DWI对颈部淋巴瘤与鳞癌颈部淋巴结转移鉴别价值的初步研究

发布时间：2018-06-05 11:11

本文选题：扩散加权成像 + 颈部　；参考：《山西医科大学》2013年硕士论文

【摘要】：研究背景及目的磁共振扩散加权成像(diffusion-weightedimaging，DWI)是近年来核磁检查一项新技术，是目前唯一一种观察活体组织中水分子扩散运动的成像方法，其宏观表现用表观扩散系数(apparentdiffusioncoefficient，ADC)表示。目前已成为脑缺血、脑梗死超急性期诊断的常规序列。肿瘤病变的组织学类型、细胞密实程度、分化程度及肿瘤病理分型与ADC值有很高的相关性，使根据ADC值进行定性诊断及鉴别诊断成为可能。本研究重点探讨ADC值对颈部淋巴瘤与鳞癌淋巴结转移瘤二者之间的鉴别价值；对不同b值，计算ROC曲线下面积，并选取最佳ADC值对二者鉴别有较高的敏感性和特异性。材料和方法收集我院2012年10月至2013年2月初诊的颈部淋巴瘤及鳞癌淋巴结转移瘤患者，男性35例，女性16例，年龄4-79岁，平均年龄50岁。其中淋巴瘤27例，包括20例非霍奇金淋巴瘤、7例霍奇金淋巴瘤；颈部鳞癌淋巴结转移瘤24例。均经淋巴结穿刺活检或术后病理证实。使用荷兰飞利浦公司生产的飞利浦Achieva3.0TTX多源发射磁共振成像系统，使用SENSE-NV-16通道头颈联合线圈，除常规头颈部扫描外，DWI扫描使用单次激发自旋回波平面回波成像(Singleshot-EchoPlanarImagingSE-EPI)技术，扫描层厚、层间距及范围均与轴位T1WI及T2WI相同，以便于能对颈部淋巴结位置进行准确判断。在X、Y、Z轴三个方向上施加敏感梯度脉冲，分别取0、600s/mm2、800s/mm2、1000s/mm2四组b值，得到不同b值下淋巴结病变DWI图像及ADC图像，分别测得各个b值下淋巴结病变的ADC值。计量资料以均数±标准差（x±S），组间比较采用两样本t检验，P0.05认为差别有统计学意义。结果b值为600s/mm2时，淋巴瘤与转移瘤ADC值分别为0.75±0.14×10-3mm2/s和1.12±0.12×10~(-3)mm~2/s，b值为800s/mm2时，淋巴瘤与转移瘤ADC值分别为0.68±0.11×10-3mm2/s和1.02±0.13×10-3mm2/s，，b值为1000s/mm2时，淋巴瘤和转移瘤ADC值分别为0.64±0.10×10-3mm2/s和0.96±0.13×10-3mm2/s，在各个b值下，颈部淋巴瘤和鳞癌颈部淋巴结转移瘤之间的ADC值差异均有统计学意义（P0.05）。在不同b值下，淋巴瘤在b值取800s/mm2和1000s/mm2时二者之间差别无统计学意义（P0.05），余各组间差别有统计学意义（P0.05）；转移瘤在b值取800s/mm2和1000s/mm2时二者之间差别无统计学意义（P0.05），余各组间差别有统计学意义（P0.05）。通过ROC曲线分析，不同b值下，淋巴瘤与鳞癌颈部淋巴结转移瘤的ADC值均可以对二者进行鉴别，且在b值为1000s/mm2时曲线下面积最大，诊断效能最高，此时ADC诊断最佳阈值为0.741×10-3mm2/s。结论对颈部淋巴瘤和鳞癌颈部淋巴结转移瘤可通过ADC值的测定进行鉴别。
[Abstract]:Background and objective Diffusion-weighted imaging (DWI) is a new technique for nuclear magnetic examination in recent years. It is the only imaging method for observing the diffusion motion of water molecules in living tissues, and its macroscopic manifestations are expressed by the apparent diffusion coefficient apparentdiffusion-diffusion coefficient (ADCA). At present, it has become a routine sequence for the diagnosis of cerebral ischemia and cerebral infarction. The histological type, cell density, differentiation degree and pathological type of tumor were highly correlated with ADC value, which made it possible to make qualitative diagnosis and differential diagnosis according to ADC value. This study focused on the value of ADC value in the differential diagnosis between cervical lymphoma and squamous cell carcinoma lymph node metastasis, and calculated the area under ROC curve for different b values, and selected the best ADC value to distinguish them with high sensitivity and specificity. Materials and methods from October 2012 to February 2013, 35 patients with cervical lymphoma and squamous cell carcinoma with lymph node metastasis were collected, including 35 males and 16 females, aged 4-79 years, with an average age of 50 years. There were 27 cases of lymphoma including 20 cases of non-Hodgkin's lymphoma 7 cases of Hodgkin's lymphoma and 24 cases of cervical squamous cell carcinoma lymph node metastasis. All cases were confirmed by lymph node biopsy or postoperative pathology. Using Philips Achieva3.0TTX multi-source emission magnetic resonance imaging system produced by Philips Company in the Netherlands, using SENSE-NV-16 channel head and neck coils, using single excitation spin echo plane echo imaging Singleshot-Echo Planar ImagingSE-EPI technique, scanning slice thickness, in addition to routine head and neck scanning. The interlaminar spacing and range are the same as axial T1WI and T2WI so as to accurately judge the location of cervical lymph nodes. The sensitive gradient pulse was applied in three directions of the X _ (Y) Z axis. Four groups of b values (0.600 s / mm ~ (2) 2800s / mm ~ (2) and 1000s / mm ~ (2) were taken respectively. The DWI images and ADC images of lymph node lesions were obtained under different b values, and the ADC values of lymph node lesions under each b value were measured respectively. The mean 卤standard deviation was used as the measurement data, and the difference was statistically significant by using two samples t test (P0.05). Results when b value was 600s/mm2, the ADC value of lymphoma and metastatic tumor was 0.75 卤0.14 脳 10-3mm2/s and 1.12 卤0.12 脳 10 ~ (-1) 脳 10 ~ (-3) mm ~ (-2) 800s/mm2, respectively. When the ADC value of lymphoma and metastatic tumor was 0.68 卤0.11 脳 10-3mm2/s and 1.02 卤0.13 脳 10 ~ (-3) mm ~ (2) 路s ~ (sb) respectively, the ADC value of lymphoma and metastatic tumor was 0.64 卤0.10 脳 10-3mm2/s and 0.96 卤0.13 脳 10 ~ (-3) mm ~ (-2) s, respectively. Under each b value, the ADC value of lymphoma and metastatic tumor was 0.64 卤0.10 脳 10-3mm2/s and 0.96 卤0.13 脳 10 ~ (-3) mm ~ (-2) / s, respectively. There were significant differences in ADC between cervical lymphomas and squamous cell carcinomas (P 0.05). At different b values, There was no significant difference between 800s/mm2 and 1000s/mm2 when b value was taken from lymphoma, but there was significant difference between other groups (P 0.05), but there was no significant difference between 800s/mm2 and 1000s/mm2 in metastatic tumor (P 0.05), but there was significant difference between other groups (P 0.05). By ROC curve analysis, the ADC values of lymphomas and squamous cell carcinoma cervical lymph node metastases can be distinguished under different b values. When b value is 1000s/mm2, the area under the curve is the largest and the diagnostic efficiency is the highest. The best threshold value for ADC diagnosis is 0.741 脳 10 ~ (-3) mm ~ (2) / s. Conclusion Cervical lymph node metastasis of cervical lymphoma and squamous cell carcinoma can be distinguished by ADC.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R730.44

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