酰胺质子转移成像联合表观扩散系数鉴别软组织肿瘤良恶性的应用  

Application of amide proton transfer imaging combined with apparent diffusion coefficient in the differentiation of benign and malignant soft tissue tumors

作　　者：吴丽芳 林燕桃 汤奕林 欧阳林[1] 耿月华[1] 陈懿 WU Lifang;LIN Yantao;TANG Yilin;OUYANG Lin;GENG Yuehua;CHEN Yi(Department of Radiology,the 909th Hospital(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)放射科,漳州363000

出　　处：《磁共振成像》2024年第12期138-142,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：福建省自然科学基金项目(编号:2023J011840)。

摘　　要：目的探讨酰胺质子转移(amide proton transfer,APT)成像联合表观扩散系数(apparent diffusion coefficient,ADC)在软组织肿瘤良恶性鉴别诊断中的应用价值。材料与方法回顾性分析55例经病理证实软组织肿瘤,良性肿瘤31例,恶性肿瘤24例。所有患者术前均行磁共振APT及扩散加权成像(diffusion-weighted imaging,DWI)检查,2名观察者分别测量获取DWI的ADC值以及APT的非对称性磁化传递率[MTRasym(3.5 ppm)](APT值),比较良恶性肿瘤中ADC值及APT值的差异;绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评价ADC、APT及两者联合鉴别软组织肿瘤良恶性的诊断效能。结果良性肿瘤的APT值小于恶性肿瘤(1.90%±1.06%vs.3.29%±0.94%),差异有统计学意义(t=-5.07,P<0.01);良性肿瘤的ADC值高于恶性肿瘤[(1.70±0.54)×10^(-3)mm^(2)/svs.(1.15±0.56)×10^(-3)mm^(2)/s],差异有统计学意义(t=3.68,P<0.01)。ADC、APT及二者联合的ROC曲线下面积(areaunderthecurve,AUC)、敏感度、特异度分别为0.778[95%置信区间(confidenceinterval,CI):0.646~0.879]、62.5%、87.1%,0.838(95%CI:0.714~0.924)、70.8%、90.3%及0.895(95%CI:0.783~0.962)、83.3%、87.1%,DeLong检验结果显示ADC与APT的AUC差异无统计学意义(Z=0.664,P>0.05),二者联合诊断的AUC高于ADC(Z=2.086,P<0.05),但与APT的AUC差异无统计学意义(Z=1.394,P>0.05)。结论APT及ADC均可用于软组织肿瘤良恶性病变的鉴别,二者联合可提高诊断效能。Objective:To investigate the application value of amide proton transfer(APT)imaging combined with apparent diffusion coefficient(ADC)in the differential diagnosis of benign and malignant soft tissue tumors.Materials and Methods:Fifty-five patients with soft tissue tumors confirmed by pathology were retrospectively analyzed.There were 31 benign tumors and 24 malignant tumors.All patients underwent magnetic resonance APT and diffusion weighted imaging(DWI)examination before operation.Two observers measured the ADC value of DWI and the asymmetric magnetization transfer ratio of APT[MTRasym(3.5 ppm),and The APT value is abbreviated].The differences of ADC and APT values between benign and malignant tumors were compared.Receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of ADC,APT and their combination in differentiating benign and malignant soft tissue tumors.Results:The APT values of benign tumors were less than those of malignant tumors[1.90%+1.06%vs.3.29%+0.94%],the difference was statistically significant(t=−5.07,P<0.01).The ADC values of benign tumors were higher than those of malignant tumors[(1.70±0.54)×10^(-3) mm^(2)/s vs.(1.15±0.56)×10^(-3) mm^(2)/s],and the difference was statistically significant(t=3.68,P<0.01).The area under the curve(AUC),sensitivity and specificity of ADC,APT and their combination were 0.778[95%confidence interval(CI):0.646-0.879],62.5%,87.1%;0.838(95%CI:0.714-0.924),70.8%,90.3%;0.895(95%CI:0.783-0.962),83.3%,87.1%,respectively.There was no significant difference in AUC between ADC and APT(Z=0.664,P>0.05).The AUC of the combined diagnosis of the two was higher than that of ADC(Z=2.086,P<0.05),but there was no statistically significant difference in AUC with APT(Z=1.394,P>0.05)alone.Conclusions:Both APT and ADC can be used for the differential diagnosis of benign and malignant soft tissue tumors.The combination of APT and ADC can improve the diagnostic efficiency.

关 键 词：软组织肿瘤 磁共振成像 酰胺质子转移成像 表观扩散系数 扩散加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R738.6[医药卫生—诊断学]