3.0 T MRI动态增强对腮腺肿瘤良恶性的鉴别及其ADC值与病理分级的相关性研究
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摘要
目的探讨3.0 T动态增强磁共振成像(DCE-MRI)半定量、定量分析对腮腺肿瘤良恶性的鉴别及其表观扩散系数(ADC)值与病理分级的相关性。方法回顾性分析2017年5月至2018年5月广东医科大学附属医院收治的腮腺肿瘤患者56例(共计74个肿块),对所有患者的MRI以及扩散加权成像(DWI)资料进行整合。对各肿块的ADC值、时间信号强度曲线(TIC)类型以及定量参数值进行统计分析,并通过受试者工作特征(ROC)曲线来计算诊断恶性肿瘤的各参数阈值,从而总结3.0 T DCE-MRI对腮腺肿瘤良恶性鉴别的异同点。结果良性肿瘤中的多形性腺瘤中86.67%(13/15)呈A型曲线,13.23%(2/15)呈C型曲线;腺淋巴瘤中有73.07%(19/26)呈B型曲线,另26.93%(7/26)呈C型曲线。恶性肿瘤中90.00%(9/10)呈C型曲线,10.00%(1/10)呈B型曲线。对良恶性腮腺肿瘤的TIC类型行χ~2检验,P<0.05。选择TIC C型作为恶性肿瘤的诊断标准,其敏感度、特异度、准确度分别为76%、90%、78%。将多形性腺瘤、腺淋巴瘤、恶性肿瘤的ADC进行计算,分别为(1.467±0.920)×10~(-3)mm~2/s、(0.764±1.175)×10~(-3)mm~2/s、(1.081±0.097)×10~(-3)mm~2/s,行Kruskal-Wallis检验与χ~2检验,P<0.05。恶性肿瘤、多形性腺癌、腺淋巴瘤以及其他良性肿瘤行χ~2检验,结果发现,速率常数(K_(ep))值与血管外细胞外容积分数(Ve)值在各类肿瘤间差异具有统计学意义(P<0.05)。结论 3.0 T DCE-MRI对腮腺肿瘤良恶性的鉴别有着较高的临床价值,且可以根据ADC值对恶性肿瘤与多形性腺瘤、腺淋巴瘤进行鉴别诊断,因此应在临床上进一步推广应用。
Objective To investigate the differential diagnosis and differential analysis of 3.0 T MRI dynamic enhancement(DCE-MRI) for the differential diagnosis of benign and malignant tumors and the correlation between ADC value and pathological grade.Methods A retrospective analysis of 56 patients with a tumor of the parotid gland admitted to the Affiliated Hospital of Guangdong Medical University from May 2017 to May 2018(a total of 74 tumors) was performed.All patients were integrated with MRI and DWI data.The ADC value,time-signal intensity curve(TIC) type and quantitative parameter value of each tumor were statistically analyzed,and the threshold value of each parameter for diagnosis of malignant tumor was calculated by ROC curve,and the 3.0 T MRI dynamic enhancement was used to improve the benign and malignant tumors of the parotid gland.Identification of similarities and differences.Results 86.67%(13/15) of the pleomorphic adenomas in benign tumors showed a type A curve,13.23%(2/15) showed a C-shaped curve,and 73.07%(19/26) showed a B-shaped curve in adenolymphoma.Another 26.93%(7/26) showed a C-shaped curve.90.00%(9/10) of malignant tumors showed a C-shaped curve,and 10.00%(1/10) showed a B-shaped curve.The TIC type of benign and malignant salivary gland tumors was examined by χ~2 test,P<0.05.The TIC C type was selected as the diagnostic criteria for malignant tumors,and its sensitivity,specificity,and accuracy were 76%,90%,and 78%,respectively.The ADCs of pleomorphic adenomas,adenomas,and malignant tumors were calculated as(1.467 ± 0.920) × 10~(-3)mm~2/s,(0.764±1.175)×10~(-3)mm~2/s,(1.081±,respectively).0.097)×10~(-3)mm~2/s,Kruskal-Wallis test and χ~2 test,P<0.05.Malignant tumors,pleomorphic adenocarcinoma,adenolymphoma and other benign tumors were examined by χ~2 test.The results showed that the difference between Kepvalue and Vevalue was statistically significant(P<0.05).Conclusion The dynamic enhancement of 3.0 T MRI has a high clinical value in the differential diagnosis of benign and malignant tumors.It can be used for the differential diagnosis of malignant tumors and pleomorphic adenomas and adenolymphomas according to ADC values.Therefore,it should be further promoted and applied in clinical practice.
Objective To investigate the differential diagnosis and differential analysis of 3.0 T MRI dynamic enhancement(DCE-MRI) for the differential diagnosis of benign and malignant tumors and the correlation between ADC value and pathological grade.Methods A retrospective analysis of 56 patients with a tumor of the parotid gland admitted to the Affiliated Hospital of Guangdong Medical University from May 2017 to May 2018(a total of 74 tumors) was performed.All patients were integrated with MRI and DWI data.The ADC value,time-signal intensity curve(TIC) type and quantitative parameter value of each tumor were statistically analyzed,and the threshold value of each parameter for diagnosis of malignant tumor was calculated by ROC curve,and the 3.0 T MRI dynamic enhancement was used to improve the benign and malignant tumors of the parotid gland.Identification of similarities and differences.Results 86.67%(13/15) of the pleomorphic adenomas in benign tumors showed a type A curve,13.23%(2/15) showed a C-shaped curve,and 73.07%(19/26) showed a B-shaped curve in adenolymphoma.Another 26.93%(7/26) showed a C-shaped curve.90.00%(9/10) of malignant tumors showed a C-shaped curve,and 10.00%(1/10) showed a B-shaped curve.The TIC type of benign and malignant salivary gland tumors was examined by χ~2 test,P<0.05.The TIC C type was selected as the diagnostic criteria for malignant tumors,and its sensitivity,specificity,and accuracy were 76%,90%,and 78%,respectively.The ADCs of pleomorphic adenomas,adenomas,and malignant tumors were calculated as(1.467 ± 0.920) × 10~(-3)mm~2/s,(0.764±1.175)×10~(-3)mm~2/s,(1.081±,respectively).0.097)×10~(-3)mm~2/s,Kruskal-Wallis test and χ~2 test,P<0.05.Malignant tumors,pleomorphic adenocarcinoma,adenolymphoma and other benign tumors were examined by χ~2 test.The results showed that the difference between Kepvalue and Vevalue was statistically significant(P<0.05).Conclusion The dynamic enhancement of 3.0 T MRI has a high clinical value in the differential diagnosis of benign and malignant tumors.It can be used for the differential diagnosis of malignant tumors and pleomorphic adenomas and adenolymphomas according to ADC values.Therefore,it should be further promoted and applied in clinical practice.
引文
1童娟,胡春洪,王小林,等.扩散加权联合动态对比增强磁共振成像鉴别诊断腮腺良恶性肿瘤[J].中国医学影像技术,2017,33:1197-1201.
2李大海,栗建辉,史建洁.声触诊组织量化鉴别腮腺良恶性结节的价值[J].中华超声影像学杂志,2016,25:265-266.
3杨静,孙聚葆,詹浩辉.腮腺单发肿块的MRI诊断[J].中国医学影像学杂志,2016,24:170-174.
4李磊,李冉,刘江,等.三种自噬调控蛋白在腮腺良、恶性多形性腺瘤中的表达及意义[J].解剖学杂志,2016,39:549-552.
5 Sagiv D,Witt RL,Glikson E,et al.Warthin tumor within the superficial lobe of the parotid gland:a suggested criterion for diagnosis[J].Eur Arch Otorhinolaryngol,2017,274:1993-1996.
6俞顺,包强,苏家威.磁共振扩散峰度成像对腮腺肿瘤的鉴别诊断价值[J].放射学实践,2017,32:821-826.
7童国勇,余周庆,戈春城.彩超引导下的粗针穿刺活检术在腮腺肿瘤诊断中的应用[J].口腔医学研究,2017,33:336-338.
8 SkálováA,Vanecek T,Simpson RH,et al.Mammary Analogue Secretory Carcinoma of Salivary Glands:Molecular Analysis of 25 ETV6Gene Rearranged Tumors With Lack of Detection of Classical ETV6-NTRK3 Fusion Transcript by Standard RT-PCR:Report of 4 Cases Harboring ETV6-X Gene Fusion[J].Am J Surg Pathol,2016,40:3-13.
9申洋,周延,何为,等.基于IVIM模型的扩散加权成像和动态增强核磁共振在卵巢肿瘤良恶性鉴别中的应用价值[J].临床放射学杂志,2016,35:410-414.
10史昭菲,刘绪忠,柏根基.磁共振动态增强扫描定量分析方法评价肺部肿块良恶性初步研究[J].中国临床医学影像杂志,2017,28:475-479.
11景国东,金爱国,吴骋,等.前列腺癌、增生结节及外周带非癌组织在3.0T MR动态增强灌注成像中的强化表现[J].放射学实践,2016,31:756-759.
12赵莲萍,高鹏,张文文,等.3.0T多参数MRI对前列腺良恶性病变的诊断价值[J].中国医学影像学杂志,2016,24:778-782,784.
13司丽芳,刘小娟,杨开颜,等.3.0T磁共振扩散张量成像对乳腺肿块性病变的鉴别诊断价值[J].中华医学杂志,2016,96:1510-1514.
14魏乐群,陈殿森,孙聚葆,等.MR体素内不相干运动成像对乳腺良恶性病变的鉴别诊断价值[J].中国医学影像学杂志,2016,24:906-908.
15 Gudmundsson JK,Ajan A,Abtahi J.The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses:a clinicopathological study of 114 patients[J].J Appl Oral Sci,2016,24:561-567.
16胡小华,黄桂林,易杰,等.功能性腮腺切除术治疗腮腺深叶良性肿瘤[J].实用口腔医学杂志,2016,32:402-405.
17 Lewis AG,Tong T,Maghami E.Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland[J].Otolaryngol Clin North Am,2016,49:343-380.
18于金芬,王祥生,曹广亮,等.磁共振弥散峰度成像在腮腺肿瘤诊断与鉴别诊断的临床价值[J].中国医学装备,2017,14:62-66.
19 Fonseca FP,Sena Filho M,Altemani A,et al.Molecular signature of salivary gland tumors:potential use as diagnostic and prognostic marker[J].J Oral Pathol Med,2016,45:101-110.
20李磊,李冉,刘江,等.自噬调控因子m TOR和Beclin1在良恶性多形性腺瘤中的表达及意义[J].重庆医学,2017,46:5083-5085.
2李大海,栗建辉,史建洁.声触诊组织量化鉴别腮腺良恶性结节的价值[J].中华超声影像学杂志,2016,25:265-266.
3杨静,孙聚葆,詹浩辉.腮腺单发肿块的MRI诊断[J].中国医学影像学杂志,2016,24:170-174.
4李磊,李冉,刘江,等.三种自噬调控蛋白在腮腺良、恶性多形性腺瘤中的表达及意义[J].解剖学杂志,2016,39:549-552.
5 Sagiv D,Witt RL,Glikson E,et al.Warthin tumor within the superficial lobe of the parotid gland:a suggested criterion for diagnosis[J].Eur Arch Otorhinolaryngol,2017,274:1993-1996.
6俞顺,包强,苏家威.磁共振扩散峰度成像对腮腺肿瘤的鉴别诊断价值[J].放射学实践,2017,32:821-826.
7童国勇,余周庆,戈春城.彩超引导下的粗针穿刺活检术在腮腺肿瘤诊断中的应用[J].口腔医学研究,2017,33:336-338.
8 SkálováA,Vanecek T,Simpson RH,et al.Mammary Analogue Secretory Carcinoma of Salivary Glands:Molecular Analysis of 25 ETV6Gene Rearranged Tumors With Lack of Detection of Classical ETV6-NTRK3 Fusion Transcript by Standard RT-PCR:Report of 4 Cases Harboring ETV6-X Gene Fusion[J].Am J Surg Pathol,2016,40:3-13.
9申洋,周延,何为,等.基于IVIM模型的扩散加权成像和动态增强核磁共振在卵巢肿瘤良恶性鉴别中的应用价值[J].临床放射学杂志,2016,35:410-414.
10史昭菲,刘绪忠,柏根基.磁共振动态增强扫描定量分析方法评价肺部肿块良恶性初步研究[J].中国临床医学影像杂志,2017,28:475-479.
11景国东,金爱国,吴骋,等.前列腺癌、增生结节及外周带非癌组织在3.0T MR动态增强灌注成像中的强化表现[J].放射学实践,2016,31:756-759.
12赵莲萍,高鹏,张文文,等.3.0T多参数MRI对前列腺良恶性病变的诊断价值[J].中国医学影像学杂志,2016,24:778-782,784.
13司丽芳,刘小娟,杨开颜,等.3.0T磁共振扩散张量成像对乳腺肿块性病变的鉴别诊断价值[J].中华医学杂志,2016,96:1510-1514.
14魏乐群,陈殿森,孙聚葆,等.MR体素内不相干运动成像对乳腺良恶性病变的鉴别诊断价值[J].中国医学影像学杂志,2016,24:906-908.
15 Gudmundsson JK,Ajan A,Abtahi J.The accuracy of fine-needle aspiration cytology for diagnosis of parotid gland masses:a clinicopathological study of 114 patients[J].J Appl Oral Sci,2016,24:561-567.
16胡小华,黄桂林,易杰,等.功能性腮腺切除术治疗腮腺深叶良性肿瘤[J].实用口腔医学杂志,2016,32:402-405.
17 Lewis AG,Tong T,Maghami E.Diagnosis and Management of Malignant Salivary Gland Tumors of the Parotid Gland[J].Otolaryngol Clin North Am,2016,49:343-380.
18于金芬,王祥生,曹广亮,等.磁共振弥散峰度成像在腮腺肿瘤诊断与鉴别诊断的临床价值[J].中国医学装备,2017,14:62-66.
19 Fonseca FP,Sena Filho M,Altemani A,et al.Molecular signature of salivary gland tumors:potential use as diagnostic and prognostic marker[J].J Oral Pathol Med,2016,45:101-110.
20李磊,李冉,刘江,等.自噬调控因子m TOR和Beclin1在良恶性多形性腺瘤中的表达及意义[J].重庆医学,2017,46:5083-5085.