磁共振DCE和DWI联合评价孤立性肺结节的临床意义

发布时间：2018-03-30 11:16

本文选题：硬币病变　切入点：肺　出处：《中国临床医学影像杂志》2015年08期

【摘要】：目的:研究MRI动态对比增强(DCE)联合扩散加权成像(DWI)对孤立性肺结节(SPN)的鉴别诊断价值。方法:收集SPN患者62例,其中恶性35例,良性27例,全部先行MRI胸部常规T1WI、T2WI和DWI检查,再行DCE检查。在工作站测量SPN在不同b值时的ADC值;根据Schaefer分型标准观察动态增强曲线类型,并计算曲线最大斜率(Steepest slope,SS)和廓清率(Washout ratio,WR)。评价诊断恶性SPN的敏感性、特异性及准确率。结果:良、恶性SPN曲线类型之间差异无显著统计学意义(P0.05);B型曲线在良、恶性SPN之间有重叠,SS在二者间有显著统计学意义(P0.05);以SS2.5%/s作为诊断恶性SPN的依据,DCE诊断恶性SPN的敏感性、特异性、准确率分别为64%、60%、62%。B型曲线类型SPN在b值为800 s/mm2和1 000 s/mm2时,其ADC值差异有显著统计学意义(P0.05),以ADC值1.34×10-3mm2/s作为诊断依据,DCE联合DWI诊断恶性SPN的敏感性、特异性、准确率分别为80%、75%、78%;结论:DCE和DWI对良、恶性SPN的鉴别诊断分别有意义,综合运用DCE和DWI参数能提高恶性SPN的诊断准确率。
[Abstract]:Objective: to study the value of dynamic contrast enhanced MRI combined with diffusion-weighted imaging (DWI) in the differential diagnosis of solitary pulmonary nodules (SPN). Methods: 62 cases of SPN were collected, including 35 malignant cases and 27 benign cases. All patients were examined with MRI chest routine T _ 1W _ I _ T _ 2WI and DWI. The ADC value of SPN at different b values was measured at workstation, the type of dynamic enhancement curve was observed according to Schaefer classification standard, and the maximum slope of curve was calculated. The sensitivity of diagnosis of malignant SPN was evaluated. Results: there was no significant difference between benign and malignant SPN curve types. There was significant statistical significance between malignant SPN and SS in the diagnosis of malignant SPN (P 0.05). The sensitivity, specificity and accuracy of SS2.5%/s for diagnosis of malignant SPN were 64% and 60%, respectively, when the value of b was 800 s/mm2 and 1 000 s/mm2, respectively. The difference of ADC value was significant (P 0.05). The sensitivity, specificity and accuracy of ADC 1.34 脳 10-3mm2/s combined with DWI in the diagnosis of malignant SPN were 800.75 and 780.Conclusion the differential diagnosis of benign and malignant SPN by ADC and DWI is significant, respectively. The diagnostic accuracy of malignant SPN can be improved by using the parameters of DCE and DWI.
【作者单位】：河北省任丘市华北石油总医院;
【分类号】：R563;R445.2

【参考文献】