动脉自旋标记联合扩散张量成像对腮腺肿瘤的鉴别诊断价值  

Differential diagnostic value of arterial spin labeling combined with diffusion tensor imaging in parotid gland tumors

作　　者：周金亮 崔运福 张迪鸣 任瑞[2] 狄宁宁[1] 沈善昌 姜兴岳[1] 王山山[1] ZHOU Jinliang;CUI Yunfu;ZHANG Diming;REN Rui;DI ningning;SHEN Shanchang;JIANG Xingyue;WANG Shanshan(Department of Radiology,Binzhou Medical University Hospital,Binzhou 256600,China;Department of Out-Patient,Binzhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院放射科,滨州256600 [2]滨州医学院附属医院门诊部,滨州256600

出　　处：《磁共振成像》2024年第3期50-55,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：滨州医学院科研计划与科研启动基金项目(编号:BY2021KJ34)。

摘　　要：目的探讨应用动脉自旋标记(arterial spin labeling,ASL)和扩散张量成像(diffusion tensor imaging,DTI)评价多参数MRI在鉴别腮腺肿瘤中的临床价值。材料与方法回顾性分析滨州医学院附属医院2019年6月至2023年11月66名经手术病理证实的腮腺肿瘤患者,术前均行3D ASL和DTI,并测量肿瘤最大血流量(maximum tumor blood flow,TBFmax)和最小表观扩散系数(minimum apparent diffusion coefficient,ADCmin)、各向异性分数(fraction anisotropy,FA)。使用Mann-Whitney U检验或Kruskal-Wallis检验比较良性肿瘤(benign tumors,BT)和恶性肿瘤(malignant tumors,MT)的各参数值。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析评估各参数和联合有差异的参数对腮腺肿瘤的诊断效能。结果66例腮腺肿瘤患者中,BT 55例[其中Warthin瘤(Warthin tumors,WT)15例,多形性腺瘤(pleomorphic adenomas,PA)23例,其他17例],MT11例。BT的FA值低于MT(0.13±0.06 vs.0.18±0.04,P=0.003)。PA的TBFmax值[(43.72±37.64)mL/(100 g·min^(-1))]低于MT[(92.56±58.26)mL/(100 g·min^(-1))](P<0.001)和WT[(145.26±64.54)mL/(100 g·min^(-1))](P=0.016)。PA的ADCmin值[(1.55±0.51)×10^(-3)mm^(2)/s]高于MT[(1.11±0.28)×10^(-3)mm^(2)/s](P=0.016)和WT[(1.03±0.53)×10^(-3)mm^(2)/s](P<0.001)。MT的FA值(0.18±0.05)高于PA(0.11±0.04)(P<0.001)和WT(0.12±0.02)(P=0.015)。FA鉴别腮腺BT与MT的曲线下面积(area under the curve,AUC)为0.78,敏感度、特异度分别为81.82%、70.18%。FA区分WT、PA与MT的AUC分别为0.85、0.87,敏感度分别为72.73%、100.00%,特异度分别为94.12%、65.22%。TBFmax、ADCmin鉴别WT与PA的AUC分别为0.90、0.85,敏感度分别为94.12%、95.65%,特异度分别为91.30%、82.35%。三者联合鉴别PA与MT的AUC可提高至0.98,敏感度为100.00%,特异度为86.96%。结论ASL联合DTI有助于鉴别诊断腮腺良恶性肿瘤,综合运用多参数各优势有助于区分WT、PA和MT。联合有差异的参数可显著提高区分PA与MT的诊断效能。Objective:To evaluate the clinical value of multi-parameter MRI in distinguishing parotid tumors by arterial spin labeling(ASL)and diffusion tensor imaging(DTI).Materials and Methods:A total of 66 patients with surgically and pathologically proven parotid gland tumors from Binzhou Medical University Hospital from June 2019 to November 2023 were retrospectively analyzed.3D ASL imaging and DTI were perfomed before surgery,and the maximum tumor blood flow(TBFmax),minimum apparent diffusion coefficient(ADCmin)and fraction anisotropy(FA)were measured.The Mann-Whitney U test or Kruskal-Wallis test were used to compare the parameters of benign tumors(BT)and malignant tumors(MT).Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic efficacy of each parameter and the combination of different parameters for parotid tumors.Results:There were 66 patients with parotid gland tumors,including 55 BT[15 Warthin tumors(WT),23 pleomorphic adenomas(PA),17 others]and 11 MT.The FA value of BT was lower than that of MT(0.13±0.06 vs.0.18±0.04,P=0.003).The TBFmax value of PA[(43.72±37.64)mL/(100 g·min^(-1))]was lower than that of MT[(92.56±58.26)mL/(100 g·min^(-1))](P<0.001)and WT[(145.26±64.54)mL/(100 g·min^(-1))](P=0.016).The ADCmin value of PA[(1.55±0.51)×10^(-3) mm^(2)/s]was higher than that of MT[(1.11±0.28)×10^(-3) mm^(2)/s](P=0.016)and WT[(1.03±0.53)×10^(-3) mm^(2)/s](P<0.001).The FA value of MT(0.18±0.05)was higher than that of PA(0.11±0.04)(P<0.001)and WT(0.12±0.02)(P=0.015).The area under the curve(AUC)for distinguishing BT from MT by FA was 0.78,and the sensitivity and specificity were 81.82%and 70.18%,respectively.The AUC for distinguishing WT,PA from MT by FA were 0.85 and 0.87,the sensitivity were 72.73%and 100.00%,and the specificity were 94.12%and 65.22%,respectively.The AUC for distinguishing WT from PA by TBFmax and ADCmin were 0.90 and 0.85,the sensitivity were 94.12%and 95.65%,and the specificity were 91.30%and 82.35%,respectively.The AUC for distinguishing PA from M

关 键 词：腮腺肿瘤 WARTHIN瘤 多形性腺瘤 恶性肿瘤 动脉自旋标记成像 扩散张量成像 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.87[医药卫生—诊断学]