磁共振背景信号抑制弥散加权成像技术在胸部肿瘤性病变诊断中的应用

The Application of Whole Body Diffusion Weighted Imaging with Background Body Signal Suppression in the Diagnosis of Thoracic Tumorous Lesions

目的:探讨磁共振背景信号抑制弥散加权成像技术在胸部肿瘤性病变诊断中的应用价值。材料与方法:选择2009年1月～2010年12月在北京煤炭总医院就诊的临床怀疑胸部肿瘤患者102例,共计158处病灶,包括肺癌病灶33例,肺部良性肿瘤性病变18例,恶性淋巴瘤病灶24例,纵隔及腋下淋巴结转移病灶24例,乳腺癌病灶22例,乳腺良性病灶17例,20处正常乳腺组织。全部病例均行磁共振背景信号抑制弥散加权STIR-EPI序列成像,其中33例病灶同时行SE-EPI(SPIR)序列扫描,另有4例行全身大范围采集,包括胸部、腹部及盆腔;DWIBS图像后处理后可获得ADC图,利用ADC图各病变的ADC值,对其进行评价;利用3D MIP重建及黑白翻转技术立体观察病灶。结果:①STIR-EPI的背景抑制效果优于SE-EPI(SPIR)(P<0.05),经过3D MIP重建及黑白翻转技术可以得到类PET图像,从而更加清晰地观察病变。②胸部转移淋巴结ADC值为(1.37±0.41)mm2/s×10-3,而胸部淋巴瘤ADC值约为(0.91±0.12)mm2/s×10-3,差异有统计学意义(P<0.05);肺癌ADC值为(1.61±0.18)mm2/s×10-3,肺部良性肿瘤性病变ADC值为(2.06±0.21)mm2/s×10-3,差异有统计学意义;乳腺癌病灶、乳腺良性病灶和乳腺正常组织ADC值分别为(1.01±0.13)mm2/s×10-3、(1.81±0.18)mm2/s×10-3、(1.91±0.26)mm2/s×10-3,两两比较差异均有统计学意义。③不同类型胸部肿瘤性病变ADC值比较,除正常乳腺组织与乳腺良性病变、恶性淋巴瘤和乳腺癌之间差异无统计学意义外,其余各组之间差异均有统计学意义。④4例患者行大范围扫描(胸部、腹部及盆腔),3例发现远处转移。结论:①磁共振背景信号抑制弥散加权成像是一种安全有效的影像学检查方法;②胸部肿瘤性病变中,恶性病变ADC值低于良性病变,可以帮助判断病变良恶性;③不同类型恶性肿瘤ADC值不同,可用于鉴别诊断;④可用于肿瘤的筛查及疗效评估。

Objective：To evaluate the role of DWIBS in the diagnosis of thoracic tumorous lesions.Materials and Methods：102 cases（patients suspected chest tumors clinically in Beijing Coal General Hospital from 01,2009 to 12,2010,total 158 lesions）were involved in this study,including 33 lung cancer,18 pulmonary benign tumorous lesions,24 malignant lymphoma,24 mediastinal and subaxillary lymph node metastasis,22 breast cancer,17 breast benign lesions and 20 focal normal breast tissues.All 158 lesions were performed DWIBS（STIR） examination and 33 of them also received DWIBS（SPIR）examination and another 4 cases received thoracic-abdomen-pelvis DWIBS（STIR）scan,then their ADC value were measured and compared.The lesions were displayed by background suppression rebuilding with 3D MIP（3 dimensional maximum intensity projection） and technique with reverse black and white.The ADC values of all lesions were measured.Results：（1）The effect of background suppression of STIR-EPI was better than SE-EPI（SPIR）and could get PET-like images with 3D MIP rebuilding and reverse black and white technique to observe the lesion more clearly.（2）The mean ADC value of thoracic metastatic lymph nodes was 1.37±0.41 mm^2/s×10^-3 and 0.91±0.12 mm^2/s×10^-3in thoracic lymphoma.There was significant difference between them（P0.05）;The mean ADC value of lung cancer was 1.61±0.18 mm^2/s×10 ^-3and 2.06±0.21 mm 2/s×10 ^-3in pulmonary benign lesions,and it was significantly ower than that of benign lesions.（3）The ADC value of different types of malignant different between the two types of lesions;The mean ADC value of breast cancer,breast benign lesion and normal breast tissue was 1.01±0.13 mm^2/s×10 ^-3,1.81±0.18 mm 2/s×10 ^-3and 1.91±0.26 mm 2/s×10 ^-3respectively,and there was significant difference between either two groups.（3）The ADC values of different types of malignant tumors were significantly different.（4）Among the 4 cases with thoracic-abdomen and pelvis DWIBS examination, 3 cases were with distal metastasis.Conclusions：（1）DWIBS was a safe and effective imaging examination.（2）It benefited to identify the property of the thoracic tumorous lesion that was benign or malignant,the ADC value of malignant lesions was l tumors was significantly different.（4）DWIBS can be used in tumor screening and the therapeutic evaluation due to its large range scan.