摘要
目的:以术后组织病理结果为参考标准,确定不同b值下的弥散加权成像(DWI)和表观扩散系数(ADC)在鉴别甲状腺良恶性结节中的诊断作用。方法:收集2017-01-2018-06期间山西省肿瘤医院头颈外科经超声诊断为甲状腺结节的64例患者,共80处结节,均采用飞利浦3.0T超导型磁共振成像系统进行T1加权、T2加权、DWI横轴位扫描成像,b值分别取300、500、800和1 000 s/mm^2。以术后组织病理结果为参考标准,对所有受试者的甲状腺结节ADC值进行计算和比较,并绘制所有b值的受试者工作特征(ROC)曲线,计算曲线下面积,得到区分甲状腺良恶性结节的阈值。结果:共80处结节,排除1例弥漫B细胞非霍奇金淋巴瘤、2例甲状旁腺囊肿、1例纯囊性患者,共纳入76处(33处为恶性、43处为良性)结节。在b值为300、500、800和1 000 s/mm^2时,恶性结节的平均ADC值分别为(1.498±0.210)×10^(-3)mm^2/s、(1.311±0.190)×10^(-3)mm^2/s、(1.134±0.170)×10^(-3)mm^2/s、(0.972±0.150)×10^(-3)mm^2/s;良性结节的平均ADC值分别为(2.207±0.390)×10^(-3)mm^2/s、(1.928±0.430)×10^(-3)mm^2/s、(1.702±0.410)×10^(-3)mm^2/s、(1.557±0.420)×10^(-3)mm^2/s。同一b值下,恶性结节的平均ADC值低于良性结节,差异有统计学意义(t=9.279、7.641、7.301、7.569,P=0.000、0.000、0.000、0.000)。良、恶性结节的平均ADC值,均随着b值升高而降低,差异有统计学意义(良、恶性组的F=210.091、353.822;P=0.000、0.000)。不同b值下ROC曲线下面积分别为0.927、0.884、0.878、0.901,95%CI分别为0.862～0.993、0.804～0.956、0.794～0.962、0.829～0.972。在b值为300 s/mm^2时,曲线下面积最大,说明其是区分甲状腺良恶性结节的最佳指标,区分良恶性结节的诊断阈值为1.802×10^(-3)mm^2/s,特异性、敏感性、准确性、阳性预测值及阴性预测值分别为95.00%、86.11%、90.79%、93.94%及88.37%。结论:DWI是一种无创诊断工具,可用于鉴别良恶性甲状腺结节;可以在�
Objective: To determine the diagnostic role of diffusion-weighted imaging(DWI) and apparent diffusion coefficient(ADC) under different b values in differentiating benign and malignant thyroid nodules by using postoperative histopathological results were taken as the reference standard. Method: From January 2017 to June 2018, 64 patients with thyroid nodules diagnosed by ultrasound in the head and neck surgery of Shanxi Cancer Hospital were collected, and a total of 80 nodules were collected. The Philips 3.0 T superconducting magnetic resonance imaging system was used for T1 weighting, T2 weighting, and DWI horizontal axis scanning imaging. The b values were 300, 500, 800 and 1 000 s/mm2, respectively. Taking postoperative histopathological results as the reference standard, the ADC values of thyroid nodules of all subjects were calculated and compared, and the working characteristics(ROC) curves of all subjects with b values were drawn, the area under the curve was calculated, and the threshold value of differentiating benign and malignant thyroid nodules was obtained. Result: A total of 80 nodules, 33 malignant and 43 benign were excluded, including 1 diffuse b-cell non-hodgkin’s lymphoma, 2 parathyroid cysts, and 1 pure cystic patient. A total of 76 nodules were included. When b values were 300, 500, 800 and 1 000 s/mm2, the average ADC values of malignant nodules were(1.498±0.210) ×10-3mm2/s,(1.311±0.190) ×10-3mm2/s,(1.134±0.170) ×10-3mm2/s,(0.972±0.150) ×10-3mm2/s. The mean ADC values of benign nodules were(2.207±0.390) ×10-3mm2/s,(1.928±0.430) ×10-3mm2/s,(1.702±0.410) ×10-3mm2/s,(1.557±0.420) ×10-3mm2/s. At the same b value, the average ADC value of malignant nodules was lower than that of benign nodules, and the difference was statistically significant(t values were 9.279, 7.641, 7.301, 7.569, P values were 0.000, 0.000, 0.000, 0.000, 0.000). The average ADC values of the benign and malignant nodules decreased with the increase of b value, and the difference was statistically significant(t
作者
李智林
南杰
崔雨田
杜笑松
郝慧超
张剑锋
张茜
高泽慧
LI Zhilin;NAN Jie;CUI Yutian;DU Xiaosong;HAO Huichao;ZHANG Jianfeng;ZHANG Qian;GAO Zehui(Department of Head and Neck Surgery,Shanxi Province Tumor Hospital,Taiyuan,030013,China)
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2019年第4期342-346,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
山西省卫计委科技攻关计划(No:201601065)
关键词
弥散加权成像
表观扩散系数
甲状腺结节
diffusion-weighted imaging
apparent diffusion coefficient
thyroid nodule
