 [2]济南南郊医院影像科,山东济南250003 [3]山东省潍坊市人民医院新生儿科,山东潍坊261041

出　　处：《肿瘤影像学》2023年第3期275-280,共6页Oncoradiology

基　　金：济南市卫生健康委员会科技计划项目(2022-1-46)。

摘　　要：目的:分析快速自旋回波弥散加权成像(fast spin-echo diffusion-weighted imaging,TSE-DWI)在评估单眼发病眼内期视网膜母细胞瘤(retinoblastoma,RB)患儿病灶活动性中的价值。方法:收集2014年5月—2018年7月于山东大学附属儿童医院临床诊治的180例单眼发病眼内期RB患儿及53例社区健康志愿者(对照组)的磁共振成像(magnetic resonance imaging,MRI)资料及相关临床资料。所有患儿均行MRI常规序列、TSE-DWI及动态对比增强MRI(dynamic contrastenhanced MRI,DCE-MRI)检查,患儿分别于治疗前、后及稳定期各检查1次,对照组只进行1次扫描。对比患儿眼球内病灶活动期、稳定期及对照组表观弥散系数(apparent diffusion coefficient,ADC)及信号强度增强率(signal strength enhancement ratio,△SI)的变化及两者在评估病灶是否具有活动性中的效能。结果:治疗前病灶TSE-DWI呈高信号,ADC图呈低信号,增强扫描呈不同程度强化;治疗后病灶体积缩小,DWI信号减低,ADC图信号增高,增强后不强化或轻度强化。病灶活动期、稳定期及对照组ADC与△SI差异均有统计学意义(P<0.001)。△SI=1.14%时,鉴别病灶是否具有活动性的灵敏度、特异度及准确度分别为75.91%、82.31%及87.56%,ADC=1.17×10^(-3)/mm^(2)时,鉴别病灶是否具有活动性的灵敏度、特异度及准确度分别为95.72%、87.23%及93.76%。两者鉴别病灶是否具有活动性的能效相似。结论:在评估病灶是否具有活动性方面,TSE-DWI与DCE-MRI价值相似,但TSE-DWI更具优势。Objective:To analyze the value of fast spin-echo diffusion-weighted imaging(TSE-DWI)in the evaluation of focal activity in children with intraocular simultaneous unilateral retinoblastoma(RB).Methods:The magnetic resonance imaging(MRI)data and relevant clinical data of 180 children with intraocular simultaneous unilateral RB who were clinically diagnosed and treated in the Affiliated Children’s Hospital of Shandong University from May 2014 to July 2018 and 53 communal healthy volunteers(control group)were collected.All cases were performed MRI routine sequence,TSE-DWI and dynamic contrast-enhanced MRI(DCE-MRI),and were examined once before treatment,after treatment and in stable period,the control group was scanned once.The changes of apparent diffusion coefficient(ADC)and signal intensity enhancement ratio(△SI)in the active and stable stage of the intraocular lesions and the control group were compared,and their effectiveness in evaluating whether the lesions were active or no.Results:The TSE-DWI of lesions before treatment showed high signal,the corresponding ADC image showed low signal,and the enhanced scanning showed enhancement with different degrees.After treatment,the lesion volume decreased,the DWI signal decreased,the ADC image signal increased,no or medium enhancement.The differences of ADC and△SI in active phase,stable phase and control group were statistically significant(P<0.001).When△SI=1.14%,the sensitivity,specificity and accuracy of identifying whether the lesion was active were 75.91%,82.31%,and 87.56%respectively.When ADC=1.17×10^(-3)/mm^(2),the sensitivity,specificity and accuracy of identifying whether the lesion was active were 95.72%,87.23%and 93.76%respectively.The energy efficiency of the two method to distinguish whether the lesion was active similarly.Conclusion:In assessing whether the lesion is active or not,the value of TSE-DWI was similar to the DCE-MRI,but TSE-DWI has the advantage.

关 键 词：磁共振成像 眼内期 视网膜母细胞瘤 表观弥散系数 动态对比增强磁共振成像 

分 类 号：R739.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]