MR信号强度值对区分腮腺多形性腺瘤及与沃辛瘤的诊断价值

The Differential Value of MR Signal Intensity for Parotid Pleomorphic Adenoma and Warthin Tumor

目的:评估磁共振T1WI及T2WI信号强度值对腮腺多形性腺瘤(pleomorphic adenoma,PA)和沃辛瘤(Warthin tumor,WT)鉴别诊断中的价值。方法:将2018年1月—2020年6月于本院完成MR检查并经病理组织学证实的29例PA及37例WT患者纳入研究。29例PA患者中,男7例、女22例,平均年龄(43±16)岁。37例WT患者中,男35例、女2例,平均年龄(59±11)岁。所有患者在术前行腮腺MRI平扫检查,包括横轴位TSE T1WI、横轴位及冠状位STIR T2WI序列。测量两者MR序列横轴位上信号强度值(SI),T1-max-SI和T2-SI、T2-max-SI、T2-min-SI,并以病灶同层面同侧咬肌SI为参照,计算肿瘤与咬肌的信号强度比值(SIR),比较PA与WT的T1-max-SIR、T2-SIR、T2-max-SIR和T2-min-SIR的差异,并绘制ROC曲线评价以上参数的诊断价值。结果:WT的T1-max-SIR大于PA(P=0.00),T1-max-SIR用于鉴别WT和PA的ROC曲线下面积(AUC)为0.83±0.05,其灵敏度为72.41%,特异度为83.78%。而WT的T2-SIR、T2-min-SIR均小于PA(P=0.01,P=0.01),T2-SIR用于鉴别WT和PA的AUC为0.81±0.06,其灵敏度为86.21%,特异度为75.68%。T2-min-SIR用于鉴别WT和PA的AUC为0.80±0.06,其灵敏度为93.10%,特异度为70.27%。而T2-max-SIR在鉴别WT和PA中差异没有统计学意义(P=0.06),AUC为0.63±0.07,其灵敏度为51.72%,特异度为78.38%。结论:T1-max-SIR、T2-SIR及T2-min-SIR有助于PA及WT的鉴别诊断,诊断阈值分别为1.59、3.52和1.81。

Purpose:To evaluate the differential diagnosis value of MR T1WI and T2WI signal intensity in parotid pleomorphic adenoma(PA)and Warthin tumor(WT).Methods:Twenty-nine PAs[7 males and 22 females,with mean age(43±16)years old]and 37 WTs[35 males and 2 females,with the mean age(59±11)years old]admitted to Jinhua Central Hospital from January 2018 to June 2020 were retrospectively analyzed and compared.All patients were examined by preoperative MRI in parotid scan,including axial TSE T1WI,axial and coronal STIR T2WI sequences.The signal intensity(SI)on both T1WI and T2WI sequences,T1-max-SI,T2-SI,T2-max-SI and T2-min-SI were measured,and the SI of the ipsilateral masseter muscle at the same level was used as the reference.The signal intensity ratio of tumor to masseter muscle(SIR)was calculated.The differences of T1-max-SIR,T2-SIR,T2-max-SIR,T2-min-SIR were compared,and the ROC curve was drawn to evaluate the diagnostic value of the above parameters.Results:T1-max-SIR was higher in WTs than that in PAs(P=0.00).The area under the curve(AUC)of T1-max-SIRs for differentiating WTs from PAs was 0.83±0.05,with a sensitivity of 72.41%and a specificity of83.78%.However,T2-SIR and T2-min-SIR were both lower in WTs than those in PAs(P=0.01,P=0.01),and the AUC of T2-SIR to identify WTs and PAs was 0.81±0.06,with a sensitivity of 86.21%and a specificity of 75.68%.The AUC of T2-min-SIR used to identify WTs and PAs was 0.80±0.06,with a sensitivity of 93.10%and a specificity of 70.27%.T2-max-SIR was not significant in identifying WTs and PAs(P=0.06),with an AUC of 0.63±0.07,with a sensitivity of 51.72%and a specificity of 78.38%.Conclusion:T1-max-SIR,T2-SIR,and T2-min-SIR contributed to the differential diagnosis of PA and WT,with the diagnostic thresholds of 1.59,3.52,and 1.81,respectively.