磁共振DWI对肺内孤立性病变鉴别诊断价值
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摘要
目的评价MRI扩散加权成像(DWI)对肺内孤立性病变的鉴别诊断价值。方法搜集经手术、活检或临床治疗随访后证实的56例肺内孤立性病变患者,其中恶性35例,良性21例,行MRI胸部常规T_1WI、T_2WI和DWI检查,b值选择300,500,800和1000 s/mm~2。分别测量不同b值时的表观扩散系数(ADC)和病变脊髓比值(LSR)。计算不同b值时受试者工作特征(ROC)曲线下ADC和LSR面积。结果良、恶性肺内孤立性病变在b值300～800 s/mm~2时,其ADC值有统计学意义(t=2.07,P_(300)=0.04<0.05;t=4.68,P_(500)=0.000;t=3.32,P_(800)=0.03<0.05);ROC曲线下面积分别为0.72、0.88、0.66、0.54。而b值在300～1000 s/mm~2时,其LSR值均有统计学意义(P_(300～1000)<0.001),ROC曲线下面积分别为0.98、0.93、0.92、0.93。结论 DWI的ADC和LSR值可以实现良、恶性肺内孤立性病变定量分析;LSR值的鉴别诊断效能优于ADC值,更有实用性。
Objective To evaluate the value of diffusion-weighted imaging(DWI) for distinguishing solitary pulmonary lesions by magnetic resonance imaging. Methods 56 patients with solitary pulmonary lesions(malignant in 35 and benign in 21) who were confirmed by operation,biopsy and clinical follow up after treatment, underwent routine chest T_1WI,T_2WI and DWI. The b values were chosen as 300,500,800 and 1000 s/mm~2. and the corresponding apparent diffusion coefficient(ADC) and lesion-to-spinal cord ratio(LSR) were respectively measured. The area of ADC and LSR were calculated under Receiver operating characteristics(ROC) curve at different b values. Results The ADC value between benign and malignant pulmonary lesions was statistically significant with b values from 300 to 800 s/mm2(t=2.07,P_(300)=0.04<0.05;t=4.68,P_(500)=0.000;t=3.32,P_(800)=0.03<0.05),the area under ROC curve was 0.72、0.88、0.66 and 0.54 respectively,meanwhile the LSR value was all statistically significant with b values from 300 to 1000 s/mm~2(P_(300-1000)<0.001))and the area under ROC curve was 0.98、0.93、0.92 and 0.93 respectively. Conclusion The ADC and LSR value of DWI can be used for quantitative analysis in benign and malignant solitary pulmonary lesions; the differential diagnostic efficiency of LSR value is superior to ADC value and more practical.
Objective To evaluate the value of diffusion-weighted imaging(DWI) for distinguishing solitary pulmonary lesions by magnetic resonance imaging. Methods 56 patients with solitary pulmonary lesions(malignant in 35 and benign in 21) who were confirmed by operation,biopsy and clinical follow up after treatment, underwent routine chest T_1WI,T_2WI and DWI. The b values were chosen as 300,500,800 and 1000 s/mm~2. and the corresponding apparent diffusion coefficient(ADC) and lesion-to-spinal cord ratio(LSR) were respectively measured. The area of ADC and LSR were calculated under Receiver operating characteristics(ROC) curve at different b values. Results The ADC value between benign and malignant pulmonary lesions was statistically significant with b values from 300 to 800 s/mm2(t=2.07,P_(300)=0.04<0.05;t=4.68,P_(500)=0.000;t=3.32,P_(800)=0.03<0.05),the area under ROC curve was 0.72、0.88、0.66 and 0.54 respectively,meanwhile the LSR value was all statistically significant with b values from 300 to 1000 s/mm~2(P_(300-1000)<0.001))and the area under ROC curve was 0.98、0.93、0.92 and 0.93 respectively. Conclusion The ADC and LSR value of DWI can be used for quantitative analysis in benign and malignant solitary pulmonary lesions; the differential diagnostic efficiency of LSR value is superior to ADC value and more practical.
引文
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6 刘成平,汤砺,何茂.动态CT增强扫描对良恶性孤立性肺结节(SPN)的诊断价值研究[J].中国CT和MRI杂志,2016,14:58-60.
7 库雷志,马明平,俞顺,等.扩散加权成像表观扩散系数值在不同类型肺癌鉴别中的价值[J].中国医学影像学杂志,2016,24:459-463.
8 Regier M,Schwarz D,Henes FO,et al.Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla:intra individual comparison with multi detector computed tomography[J].Med Imaging Radiat Oncol,2011,55:266-274.
9 朱婵,俞同福.快速反转恢复序列和多b值DWI序列鉴别肺结节的良恶性[J].实用放射学杂志,2014,30:751-754.
10 Wu LM,Xu JR,Hua J,et al.Can diffusion-weighted imaging be used as a reliable sequence in the detection of malignant pulmonary nodules and masses?[J].Magn Reson Imaging,2013,31:235-246.
11 Koyamaa H,Ohnobc Y,Sekia S,et al.Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules[J].European Journal of Radiology.2015,84:509-515.
12 Concatto NH,Watte G,Marchiori E,et al.Magnetic resonance imaging of pulmonary nodules:accuracy in a granulomatous disease-endemic region[J].Eur Radiol,2016,26:2915-2920.
13 任进军,赵宝宏,訾学荣,等.磁共振DWI鉴别实性孤立性肺结节价值研究[J].实用放射学杂志,2015,31:925-928.
14 周舒畅,夏黎明,吴维,等.单b值磁共振DWI对肺部良恶性病变的诊断价值[J].放射学实践,2016,31:728-733.
2 Gümü?ta? S,Inan N,Akansel G,et al.Differentiation of malignant and benign lung lesions with diffusion-weighted MR imaging[J].Radiol oncol,2012,46:106-113.
3 蒋洁智,李卓琳,李鹍,等.1.5T MR肺癌DWI优化b值的初步研究[J].实用放射学杂志,2014,30:664-666.
4 潘江峰,应明亮,李惠民,等.肺结节的3T多b值磁共振扩散加权成像鉴别诊断[J].中国医学计算机成像杂志,2015,21:533-537.
5 左玉强,冯平勇,孟庆春,等.肺纯磨玻璃结节微浸润腺癌与浸润性腺癌的CT鉴别诊断[J].临床放射学杂志,2017,36:495-498.
6 刘成平,汤砺,何茂.动态CT增强扫描对良恶性孤立性肺结节(SPN)的诊断价值研究[J].中国CT和MRI杂志,2016,14:58-60.
7 库雷志,马明平,俞顺,等.扩散加权成像表观扩散系数值在不同类型肺癌鉴别中的价值[J].中国医学影像学杂志,2016,24:459-463.
8 Regier M,Schwarz D,Henes FO,et al.Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla:intra individual comparison with multi detector computed tomography[J].Med Imaging Radiat Oncol,2011,55:266-274.
9 朱婵,俞同福.快速反转恢复序列和多b值DWI序列鉴别肺结节的良恶性[J].实用放射学杂志,2014,30:751-754.
10 Wu LM,Xu JR,Hua J,et al.Can diffusion-weighted imaging be used as a reliable sequence in the detection of malignant pulmonary nodules and masses?[J].Magn Reson Imaging,2013,31:235-246.
11 Koyamaa H,Ohnobc Y,Sekia S,et al.Value of diffusion-weighted MR imaging using various parameters for assessment and characterization of solitary pulmonary nodules[J].European Journal of Radiology.2015,84:509-515.
12 Concatto NH,Watte G,Marchiori E,et al.Magnetic resonance imaging of pulmonary nodules:accuracy in a granulomatous disease-endemic region[J].Eur Radiol,2016,26:2915-2920.
13 任进军,赵宝宏,訾学荣,等.磁共振DWI鉴别实性孤立性肺结节价值研究[J].实用放射学杂志,2015,31:925-928.
14 周舒畅,夏黎明,吴维,等.单b值磁共振DWI对肺部良恶性病变的诊断价值[J].放射学实践,2016,31:728-733.