体素内不相干运动扩散加权成像对良、恶性骨肿瘤的鉴别诊断价值
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摘要
目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)对良、恶性骨肿瘤的鉴别诊断价值。方法连续性搜集手术确诊为良、恶性骨肿瘤患者44例,其中良性肿瘤21例,恶性肿瘤23例,术前均接受GE 3.0T MRI常规和IVIM-DWI扫描(b=0、10、20、50、100、200、400、800、1200、2000 s/mm~2)。应用GE ADW 4.5工作站分别测量病灶的标准扩散系数(ADC_(stand))、单纯水分子扩散系数(ADC_(slow))、灌注相关的扩散系数(ADC_(fast))和灌注分数(f),采用统计学分析软件SPSS 17.0对上述参数值分别进行两两比较,采用ROC曲线确定诊断阈值,评估上述参数对良、恶性骨肿瘤的诊断效能。结果良性骨肿瘤组的ADC_(stand)、ADC_(slow)、ADC_(fast)值分别为(1.46±0.39)×10~(-3)mm~2/s、0.71(0.34,1.14)×10~(-3)mm~2/s、4.87(2.93,23.50)×10~(-3)mm~2/s,明显高于恶性骨肿瘤组的(0.99±0.42)×10~(-3)mm~2/s、0.42(0.29,0.50)×10~(-3)mm~2/s、2.98(2.36,7.40)×10~(-3)mm~2/s,差异具有统计学意义(P<0.05)。良性骨肿瘤组的f值为(0.52±0.25),恶性骨肿瘤组的f值为(0.57±0.23),差异无统计学意义(P=0.449)。在鉴别诊断良、恶性骨肿瘤方面,ADC_(stand)的ROC曲线下面积最大(0.803),以1.125×10~(-3)mm~2/s为诊断阈值时,其敏感性及特异性分别为85.7%、73.9%。结论 IVIM-DWI的参数ADC_(stand)、ADC_(slow)、ADC_(fast)值对良、恶性骨肿瘤的鉴别有一定价值,而f值诊断价值有限,其中ADC_(stand)值诊断效能最大。
Objective To evaluate the value of intravoxel Incoherent motion diffusion-weighted magnetic resonance imaging(IVIM-DWI) in the differential diagnosis of benign and malignant bone tumors. Methods Forty-four patients with bone tumors confirmed pathologically after surgical resections were collected. According to the result of pathologic diagnosis,patients were divided into benign group(n=21) and malignant group(n=23),IVIM-DWI was performed in addition to routine MRI examination with a 3.0 MRI scanner. Ten b values including 0,10,20,50,100,200,400,800,1200,2000 s/mm~2 were used. GE ADW 4.5 work station was used to calculate the values of the apparent diffusion coefficient(ADCstand),pure diffusion coefficient(ADCslow),pseudodiffusion coefficient(ADCfast),and perfusion fraction(f). Statistical analyses were performed using the SPSS 17.0 software packages. Receiver operating characteristic(ROC) analysis was performed and the areas under the curve(AUC) values obtained were used to compare the diagnostic performances of different parameters. Results ADCstand,ADCslow,ADCfast values for benign group were(1.46±0.39)×10~(-3)mm~2/s,0.71(0.34,1.14)×10~(-3)mm~2/s,4.87(2.93,23.50)×10~(-3)mm~2/s,which higher than those of malignant group[(0.99±0.42)×10~(-3)mm~2/s,0.42(0.29,0.50)×10~(-3)mm~2/s,2.98(2.36,7.40)×10~(-3)mm~2/s ],and the differences were all statistically significant(P<0.05). The f value of benign group was(0.52±0.25),and malignant group was(0.57±0.23),there were no significant differences between the two groups(P=0.449). With ROC curve analysis for each parameter values,the area under the curve(AUC) of ADCstand was 0.803,which was the highest one,and corresponding diagnostic sensitivity and specificity were 85.7%,73.9%,while taking the optimal threshold of 1.125×10~(-3)mm~2/s. Conclusion The values of the ADCstand,ADCslow,ADCfast of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging can be used to differentiate between benign and malignant bone tumors. The diagnostic efficiency of f performs poorly. The ADCstand values afforded a better diagnostic performance than other parameters of such differentiation.
Objective To evaluate the value of intravoxel Incoherent motion diffusion-weighted magnetic resonance imaging(IVIM-DWI) in the differential diagnosis of benign and malignant bone tumors. Methods Forty-four patients with bone tumors confirmed pathologically after surgical resections were collected. According to the result of pathologic diagnosis,patients were divided into benign group(n=21) and malignant group(n=23),IVIM-DWI was performed in addition to routine MRI examination with a 3.0 MRI scanner. Ten b values including 0,10,20,50,100,200,400,800,1200,2000 s/mm~2 were used. GE ADW 4.5 work station was used to calculate the values of the apparent diffusion coefficient(ADCstand),pure diffusion coefficient(ADCslow),pseudodiffusion coefficient(ADCfast),and perfusion fraction(f). Statistical analyses were performed using the SPSS 17.0 software packages. Receiver operating characteristic(ROC) analysis was performed and the areas under the curve(AUC) values obtained were used to compare the diagnostic performances of different parameters. Results ADCstand,ADCslow,ADCfast values for benign group were(1.46±0.39)×10~(-3)mm~2/s,0.71(0.34,1.14)×10~(-3)mm~2/s,4.87(2.93,23.50)×10~(-3)mm~2/s,which higher than those of malignant group[(0.99±0.42)×10~(-3)mm~2/s,0.42(0.29,0.50)×10~(-3)mm~2/s,2.98(2.36,7.40)×10~(-3)mm~2/s ],and the differences were all statistically significant(P<0.05). The f value of benign group was(0.52±0.25),and malignant group was(0.57±0.23),there were no significant differences between the two groups(P=0.449). With ROC curve analysis for each parameter values,the area under the curve(AUC) of ADCstand was 0.803,which was the highest one,and corresponding diagnostic sensitivity and specificity were 85.7%,73.9%,while taking the optimal threshold of 1.125×10~(-3)mm~2/s. Conclusion The values of the ADCstand,ADCslow,ADCfast of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging can be used to differentiate between benign and malignant bone tumors. The diagnostic efficiency of f performs poorly. The ADCstand values afforded a better diagnostic performance than other parameters of such differentiation.
引文
1 Le Bihan D,Breton E,Lallemand D,et al.MR imaging of intravoxel incoherent motions:application to diffusion and perfusion in neurologic disorders[J].Radiology,1986,161:401-407.
2 Klauss M,Mayer P,Maier-Hein K,et al.IVIM-diffusion-MRI for the differentiation of solid benign and malign hypervascular liver lesions-Evaluation with two different MR scanners[J].Eur J Radiol,2016,85:1289-1294.
3 Pesapane F,Patella F,Fumarola EM,et al.Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification[J].Med Oncol,2017,34:35.
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6 Le Bihan D,Breton E,Lallemand D,et al.Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging[J].Radiology,1988,168:497-505.
7 Pang Y,Turkbey B,Bernardo M,et al.Intravoxel incoherent motion MR imaging for prostate cancer:an evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations[J].MagnReson Med,2013,69:553-562.
8 韩帅,王立峰,邵楠楠,等.体素内不一致运动序列评估直肠癌术前病理分级的可行性研究[J].临床放射学杂志,2015,34:1929-1934.
9 Park S,Kwack KS,Chung NS,et al.Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions:initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions[J].Skeletal Radiol,2017,46:675-683.
10 Iima M,Yano K,Kataoka M,et al.Quantitative non-Gaussian diffusion and intravoxelincoherent motion magnetic resonance imaging:differentiation of malignant and benign breast lesions[J].Invest Radiol,2015,50:205-211.
11 Shah R,Stieltjes B,Andrulis M,et al.Intravoxel incoherent motion imaging for assessment of bone marrow infiltration of monoclonal plasma cell diseases[J].Ann Hematol,2013,92:1553-1557.
12 梁玉玉,朱蓉蓉,哈若水.比较双指数与传统单指数模型ADC值对浸润性导管癌诊断效能研究[J].临床放射学杂志,2014,33:1165-1169.
13 徐凌斌,徐雷鸣,董海波,等.骨与软组织肿瘤三维动脉自旋标记成像、体素内非相干运动弥散加权成像与病理组织学的对照研究[J].中华骨科杂志,2014,34:1161-1166.
14 谭慧,陈军,许启仲,等.体素内不相干运动在甲状腺良恶性结节中的诊断价值[J].中国医学影像学杂志,2016,24:166-169,174.
15 Federau C,Meuli R,O'Brien K,et al.Perfusion measurement in brain gliomas with intravoxel incoherent motion MRI[J].AJNR,2014,35:256-262.
16 Sumi M,Van Cauteren M,Sumi T,et al.Salivary gland tumors:use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors[J].Radiology,2012,263:770-777.
17 D?pfert J,Lemke A,Weidner A,et al.Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging[J].MagnReson Imaging,2011,29:1053-1058.
18 陈小溪,吴连明,张晓斐,等.前列腺癌IVIM弥散加权成像与Gleason评分的相关性研究[J].上海交通大学学报(医学版),2014,34:868-872.
19 Yu XP,Wen L,Hou J,et al.Discrimination between Metastatic and NonmetastaticMesorectalLymph Nodes in Rectal Cancer Using IntravoxelIncoherent Motion Diffusion-weighted Magnetic Resonance Imaging[J].Acad Radiol,2016,23:479-485.
2 Klauss M,Mayer P,Maier-Hein K,et al.IVIM-diffusion-MRI for the differentiation of solid benign and malign hypervascular liver lesions-Evaluation with two different MR scanners[J].Eur J Radiol,2016,85:1289-1294.
3 Pesapane F,Patella F,Fumarola EM,et al.Intravoxel Incoherent Motion (IVIM) Diffusion Weighted Imaging (DWI) in the Periferic Prostate Cancer Detection and Stratification[J].Med Oncol,2017,34:35.
4 Federau C,O'Brien K,Meuli R,et al.Measuring brain perfusion with intravoxel incoherent motion (IVIM):initial clinical experience[J].J MagnReson Imaging,2014,39:624-632.
5 Iima M,Le Bihan D.Clinical Intravoxel Incoherent Motion and Diffusion MR Imaging:Past,Present,and Future[J].Radiology,2016,278:13-32.
6 Le Bihan D,Breton E,Lallemand D,et al.Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging[J].Radiology,1988,168:497-505.
7 Pang Y,Turkbey B,Bernardo M,et al.Intravoxel incoherent motion MR imaging for prostate cancer:an evaluation of perfusion fraction and diffusion coefficient derived from different b-value combinations[J].MagnReson Med,2013,69:553-562.
8 韩帅,王立峰,邵楠楠,等.体素内不一致运动序列评估直肠癌术前病理分级的可行性研究[J].临床放射学杂志,2015,34:1929-1934.
9 Park S,Kwack KS,Chung NS,et al.Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions:initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions[J].Skeletal Radiol,2017,46:675-683.
10 Iima M,Yano K,Kataoka M,et al.Quantitative non-Gaussian diffusion and intravoxelincoherent motion magnetic resonance imaging:differentiation of malignant and benign breast lesions[J].Invest Radiol,2015,50:205-211.
11 Shah R,Stieltjes B,Andrulis M,et al.Intravoxel incoherent motion imaging for assessment of bone marrow infiltration of monoclonal plasma cell diseases[J].Ann Hematol,2013,92:1553-1557.
12 梁玉玉,朱蓉蓉,哈若水.比较双指数与传统单指数模型ADC值对浸润性导管癌诊断效能研究[J].临床放射学杂志,2014,33:1165-1169.
13 徐凌斌,徐雷鸣,董海波,等.骨与软组织肿瘤三维动脉自旋标记成像、体素内非相干运动弥散加权成像与病理组织学的对照研究[J].中华骨科杂志,2014,34:1161-1166.
14 谭慧,陈军,许启仲,等.体素内不相干运动在甲状腺良恶性结节中的诊断价值[J].中国医学影像学杂志,2016,24:166-169,174.
15 Federau C,Meuli R,O'Brien K,et al.Perfusion measurement in brain gliomas with intravoxel incoherent motion MRI[J].AJNR,2014,35:256-262.
16 Sumi M,Van Cauteren M,Sumi T,et al.Salivary gland tumors:use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors[J].Radiology,2012,263:770-777.
17 D?pfert J,Lemke A,Weidner A,et al.Investigation of prostate cancer using diffusion-weighted intravoxel incoherent motion imaging[J].MagnReson Imaging,2011,29:1053-1058.
18 陈小溪,吴连明,张晓斐,等.前列腺癌IVIM弥散加权成像与Gleason评分的相关性研究[J].上海交通大学学报(医学版),2014,34:868-872.
19 Yu XP,Wen L,Hou J,et al.Discrimination between Metastatic and NonmetastaticMesorectalLymph Nodes in Rectal Cancer Using IntravoxelIncoherent Motion Diffusion-weighted Magnetic Resonance Imaging[J].Acad Radiol,2016,23:479-485.