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.
引文
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