三维准连续式动脉自旋标记在诊断鼻咽癌颈部小淋巴结转移瘤中的应用价值  

Application value of three-dimensional pseudocontinuous arterial spin labeling in diagnosing cervical small lymph node metastases in nasopharyngeal carcinoma

作　　者：古冬连 刘露 吴敏 金观桥[1] GU Donglian;LIU Lu;WU Min;JIN Guanqiao(Medical Imaging Center,Cancer Hospital Affiliated to Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院医学影像中心,南宁530021

出　　处：《磁共振成像》2024年第12期109-115,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：广西自然科学基金项目(编号:2023GXNSFAA026225);广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z-A20240701)。

摘　　要：目的探讨三维准连续式动脉自旋标记(three-dimensional pseudocontinuous arterial spin labeling,3D pCASL)技术在诊断鼻咽癌颈部小淋巴结转移瘤(small metastatic lymph node,SMLN)中的应用价值。材料与方法回顾性收集63例初诊鼻咽癌病例,治疗前均行常规平扫+增强磁共振成像(magnetic resonance imaging,MRI)、3D pCASL扫描,治疗后行常规平扫+增强MRI。淋巴结的评价依据是我国鼻咽癌临床分期工作委员会制订的淋巴结转移评判标准,并结合随访期间的MRI图像。根据诊断结果将淋巴结分为3组,大淋巴结转移瘤(large metastatic lymph node,LMLN)组(短径>10 mm)、SMLN组(短径≤10 mm)、良性淋巴结(benign lymph node,BLN)组。比较各组淋巴结最大径、最短径、最短径/最大径、血流量平均值(average blood flow,BFavg)、血流量最小值(minimum blood flow,BFmin)、血流量最大值(maximum blood flow,BFmax)之间的差异。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价各参数对鼻咽癌颈部SMLN的诊断效能。结果纳入颈部淋巴结323枚,其中SMLN组152枚,LMLN组97枚,BLN组74枚。SMLN、LMLN、BLN组组间最大径、最短径、最短径/最大径、BFavg、BFmax、BFmin差异均有统计学有意义(P<0.001)。LMLN组最大径、最短径、最短径/最大径均大于SMLN、BLN组(P<0.001),SMLN组最短径、最短径/最大径大于BLN组(P=0.010,P<0.001),BLN组BFavg、BFmax、BFmin均小于SMLN、LMLN组(P<0.001)。BLN组与SMLN组最大径、LMLN组与SMLN组BFavg、BFmax、BFmin差异均无统计学意义(P>0.05)。ROC曲线分析显示,最短径、最短径/最大径、BFavg、BFmax、BFmin鉴别鼻咽癌BLN与SMLN的AUC值分别为0.712、0.740、0.952、0.990、0.791,截断值分别为0.55 cm、0.59、39.4 mL/(min·100 g)、58.5 mL/(min·100 g)、25.5 mL/(min·100 g)。结论3D pCASL可以有效鉴别鼻咽癌颈部SMLN,提高鼻咽癌N分期的准确性。Objective:To investigate the value of three-dimensional pseudocontinuous arterial spin labeling(3D pCASL)in diagnosing cervical small metastatic lymph node(SMLN)in nasopharyngeal carcinoma.Materials and Methods:A total of 63 cases of nasopharyngeal carcinoma were collected retrospectively.A combination of routine plain scanning,enhanced magnetic resonance imaging(MRI),and 3D pCASL scanning was conducted prior to treatment.Subsequent follow-ups involved routine plain scanning and enhanced MRI post-treatment.The evaluation of lymph nodes was based on the criteria for assessing lymph node metastasis established by the nasopharyngeal carcinoma Clinical Staging Committee of our country,combined with MRI images during the follow-up period.According to the diagnostic outcomes,the lymph nodes were categorized into three groups:large metastatic lymph node(LMLN)group(short diameter>10 mm),SMLN group(short diameter≤10 mm),and benign lymph node(BLN)group.The differences among various groups in terms of the maximum diameter,minimum diameter,ratio of minimum diameter to maximum diameter,average blood flow(BFavg),minimum blood flow(BFmin),and maximum blood flow(BFmax)of lymph nodes were compared among all groups.The diagnostic efficacy of various parameters for cervical SMLN in nasopharyngeal carcinoma was evaluated using the receiver operating characteristic(ROC)curve.Results:A total of 323 cervical lymph nodes were included,with 152 in the SMLN group,97 in the LMLN group,and 74 in the BLN group.There were statistically significant differences in maximum diameter,minimum diameter,the ratio of minimum diameter to maximum diameter,BFavg,BFmax,and BFmin among the SMLN,LMLN,and BLN groups(P<0.001).The maximum diameter,minimum diameter,and the ratio of minimum diameter to maximum diameter in the LMLN group were all greater than those in the SMLN and BLN groups(P<0.001).The shortest diameter and the ratio of shortest diameter to maximum diameter in the SMLN group were both greater than those in the BLN group(P=0.010,P<0.001).The B

关 键 词：鼻咽癌 淋巴结转移瘤 三维准连续式动脉自旋标记 磁共振成像 诊断 应用价值 

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]