扩散加权成像的多参数MRI模型对睾丸良恶性肿块的鉴别诊断价值  

Value of multiparameter MRI model in differential diagnosis of benign and malignant testicular masses

作　　者：徐景景[1] 钱海珍 陈月芹[1] 王皆欢[1] 朱来敏[1] 胡喜斌[1] 王唯伟 XU Jing-jing;QIAN Hai-zhen;CHEN Yue-qin;WANG Jie-huan;ZHU Lai-min;HU Xi-bin;WANG Wei-wei(Imaging Department,Affiliated Hospital of Jining Medical University,Jining Shandong 272029,China)

机构地区：[1]济宁医学院附属医院医学影像科,山东济宁2272029

出　　处：《中国临床医学影像杂志》2023年第11期807-811,共5页Journal of China Clinic Medical Imaging

基　　金：济宁市重点研发计划项目(2021YXNS035);济宁市重点研发计划项目(2022YXNS061);济医附院医学英才培养计划项目(2022-yxyc-010)。

摘　　要：目的:探讨基于扩散加权成像的MRI模型对睾丸良恶性肿块的鉴别诊断价值。方法:回顾性分析本院经病理证实的睾丸肿块患者43例,且术前2周行MRI检查,良性组21例,恶性组22例,所有病例均行扩散加权成像(DWI)、体素内不相干运动成像(IVIM)及扩散峰度成像(DKI)检查。分析两组间的临床病理资料、常规MRI征象及表观扩散系数(ADC)、真实扩散系数(D)、灌注相关扩散系数(D*)、灌注分数(f)、平均扩散峰度值(MK)、平均扩散率(MD);绘制ROC比较其诊断效能。结果:恶性组肿块的大小多大于良性组,且恶性组肿块瘤内分隔多见,边界多不清晰,两组差异有统计学意义(P值<0.05)。将肿块大小、瘤内分隔征象及肿块边界情况三者联合的AUC为0.917,敏感度为95.2%,特异度81.8%,准确度为83.7%。良性组ADC、D值高于恶性组,而D*、f、MK值低于恶性组,差异有统计学意义(P值<0.05)。当ADC≤1.03×10^(-3)mm^(2)/s、D≤0.88×10^(-3)mm^(2)/s、D*≥21.09×10^(-3)mm^(2)/s、f≥15%,MK≥0.99时,诊断倾向于恶性病变,其中D值的AUC最大,为0.823,准确度最高,为74.4%。ADC+D+D*+f+MK值的AUC为0.950,诊断效能均高于单一参数(Z=2.227,P=0.0260;Z=2.231,P=0.0257;Z=2.092,P=0.0364;Z=2.314,P=0.0207;Z=2.592,P=0.0095);敏感度为100%,特异度90.9%,准确度为90.7%,均高于常规MRI模型。结论:扩散加权成像的多参数MRI模型可用于睾丸良恶性肿块的预测,DWI+IVIM+DKI联合模型可提升睾丸良恶性肿块鉴别准确性,有利于患者术前精准治疗。Objective:To explore the value of MRI model based on DWI for the differential diagnosis of benign and malignant testicular masses.Methods:A retrospective analysis was conducted on 43 patients with testicular masses confirmed by pathology in our hospital,MRI examination was performed 2 weeks before surgery,including 21 cases in the benign group and 22 cases in the malignant group.All patients underwent DWI,intravoxel incoherent motio(IVIM)and diffusion kurtosis imaging(DKI).The clinicopathological characteristics and conventional MRI features and apparent diffusion coefficient(ADC),true diffusion coefficient(D),perfusion correlation diffusion coefficient(D*),perfusion fraction(f),mean diffusion kurtosis value(MK),and mean diffusion rate(MD)between the two groups were analyzed.The ROC was used to compare the diagnostic efficiency.Results:The size of the tumor in the malignant group was mostly larger than that in the benign group.The intratumoral septa in the malignant group was more common,and the boundaries of malignant group were mostly unclear.The difference between the two groups was statistically significant(P<0.05).The AUC of the combination of tumor size,intratumoral septa signs and tumor boundary conditions was 0.917,with a sensitivity of 95.2%,specificity of 81.8%,and accuracy of83.7%.The ADC and D values in benign group were higher than those in malignant group,while D*,f and MK values in benign group were lower than those in malignant group,with statistical significance(P0.05).When ADC≤1.03×10^(-3)mm^(2)/s,D≤0.88×10^(-3)mm^(2)/s,D*≥21.09×10^(-3)mm^(2)/s,f≥15%,MK≥0.99,the diagnosis tended to be malignant lesions.The AUC of D value was largest(0.823),with the highest accuracy of 74.4%.When ADC,D,D*,f and MK were combined,the AUC was0.950,and the diagnostic efficiency was higher than that of a single parameter(Z=2.227,P=0.0260;Z=2.231,P=0.0257;Z=2.092,P=0.0364;Z=2.314,P=0.0207;Z=2.592,P=0.0095).The sensitivity,specificity and accuracy were 100%,90.9%and90.7%respectively,all higher than conventi

关 键 词：睾丸肿瘤 磁共振成像 

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