多参数MRI对口底癌颈部淋巴结转移的预测价值  

Value of multi-parameter MRI in predicting cervical lymph node metastasis of oral floor cancer

作　　者：刘硕 史灵雪 应鸿飞 于保婷 郑雪微 郭昊 LIU Shuo;SHI Lingxue;YING Hongfei;YU Baoting;ZHENG Xuewei;GUO Hao(Department of Radiology,Xiong’an Xuanwu Hospital,Xiong’an 070001,China;Department of Radiology,Jilin Provincial People’s Hospital,Changchun 130021,China;Department of Radiology,Third Bethune Hospital of Jilin University,Changchun 130003,China;Department of Radiology,Changchun People’s Hospital,Changchun 130033,China)

机构地区：[1]河北省雄安宣武医院放射科,河北雄安070001 [2]吉林省人民医院放射线科,吉林长春130021 [3]吉林大学白求恩第三医院放射线科,吉林长春130003 [4]吉林省长春市人民医院放射线科,吉林长春130033

出　　处：《中国中西医结合影像学杂志》2024年第3期290-293,310,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：吉林省教育厅科研基金资助课题(JJKH20201057KJ)。

摘　　要：目的:评价多参数MRI预测口底癌颈部淋巴结转移的可行性及应用价值。方法:回顾性分析经手术病理证实且影像资料完整的口底癌患者53例,根据病理结果分为颈部淋巴结转移组26例,其中单侧转移13例,双侧转移13例;无淋巴结转移组27例。53例均行MRI平扫及DWI检查。测量并记录患者年龄、肿瘤最大长径、肿瘤浸润深度、肿瘤边缘距口底中线垂直距离,以及肿瘤最小ADC值(ADC_(min))、平均ADC值(ADC_(mean))、最大ADC值(ADC_(max))。采用独立样本t检验及Mann-Whitney U检验比较2组间、单侧和双侧颈部淋巴结转移各参数的差异,并通过ROC曲线评价差异有统计学意义的指标。结果:有、无颈部淋巴结转移组间患者年龄、肿瘤边缘距口底中线垂直距离、ADC_(mean)、ADC_(max)值差异均无统计学意义(均P>0.05);肿瘤最大长径、浸润深度、ADC_(min)值差异均有统计学意义(均P<0.01)。单、双侧颈部淋巴结转移患者间肿瘤边缘距口底中线垂直距离差异有统计学意义(P<0.05),年龄、肿瘤最大长径、浸润深度、ADC_(min)、ADC_(mean)、ADC_(max)值差异均无统计学意义(均P>0.05)。肿瘤浸润深度、最大长径、ADC_(min)值预测颈部淋巴结转移的AUC分别0.693、0.817和0.878,分别以47.65、40.35 mm及0.922×10^(-3)mm^(2)/s为阈值预测颈部淋巴结转移的敏感度分别为77.3%、81.4%、89.3%,特异度分别为70.1%、82.2%、85.2%。肿瘤边缘距口底中线垂直距离预测双侧颈部淋巴结转移的AUC为0.760,以-14 mm为阈值,预测双侧颈部淋巴结转移的敏感度和特异度分别为92.1%和62.3%。结论:口底癌患者MRI多参数图像上,肿瘤浸润深度、最大长径与ADC_(min)值可作为预测颈部淋巴结转移的重要指标;肿瘤边缘距口底中线垂直距离对预测双侧颈部淋巴结转移有一定价值。Objective:To evaluate the feasibility and application value of multi-parameter MRI in predicting cervical lymph node metastasis(CLNM)of oral floor cancer.Methods:A total of 53 patients with oral floor cancer were enrolled and divided into the CLNM group(26 cases,13 cases of unilateral metastasis and 13 cases of bilateral metastasis)and the non-CLNM group(27 cases).All patients underwent MRI and DWI.The patient’s age,maximum length diameter of tumor,depth of invasion,the vertical distance between the tumor margin and the midline of oral floor,ADC_(min),ADC_(mean)and ADC_(max)were measured and recorded.Independent sample t test and Mann-Whitney U test were used to compare the differences of parameters between the CLNM group and the non-CLNM group and between the unilateral and bilateral metastasis.The indicators with significant statistical significances were evaluated by ROC curve.Results:There were no statistically significant differences in age,the vertical distance,ADC_(mean)or ADC_(max)between the CLNM group and the non-CLNM group(all P>0.05).There were significant differences in maximum length diameter,depth of invasion and ADC_(min)(all P<0.01).Compared with the bilateral CLNM,the vertical distance between the tumor margin and the midline of oral floor in the unilateral CLNM was significantly different(P<0.05),but there were no statistically significant differences in age,maximum length diameter,depth of invasion,ADC_(min),ADC_(mean)or ADC_(max)(all P>0.05).The AUCs of invasion depth,maximum length diameter and ADC_(min)for predicting CLNM were 0.693,0.817,0.878,taking 47.65 mm,40.35 mm and 0.922×10^(-3)mm^(2)/s as the optimum cutoff values,the sensitivities were 77.3%,81.4%and 89.3%,the specificities were 70.1%,82.2%and 85.2%,respectively.The AUC of the vertical distance between the tumor margin and the midline of oral floor for predicting bilateral CLNM was 0.760,taking-14 mm as the optimum cutoff value,the the sensitivity and specificity were 92.1%and 62.3%,respectively.Conclusions:On the multi-paramet

关 键 词：口底癌 淋巴结转移 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.8[医药卫生—诊断学]