MRI扩散加权成像鉴别兔良恶性淋巴结实验研究
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摘要
目的探讨DWI鉴别良恶性淋巴结的价值。方法 32只健康新西兰大白兔,随机分为两组(每组16只),分别建立良性(16个淋巴结)和恶性淋巴结(16个淋巴结)模型。对所有实验兔均行MRI检查。在淋巴结最大层面上选取感兴趣区,获得淋巴结表观扩散系数(ADClymph node);同时测量同层肌肉的ADC值(ADCmuscle),计算相对ADC(rADC=ADClymph node/ADCmuscle)。采用两独立样本t检验分别比较良、恶性淋巴结ADC值与rADC值的差异;采用受试者工作特征曲线(ROC曲线),分析ADC及rADC定性诊断淋巴结的效能。结果良、恶性淋巴结在DWI均表现为相对高信号。良、恶性淋巴结ADC值分别为(0.92±0.13)×10~(-3)mm~2/s~(-1)和(0.76±0.08)×10~(-3)mm~2/s~(-1);良、恶性淋巴结rADC值分别为0.71±0.05和0.63±0.05,良、恶性组淋巴结的ADC值及rADC值差异均有统计学意义(P均<0.05)。利用ADC值鉴别良、恶性淋巴结的ROC曲线下面积为0.83(最佳阈值为0.84×10~(-3)mm~2/s~(-1)),利用rADC值进行鉴别的ROC曲线下面积为0.88(最佳阈值为0.66),二者比较无统计学意义(P>0.05)。结论 DWI对定性淋巴结病变有一定的价值,且rADC未能改善淋巴结的定性诊断。
Objective To explore the value of diffusion weighted imaging(DWI) in differentiating benign and malignant lymph nodes. Methods Thirty-two healthy new zealand rabbits were randomly divided into benign and malignant groups(16 rabbits per group). The benign(16 lymph nodes) and metastatic lymph node model(malignant group, a total of 16 lymph nodes) were established, respectively. All rabbits underwent the MRI examination. The apparent diffusion coefficients of lymph node(ADClymph node) and of ipsilateral muscle at the same plane(ADCmuscle) were measured. Results ADC(rADC) were obtained as following: rADC=ADC lymph node/ADCmuscle. The ADC and rADC values of benign and malignant lymph nodes were compared by using independent sample t test, and the efficacy of ADC and rADC in qualitative diagnosis of lymph nodes was analyzed by ROC curve. Results both benign and malignant lymph nodes showed the relatively high signal on DWI. The ADC and rADC values between the benign and malignant lymph nodes were statistically significant [(0.92 ± 0.13)×10~(-3) mm/s vs(0.76±0.08)×10~(-3) mm/s; 0.71±0.05 vs 0.63±0.05, respectively, and all P<0.05]. When ADC and rADC were used to differentiate benign and malignant nodes, the area under the receiver operating characteristic curve was 0.82 for ADC(the threshold of 0.84×10~(-3) mm/s) and 0.88 for rADC(the threshold of 0.66), and no significant difference was found between the two methods(P=0.53). Conclusion DWI enables the differentiation of benign from malignant lymph nodes. And rADC do not improve the capacity of ADC for differentiating of benign from malignant lymph nodes.
Objective To explore the value of diffusion weighted imaging(DWI) in differentiating benign and malignant lymph nodes. Methods Thirty-two healthy new zealand rabbits were randomly divided into benign and malignant groups(16 rabbits per group). The benign(16 lymph nodes) and metastatic lymph node model(malignant group, a total of 16 lymph nodes) were established, respectively. All rabbits underwent the MRI examination. The apparent diffusion coefficients of lymph node(ADClymph node) and of ipsilateral muscle at the same plane(ADCmuscle) were measured. Results ADC(rADC) were obtained as following: rADC=ADC lymph node/ADCmuscle. The ADC and rADC values of benign and malignant lymph nodes were compared by using independent sample t test, and the efficacy of ADC and rADC in qualitative diagnosis of lymph nodes was analyzed by ROC curve. Results both benign and malignant lymph nodes showed the relatively high signal on DWI. The ADC and rADC values between the benign and malignant lymph nodes were statistically significant [(0.92 ± 0.13)×10~(-3) mm/s vs(0.76±0.08)×10~(-3) mm/s; 0.71±0.05 vs 0.63±0.05, respectively, and all P<0.05]. When ADC and rADC were used to differentiate benign and malignant nodes, the area under the receiver operating characteristic curve was 0.82 for ADC(the threshold of 0.84×10~(-3) mm/s) and 0.88 for rADC(the threshold of 0.66), and no significant difference was found between the two methods(P=0.53). Conclusion DWI enables the differentiation of benign from malignant lymph nodes. And rADC do not improve the capacity of ADC for differentiating of benign from malignant lymph nodes.
引文
[1] 楚云谦,向映光,牟富丽.多b值磁共振扩散加权成像在颈部淋巴结病变中的应用价值[J].中外医学研究,2015,13(3):44-46.
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[3] 乔辉,刘筠,许亮,等.表观扩散系数值及相对表观扩散系数值对直肠腺癌分化程度的诊断价值[J].中国医学影像学杂志,2013,21(8):611-613.
[4] 汪秀玲,吴笑松.各种影像检查在乳腺癌诊治中的应用[J].中国介入影像与治疗学,2009,6(5):489-493.
[5] Oguz A,Karadeniz C,Temel EA,et al.Evaluation of peripheral lymphadenopathy in children [J].Pediatric Hematology & Oncology,2006,23(7):549-554.
[6] Chen C,Lin Z,Xiao Y,et al.Role of diffusion-weighted imaging in the discrimination of benign and metastatic parotid area lymph nodes in patients with nasopharyngeal carcinoma [J].SciRep,2018,8(1):281-284.
[7] Hasanzadeh F,Faeghi F,Valizadeh A,et al.Diagnostic value of diffusion weighted magnetic resonance imaging in evaluation of metastatic axillary lymph nodes in a sample of iranian women with breast cancer [J].Asian Pacific Journal of Cancer Prevention Apjcp,2017,18(5):1265-1270.
[8] 唐运成,卢瑞沾,赵相胜.DWI和PWI在颈部良恶性淋巴结诊断中的应用[J].中国CT和MRI杂志,2012,10(3):27-29.
[9] 鲁果果,孙聚葆,李新瑜,等.DWI对颈部淋巴结病变良恶性的鉴别诊断价值[J].中国中西医结合影像学杂志,2017,15(3):267-269.
[10] Bai X,Liao Q,Wang JP,et al.Differentiation of axillary inflammatory and metastatic lymph nodes with diffusion-weighted imaging in animal modes [J].Zhonghua Yi Xue Za Zhi,2012,92(9):592-596.
[11] 陈杰,邢伟,生晶,等.相对表观弥散系数鉴别兔良、恶性淋巴结[J].中国医学影像技术,2010,26(10):1819-1822.
[12] 吴冰,刘婧,王霄英.扩散加权成像鉴别兔炎性及转移性淋巴结肿大的实验研究[J].中华放射学杂志,2009,43(7):759-761.
[13] Park S,Kim JK,Park B,et al.Relative apparent diffusion coefficient:determination of reference site and validation of benefit for detecting metastatic lymph nodes in uterine cervical cancer [J].Journal of Magnetic Resonance Imaging,2010,29(2):383-390.
[2] XING Wei,SHENG Jing,CHEN Jie,et al.Relative apparent diffusion coefficient:a promising tool to differentiate metastatic from benign lymph nodes in animal models[J].中华医学杂志(英文版),2011,124(18):2907-2910.
[3] 乔辉,刘筠,许亮,等.表观扩散系数值及相对表观扩散系数值对直肠腺癌分化程度的诊断价值[J].中国医学影像学杂志,2013,21(8):611-613.
[4] 汪秀玲,吴笑松.各种影像检查在乳腺癌诊治中的应用[J].中国介入影像与治疗学,2009,6(5):489-493.
[5] Oguz A,Karadeniz C,Temel EA,et al.Evaluation of peripheral lymphadenopathy in children [J].Pediatric Hematology & Oncology,2006,23(7):549-554.
[6] Chen C,Lin Z,Xiao Y,et al.Role of diffusion-weighted imaging in the discrimination of benign and metastatic parotid area lymph nodes in patients with nasopharyngeal carcinoma [J].SciRep,2018,8(1):281-284.
[7] Hasanzadeh F,Faeghi F,Valizadeh A,et al.Diagnostic value of diffusion weighted magnetic resonance imaging in evaluation of metastatic axillary lymph nodes in a sample of iranian women with breast cancer [J].Asian Pacific Journal of Cancer Prevention Apjcp,2017,18(5):1265-1270.
[8] 唐运成,卢瑞沾,赵相胜.DWI和PWI在颈部良恶性淋巴结诊断中的应用[J].中国CT和MRI杂志,2012,10(3):27-29.
[9] 鲁果果,孙聚葆,李新瑜,等.DWI对颈部淋巴结病变良恶性的鉴别诊断价值[J].中国中西医结合影像学杂志,2017,15(3):267-269.
[10] Bai X,Liao Q,Wang JP,et al.Differentiation of axillary inflammatory and metastatic lymph nodes with diffusion-weighted imaging in animal modes [J].Zhonghua Yi Xue Za Zhi,2012,92(9):592-596.
[11] 陈杰,邢伟,生晶,等.相对表观弥散系数鉴别兔良、恶性淋巴结[J].中国医学影像技术,2010,26(10):1819-1822.
[12] 吴冰,刘婧,王霄英.扩散加权成像鉴别兔炎性及转移性淋巴结肿大的实验研究[J].中华放射学杂志,2009,43(7):759-761.
[13] Park S,Kim JK,Park B,et al.Relative apparent diffusion coefficient:determination of reference site and validation of benefit for detecting metastatic lymph nodes in uterine cervical cancer [J].Journal of Magnetic Resonance Imaging,2010,29(2):383-390.