3.0T磁共振ADC值及DCE-MRI定量分析对颈部良恶性淋巴结鉴别诊断
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摘要
目的:评估3.0T磁共振ADC值及DCE-MRI定量分析对颈部良恶性淋巴结鉴别诊断的价值。方法:回顾性分析70例(254枚淋巴结)经病理确诊或临床治疗随访证实的颈部淋巴结病变(良性30例,104枚;恶性40例,150枚)的3.0T磁共振ADC值和DCE-MRI的定量参数影像资料,评估影像资料中各项指标的诊断效能。结果:(1)良性淋巴结的平均ADC值为1.285×10~(-3) mm~2/s,恶性0.800×10-3 mm2/s,颈部良恶性淋巴结的平均ADC值差异性具有统计学意义(P<0.05);ADC值以0.927×10~(-3)mm~2/s为阈值,鉴别诊断颈部良恶性淋巴结敏感度88.5%、特异度76.0%、准确率89.6%。(2)DCE-MRI的定量参数中,良性淋巴结Ktrans、Kep值低,Ve值高;恶性淋巴结Ktrans、Kep值高,Ve值低,颈部良恶性淋巴结的Kep、Ve值差异性具有统计学意义(P<0.05);Ve以0.608为阈值,鉴别诊断敏感度78.8%、特异度80.0%、准确率82.4%;(3)颈部良恶性淋巴结的平均ADC值、Kep、Ve值三者具有相关性。结论:3.0T磁共振ADC值及DCE-MRI的定量参数对颈部良恶性淋巴结鉴别诊断具有很高的临床应用价值。
Objective:To evaluate the differential value of ADC and the quantitative parameters of DCE-MRI at 3.0 Tin diagnosing benign and malignant cervical lymph nodes.Methods:The ADC and quantitative parameters of DCE-MRI of 254 lymph nodes in 70 patients were retrospectively analyzed,including 104 benign lymph nodes from 30 cases and 150 malignant lymph nodes from 40 cases.All cases were diagnosed by pathology or clinical treatments.Results:(1)The average ADC value of benign lymph nodes was 1.285×10~(-3) mm~2/s,whereas 0.800×10-3 mm2/s for malignant lymph nodes.There was a statistical difference in ADC value between benign and malignant cervical lymph nodes(P<0.05).The threshold of the average ADC value at 0.927×10~(-3) mm~2/s had sensitivity 88.5%,specificity 76.0%,and accuracy 89.6%in diagnosing benign and malignant cervical lymph nodes.(2)The benign lymph nodes had lower Ktrans,Kep and higher Ve values,while the malignant lymph nodes showed higher Ktrans,Kep and lower Ve values.There were statistically significant differences for the Kep and Ve value between benign and malignant lymph nodes(P<0.05).The threshold of the Ve value at 0.608 has sensitivity 78.8%,specificity 80.0%,accuracy 82.4%in diagnosing benign and malignant cervical lymph nodes.(3)The average ADC,Kep and Ve values of benign and malignant cervical lymph nodes were associated with each other.Conclusion:The ADC and quantitative parameters of DCEMRI at 3.0 Tin differential diagnosis of benign and malignant cervical lymph nodes are clinically applicable.
Objective:To evaluate the differential value of ADC and the quantitative parameters of DCE-MRI at 3.0 Tin diagnosing benign and malignant cervical lymph nodes.Methods:The ADC and quantitative parameters of DCE-MRI of 254 lymph nodes in 70 patients were retrospectively analyzed,including 104 benign lymph nodes from 30 cases and 150 malignant lymph nodes from 40 cases.All cases were diagnosed by pathology or clinical treatments.Results:(1)The average ADC value of benign lymph nodes was 1.285×10~(-3) mm~2/s,whereas 0.800×10-3 mm2/s for malignant lymph nodes.There was a statistical difference in ADC value between benign and malignant cervical lymph nodes(P<0.05).The threshold of the average ADC value at 0.927×10~(-3) mm~2/s had sensitivity 88.5%,specificity 76.0%,and accuracy 89.6%in diagnosing benign and malignant cervical lymph nodes.(2)The benign lymph nodes had lower Ktrans,Kep and higher Ve values,while the malignant lymph nodes showed higher Ktrans,Kep and lower Ve values.There were statistically significant differences for the Kep and Ve value between benign and malignant lymph nodes(P<0.05).The threshold of the Ve value at 0.608 has sensitivity 78.8%,specificity 80.0%,accuracy 82.4%in diagnosing benign and malignant cervical lymph nodes.(3)The average ADC,Kep and Ve values of benign and malignant cervical lymph nodes were associated with each other.Conclusion:The ADC and quantitative parameters of DCEMRI at 3.0 Tin differential diagnosis of benign and malignant cervical lymph nodes are clinically applicable.
引文
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[2]刘妍,夏黎明.颈部淋巴结病变的MRI检查及临床意义[J].放射学实践,2006,21(5):533-535.
[3]丁忠祥,张福兴.CT、MRI及PET/CT在鼻咽癌第七版UICC分期中的价值[J].中国癌症杂志,2011,21(12):906-912.
[4] Xing W,Sheng J,Chen J,et al.Relative apparent diffusion coefficient:apromising tool to differentiate metastatic from benign lymph nodes in animal models[J].Chin Med J(Engl),2011,124(18):2907-2910.
[5]中国鼻咽癌临床分期工作委员会.鼻咽癌92分期修订工作报告[J].中华放射肿瘤学杂志,2009,18(1):2-6.
[6] Gregoire V,Ang K,Budach W,et al.Delineation of the neck node levels for head and neck tumors:a 2013update.Dahanca,Eortc,Hknpcsg,Ncic Ctg,Ncri,Rtog,Trog consensus guidelines[J].Radiother Oncol,2014,110(1):172-181.
[7]樊艳青,谭正,黄枫,等.颈部淋巴结核的MRI和Ct影像特征与病理学对照分析[J].放射学实践,2013,28(6):628-631.
[8]许楠,文亮,杨亚英.3.0T MR ADC值和相对ADC值对颈部转移性淋巴结的诊断价值[J].中国医学影像技术,2013,29(6):903-906.
[9]林成武,谢宝君.鼻咽癌颈部淋巴结转移MR多b值DWI成像研究分析[J].临床与病理杂志,2016,36(8):1187-1192.
[10]于红梅,翟昭华,马代远,等.3.0T磁共振多b值DWI在鼻咽癌N分期中的应用[J].放射学实践,2015,30(7):728-731.
[11] Habermann CR,Arndt C,Graessner J,et al.Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors:is a prediction of different histologic subtypes possible?[J].AJNR,2009,30(3):591-596.
[12]黎晓萍,李恒国.DCE-MRI结合DWI对颈部淋巴结病变的鉴别诊断价值[J].临床放射学杂志,2016,35(6):857-861.
[13] Khalifa F,Soliman A,El-Baz A,et al.Models and methods for analyzing DCE-MRI:a review[J].Med Phys,2014,41(12):e124301.
[14] Lee FK,King AD,Ma BB,et al.Dynamic contrast enhancement magnetic resonance imaging(DCE-MRI)for differential diagnosis in head and neck cancers[J].Eur J Radiol,2012,81(4):784-788.
[15]廖茜,汪俊萍,白人驹,等.CT灌注成像鉴别兔腋窝炎性增生性与转移性淋巴结[J].中国医学影像技术,2011,27(12):2423-2426.
[16]林奈尔,柴伟明,华佳.定量动态增强MRI在乳腺癌中的研究进展[J].国际医学放射学杂志,2013,36(4):336-339.
[17] Issa B,Buckley DL,Turnbull LW,et al.Heterogeneity analysis of Gd-DTPA uptake:improvement in breast lesion differentiation[J].J Comput Assist Tomogr,1999,23(4):615-621.
[18] Steingoetter A,Menne D,Braren RF.Assessing antiangiogenic therapy response by DCE-MRI:development of a physiology drivenmulti-compartment model using population pharmacometrics[J].PLoS One,2011,6(10):e26366.