颈部影像报告和数据系统在MRI诊断早期单纯黏膜型鼻咽癌局部复发中的应用  

Application of neck imaging reporting and data systems in MRI diagnosis of early exclusive mucosal local recurrent nasopharyngeal carcinoma

作　　者：汪泽燕[1] 吴磊迪 钟柱 王星蕊 肖学红[1] 王志龙[1] WANG Zeyan;WU Leidi;ZHONG Zhu;WANG Xingrui;XIAO Xuehong;WANG Zhilong(Department of Radiology,Zhongshan City People's Hospital,Zhongshan 528403,China)

机构地区：[1]中山市人民医院放射科,中山528403

出　　处：《磁共振成像》2024年第3期170-176,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：中山市公益基金与基础研究项目(编号:2022B1137)。

摘　　要：目的探讨颈部影像报告和数据系统(neck imaging reporting and data systems,NI-RADS)MRI对单纯黏膜型鼻咽癌局部复发(exclusive mucosal local recurrent nasopharyngeal carcinoma,EMLRNPC)与黏膜治疗后改变(mucosal posttreatment changes,MPTC)的诊断价值,尝试为NI-RADS MRI词典中的局灶性黏膜异常建议附加定性扩散加权成像(diffusion-weighted imaging,DWI)标准。材料与方法回顾性分析2015年2月至2023年2月经病理或影像随访确诊的21例EMLRNPC和29例MPTC。先由2名影像医师独立评价MRI表现,进行NI-RADS MRI分类,再进行附加定性DWI标准的改良NI-RADS MRI分类,3个月后,由其中的1名高年资影像医师再次进行分类。采用Cohen’s Kappa检验评估观察者间、观察者内NI-RADS分类一致性。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价这两种NI-RADS分类对EMLRNPC与MPTC的诊断效能,曲线下面积(area under the curve,AUC)的比较采用DeLong检验。结果NI-RADS MRI、改良NI-RADS MRI的分类观察者间与观察者内一致性为0.69与0.88、0.83与0.96。NI-RADS MRI和改良NI-RADS MRI鉴别诊断ELRNPC与MPTC的AUC、敏感度、特异度为0.845[95%置信区间(confidence interval,CI):0.715~0.932]、100.0%(95%CI:83.9%~100.0%)、69.0%(95%CI:49.2%~84.7%)和0.966(95%CI:0.871~0.997)、100.0%(95%CI:83.9%~100.0%)、93.1%(95%CI:77.2%~99.2%),两种分类的AUC间差异有统计学意义(Z=2.985,P=0.003)。结论NI-RADS MRI与附加定性DWI标准的改良NI-RADS MRI对EMLRNPC与MPTC均具有较高的鉴别诊断价值,改良NI-RADS MRI分类的诊断效能、一致性更高。Objective:To evaluate the diagnostic value of the neck imaging reporting and data systems(NI-RADS)MRI in exclusive mucosal local recurrent nasopharyngeal carcinoma(EMLRNPC)and mucosal posttreatment changes(MPTC),and attempted to propose adding qualitative diffusion-weighted imaging(DWI)criteria for the focal mucosal abnormality in NI-RADS MRI lexicon.Materials and Methods:From February 2015 to February 2023,totally 21 cases of EMLRNPC and 29 cases of MPTC confirmed by pathology or imaging follow-up were retrospectively enrolled.Two radiologists independently evaluated the MRI findings and assigned a NI-RADS MRI category in the first step,then reevaluated with the adding qualitative DWI criteria and assigned a modified NI-RADS MRI category in the second step.All images were reevaluated by the senior radiologist in the same steps after three months.Inter-and intra-reader agreements were assessed with Cohen's Kappa test.Receiver operating characteristic curves were generated to assess the diagnostic values of the two NI-RADS categories between EMLRNPC and MPTC.Area under the curve(AUC)was compared by DeLong's test.Results:Inter-and intra-reader agreements were 0.69 and 0.88 for NI-RADS MRI categories,and 0.83 and 0.96 for modified NI-RADS MRI categories.In differential diagnosis of EMLRNPC and MPTC,the AUC,sensitivity,specificity of NI-RADS MRI were 0.845[95%confidence interval(CI):0.715-0.932],100.0%(95%CI:83.9%-100.0%),69.0%(95%CI:49.2%-84.7%),and of modified NI-RADS MRI were 0.966(95%CI:0.871-0.997),100.0%(95%CI:83.9%-100.0%),93.1%(95%CI:77.2%-99.2%),respectively.There was statistical difference between the AUCs of two categories(Z=2.985,P=0.003).Conclusions:For both NI-RADS MRI and modified NI-RADS MRI which adding the qualitative DWI criteria,the differential diagnostic value of EMLRNPC and MPTC are great,while the consistency and diagnostic performance are stronger for the modified NI-RADS MRI.

关 键 词：鼻咽癌 局部肿瘤复发 磁共振成像 颈部影像报告和数据系统 扩散加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.62[医药卫生—诊断学]