磁共振全身弥散加权成像筛查恶性肿瘤的临床应用

Clinical Application of Whole- body Magnetic Resonance Diffusion Weighted Imaging in the Screening of Malignant Tumor

目的探讨磁共振全身弥散加权成像(whole-body magneticresonance diffusion-weighted imaging,WBDWI)筛查恶性肿瘤的临床应用价值。方法回顾性分析10例健康体检者和55例肿瘤患者的临床及WBDWI等影像学资料、恶性肿瘤原发灶及转移灶综合组织病理学结果。计算WB-DWI诊断恶性肿瘤的灵敏度及特异度,测量所有病灶的表观弥散系数(ADC值)。结果在10例健康体检者WB-DWI图像上,脑实质、涎腺、椎间盘、脊髓、脾脏、肾脏、前列腺、睾丸、子宫、卵巢及淋巴结等脏器呈高信号,其余脏器及骨骼呈等低信号,同时检出良性病灶7处。在55例肿瘤患者中WB-DWI检出原发灶35处、转移灶109处,共144处,所有恶性病灶呈高信号、其ADC值与病灶所在组织正常区域比较明显降低、降低幅度>50%,同时检出良性病灶23例37处。诊断恶性肿瘤的灵敏度为97.1%,特异度为66.7%。恶性肿瘤平均ADC值低于良性肿瘤平均ADC值(t=19.12,P<0.05)。结论 WB-DWI具备了探测恶性肿瘤原发灶及转移灶的敏感度和准确性,是适合临床有效筛查肿瘤的技术。

Objective To investigate the value of Whole- body Magnetic Resonance Diffusion Weighted Imaging( WB- DWI) in the screening of malignant tumor. Methods A total of 10 healthy individuals and 55patients with histologically confirmed tumors were analyzed retrospectively. The primary tumor and metastatic tumor were confirmed by histopathology and a variety of integrated imaging examination. Apparent diffusion coefficient( ADC) values of normal region and malignant lesions were measured and analyzed statistically. Results In 10 healthy individuals,some organs such as brain,salivary glands,intervertebral discs,spinal marrow,spleen,kidneys,prostate,testes,uterus and ovaries as well as lymph nodes showed high signal intensity on WB- DWI while the other organs including skeleton showed low signal. WB- DWI found benign lesions in 5cases of healthy individuals. In 55 cases,primary malignancy and whole body metastasis showed high signal on DWI and low signal on ADC images. Compared with the normal region,the ADC value of each lesion decreased significantly( ≥ 50%). The detection rate was 98. 9%. Conclusion WB- DWI has the sensitivity and accuracy in the screening primary lesions and metastases,and has the advantage of low price,easy and fast check method,and has advantages of no radiation,no injection of contrast agent,as well as postoperative follow- up. It is suitable for clinical screening,and is hopeful to apply extensively as a effectual new tumor screening technique.