MR扩散加权成像在CT引导下肺癌穿刺活检中的应用

The Application of DWI-MRI in the CT-guided Fine-needle Biopsy of Lung Cancer

目的探讨磁共振扩散加权成像(DWI)在CT引导下肺癌病灶细针穿刺活检中的应用价值。方法 30例影像学诊断为肺癌住院病人,先行胸部MR平扫检查,包括DWI序列,再根据DWI图及表观扩散系数(ADC)图预定穿刺针活检靶部位,然后行CT引导下肺部病变靶区细针穿刺活检术,分析穿刺诊断正确率。结果 30例病例选择穿刺靶点时,均避开病变坏死区及肺不张或阻塞性炎症区域,而选取肿瘤实性区域进行穿刺活检。穿刺病理均确诊为肺癌,穿刺阳性率为100%。结论在CT引导下肺癌穿刺活检中,对于病灶内有坏死时,或病灶远端合并肺不张及阻塞性炎症时,术前行MRI扩散加权成像检查指导穿刺靶点的选择具有一定的应用价值。

Objective To investigate the value of diffusion-weighted imaging （DWI） in the CT-guided fine-needle biopsy of lung cancer. Methods Thirty inpatients were diagnosed as lung cancer by imaging diagnosis.All cases received both chest conventional MRI and DWI examinations at first. The DWI image and apparent diffusion coefficient （ADC） map were used for the needle biopsy target site identification. CT-guided fine-needle biopsy was performed at the target site, and the invasive biopsy diagnostic accuracy was analyzed. Results For all 30 cases, the target sites for fine-needle biopsy identified by DWI image and ADC map were all in solid tumor parenchyma. Areas of lesion necrosis, pulmonary atelectasis, and obstructive inflammation were all avoided from biopsy. All biopsy results were confirmed as lung cancer with 100%positive rate. Conclusions DWI is valuable for the puncture target site identification to avoid existing necrotic lesions and lesions of both distal merger atelectasis and obstructive inflammation.