摘要
目的探讨1.5T磁共振(MR)多b值扩散加权成像(DWI)在鼻咽癌(NPC)颈部小淋巴结转移瘤中的应用价值,寻找鼻咽癌颈部小淋巴结的表观扩散系数(ADC)的诊断阈值。方法对37例经病理证实NPC及20例良性淋巴结肿大患者进行MR常规平扫、增强及多b值DWI(b=400、600、800、1000s/mm^2)检查,测量不同b值下的NPC原发灶、颈部转移性大淋巴结、转移性小淋巴结及良性淋巴结的ADC值,运用SPSS17.0统计软件包对所测数据进行统计学分析,采用受试者工作特征曲线(receiver operating characteristic,ROC)确定不同b值下鼻咽癌颈部小淋巴结转移瘤的ADC诊断阈值及其诊断效能。结果 NPC原发灶与颈部转移性大淋巴结、转移性小淋巴结及良性淋巴结的ADC值随着b值增大呈下降趋势;不同b值下NPC原发灶、颈部转移性大淋巴结与转移性小淋巴结ADC值差异无显著性(P>0.05),良性淋巴结与颈部转移性大淋巴结、转移性小淋巴结ADC值差异有显著性(P<0.05);b=800s/mm^2时对良恶性淋巴结的鉴别能力最强,截断值为0.945×10^(-3)mm^2/s时,其曲线面积为0.923,诊断敏感性及特异性分别为100%、85.4%。结论 1.5T磁共振DWI技术能有效鉴别淋巴结性质,b值取800s/mm^2时对良恶性淋巴结的鉴别能力最佳,可在临床鼻咽癌颈部小淋巴结转移的诊断中推广应用。
Objective To explore the application value of 1.5 Tesla MR multi b-value diffusion weighted imaging（DWI）for small metastatic cervical lymphy nodes of nasopharyngeal carcinoma（NPC）, and to explore the optimal diagnostic threshold value of apparent diffusion coefficient（ADC） in small metastatic cervical lymph nodes of NPC. Method 37 patients with NPC confirmed by pathological biopsy and 20 cases with benign cervical lymphadenopathy underwent conventional MR plain,MR enhanced and DWI with multi b-value（b=400、600、800、1000 s/mm^2,respectively）. The mean ADC value of each b-value were measured for NPC primary lesions,big metastatic cervical lymphy nodes group,small metastatic cervical lymphy nodes group and benign lymph nodes group. SSPS 17.0 statistics software was used for statistical analysis.The receiver operating characteristic（ROC） curve was performed to obtain the ADC threshold value of small metastatic cervical lymphy nodes and diagnostic efficacy at different b-value. Result The ADC value of NPC primary lesions, big/small metastatic cervical lymphy nodes group and benign lymph nodes group decreased with the increase b-value. There was no significant difference in ADC value among NPC,big metastatic lymphy nodes group and small metastatic lymphy nodes group（P〉0. 05）. There was significant difference in ADC value among benign lymph nodes group,big metastatic lymphy nodes group and small metastatic cervical lymphy nodes group（P〉0.05）. When b = 800 s/mm^2. it has the best diagnostic performance,then the diagnostic threshold value of ADC was 0.945×10^（-3）mm2/s,the AUC was about 0.923,and the sensitivity and specificity were respectively 100% and 85.4%. Conclusion 1.5 T MR DWI can effectively identify the nature of lymph nodes. The optimal b-value is 800 s/mm2. DWI is helpful in diagnosis of small metastatic cervical lymphy nodes of NPC.
作者
黄锦钊
袁国奇
刘海明
陈肇平
叶敬志
王航
伍明
HUANG Jin-zhao;YUAN Guo-qi;LIU Hai-ming;CHEN Zhao-ping;YE Jing-zhi;WANG Hang;WU Ming(Depart- ment Radiology, Zhongshan Chen Xing-hai Hospital, the Affiliated Hospital of Guangdong Medical University, Zhongshan 528415, China)
出处
《中国临床医生杂志》
2018年第6期651-655,共5页
Chinese Journal For Clinicians
基金
广东省中山市科技局科研立项(2016B1104)
关键词
鼻咽癌
颈部淋巴结
磁共振扩散加权成像
表观扩散系数
Nasopharyngeal carcinoma
Cervical lymphy node
Diffusion weighted imaging
Apparent diffusion coefficient
