肺结节的3T多b值磁共振扩散加权成像鉴别诊断

发布时间：2018-08-15 18:02

【摘要】：目的:探讨利用3.0T磁共振扩散加权成像(DWI)及其表观扩散系数(ADC)值鉴别诊断孤立性肺结节良恶性的效能,并优化b值。方法:收集2012年3月至2014年12月CT检查发现的孤立性肺结节患者71例,并经手术、穿刺活检或临床治疗随访证实。其中良性结节41例,恶性结节30例,全部行3.0T MRI胸部常规T1WI、T2WI和DWI检查,DWI采用附加三维容积匀场技术并减小相位方向视野,b值选择300、600、900和1200s/mm2,测量各b值下肺结节的ADC值,并绘制各b值下ADC值诊断的受试者操作特性(ROC)曲线,得出相关诊断效能,依此获得合理的b值。结果:良恶性肺结节的ADC值均随b值增加而逐渐变小,各组中均显示恶性结节的ADC值显著低于良性结节(t=4.58~6.33,P0.01)。不同b值ROC曲线下面积(AUC)依次为0.800、0.839、0.878及0.873,均有诊断意义(AUC0.5);b=900s/mm2时获得的ADC值诊断效能最大,鉴别良恶性病变的最佳阈值为1.228×10-3mm2/s,其敏感性83.3%,特异性91.2%。结论:3.0T磁共振扩散加权成像对孤立性肺结节的定性诊断有较高价值,b值900s/mm2时的ADC值诊断效能较高。
[Abstract]:Objective: to evaluate the effectiveness of 3.0T diffusion weighted imaging (DWI) and its apparent diffusion coefficient (ADC) in differentiating benign and malignant solitary pulmonary nodules and optimizing b value. Methods: from March 2012 to December 2014, 71 patients with solitary pulmonary nodules were examined by CT and confirmed by operation, puncture biopsy or clinical treatment. There were 41 cases of benign nodules and 30 cases of malignant nodules. All of them were examined with 3.0T MRI chest routine T1WII-T2WI and DWI. The ADC values of pulmonary nodules were measured under each b value by using additional three-dimensional volumetric leveling technique and reducing phase direction visual field to select 300600900 and 1200s / mm2, respectively. The (ROC) curves of the operating characteristics of subjects diagnosed by ADC under each b value were plotted, and the relative diagnostic efficacy was obtained, according to which the reasonable b value was obtained. Results: the ADC values of benign and malignant pulmonary nodules gradually decreased with the increase of b value. The ADC value of malignant nodules was significantly lower than that of benign nodules (t = 4.58 6.33 / P0.01). The area under the ROC curve with different b values was 0.800, 0.839, 0.878 and 0.873.All of them had the highest diagnostic efficacy (AUC0.5). The best threshold for differentiating benign and malignant lesions was 1.228 脳 10 ~ (-3) mm ~ (-2) / s, with a sensitivity of 83.3 and a specificity of 91.2 / mm ~ (2). Conclusion the diffusion-weighted Mr imaging at 3. 0T has a high value in the qualitative diagnosis of solitary pulmonary nodules. The diagnostic efficacy of ADC value is higher when 900s/mm2 is a higher value.
【作者单位】：浙江金华市中心医院影像科;上海交通大学医学院附属新华医院影像科;
【基金】：浙江省金华市科技局重点项目No.2012-3-007~~
【分类号】：R593.9;R445.2

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