磁共振ADC值定量鉴别胸腺上皮性肿瘤与胸腺淋巴瘤  

ADC quantitation for differential diagnosis of thymic epithelial tumors and lymphoma

作　　者：兰江涛 马宇卉 张杰 胡玉川 张振显[1] 张贝 LAN Jiangtao;MA Yuhui;ZHANG Jie;HU Yuchuan;ZHANG Zhenxian;ZHANG Bei(Medical School of Yan’an University,Shaanxi 716000,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]空军军医大学唐都医院放射科,陕西西安710038 [3]陕西省肿瘤医院CT室,陕西西安710038

出　　处：《影像诊断与介入放射学》2023年第6期408-414,共7页Diagnostic Imaging & Interventional Radiology

基　　金：陕西省科技厅社会发展一般项目(2020SF-043);空军军医大学唐都医院科技创新发展基金(2017LCYJ004)。

摘　　要：目的探讨磁共振扩散加权成像(DWI)表观扩散系数(ADC)值对胸腺上皮性肿瘤和胸腺淋巴瘤的鉴别诊断价值。方法回顾性分析2019年12月—2023年4月经手术病理证实的48例胸腺瘤、17例胸腺癌和25例胸腺淋巴瘤的DWI及临床资料。在肿瘤最大层面测定肿瘤的相对最低ADC值(ADCmin)和全域ADC值(ADCtotal)。采用Kruskal-Wallis H检验比较三组间ADCmin与ADCtotal值的差异,并采用受试者工作特征(ROC)曲线分析上述参数对胸腺瘤、胸腺癌和胸腺淋巴瘤的鉴别诊断效能。结果胸腺瘤、胸腺癌和胸腺淋巴瘤的ADCmin(1.39×10^(-3)mm^(2)/s、0.94×10^(-3)mm^(2)/s及0.76×10^(-3)mm^(2)/s)和ADCtotal(1.51×10^(-3)mm^(2)/s、1.21×10^(-3)mm^(2)/s及0.60×10^(-3)mm^(2)/s)值在三组间总体上差异均具有统计学意义(P<0.001);进一步两两比较,除ADCtotal在胸腺瘤和胸腺癌组间差异无统计学意义外(P=0.056),ADCmin与ADCtotal值在不同组间差异均具有统计学意义(P<0.05)。采用ADCmin和ADCtotal值鉴别胸腺瘤与胸腺淋巴瘤的曲线下面积(AUC)、敏感度、特异度和截断值分别为0.898、89.6%、72.0%、0.97×10^(-3)mm^(2)/s及0.968、97.9%、84.0%、0.94×10^(-3)mm^(2)/s;在鉴别胸腺癌与胸腺淋巴瘤上,AUC、敏感度、特异度和截断值分别为0.694、64.7%、68.0%、0.92×10^(-3)mm^(2)/s及0.925、94.1%、84.0%、0.93×10^(-3)mm^(2)/s。结论胸腺瘤、胸腺癌和胸腺淋巴瘤的ADCmin值和ADCtotal值存在显著统计学差异,ADC定量对鉴别胸腺上皮性肿瘤和胸腺淋巴瘤具有重要临床应用价值。Objective To explore the value of apparent diffusion coefficient(ADC)values on diffusion-weighted magnetic resonance imaging(DWI)for differentiating thymic epithelial tumors from lymphoma.Methods From December 2019 to April 2023,DWI and clinical data of histologically confirmed thymoma(48),thymic carcinoma(17),and thymic lymphoma(25)were retrospectively analyzed.The relative minimum ADC(ADCmin)and global ADC(ADCtotal)values of the tumors were measured at the largest tumor level.Kruskal Wallis H test was used to compare the difference of ADCmin and ADCtotal among thymomas,carcinomas,and lymphomas.The receiver operating characteristic(ROC)curve was used to analyze the differential diagnostic value of the above parameters.Results The ADCmin and ADCtotal of thymoma(1.39×10^(-3)mm^(2)/s,1.51×10^(-3)mm^(2)/s),thymic carcinoma(0.94×10^(-3)mm^(2)/s,1.21×10^(-3)mm^(2)/s),and thymic lymphoma(0.76×10^(-3)mm^(2)/s,0.60×10^(-3)mm^(2)/s)were significantly different among the 3 groups(P<0.001),between thymoma and lymphoma(P<0.05),between lymphoma and carcinoma(P<0.05).There was no significant difference in ADCtotal between thymoma and carcinoma(P=0.056).ADCmin(0.97×10^(-3)mm^(2)/s)and ADCtotal(0.94×10^(-3)mm^(2)/s)cut off values had the highest areas under the ROC curves(0.898,0.968),sensitivities(89.6%,97.9%),and specificities(72.0%,84.0%)for differentiating thymoma from lymphoma.ADCmin(0.92×10^(-3)mm^(2)/s)and ADCtotal(0.93×10^(-3)mm^(2)/s)cut off values had the highest areas under the ROC curves(0.694,0.925),sensitivities(64.7%,94.1%),and specificities(68.0%,84.0%)for differentiating thymic carcinoma from lymphoma.Conclusion The ADCmin and ADCtotal values of thymoma,thymic carcinoma,and thymic lymphoma are significantly different.ADC quantitation can aid in differentiating thymic epithelial tumors and thymic lymphoma.

关 键 词：扩散加权成像 表观扩散系数 胸腺淋巴瘤 胸腺癌 胸腺瘤 

分 类 号：R445.2[医药卫生—影像医学与核医学] R736.3[医药卫生—诊断学]