MRI弥散加权成像及动态增强诊断鼻咽癌侵犯斜坡

Application of MRI Diffusion Weighted Imaging and Dynamic Contrast Enhancement in Diagnosing Nasopharyngeal Carcinoma Invading Slope

目的:探讨磁共振扩散加权成像(DWI)及MRI动态增强成像(DCE-MRI)在鼻咽癌侵犯斜坡诊断中的应用价值。方法:93例临床确诊的鼻咽癌患者及16例正常志愿者的斜坡MRI分为斜坡正常组、斜坡受侵组和放疗后斜坡改变组,检测各组DWI的表观弥散系数(ADC)值及MRI动态增强参数包括强化百分数(SI%)、强化峰值(PV)、达峰时间(TTP)及TIC曲线类型,评价ADC值及动态增强参数在诊断斜坡受侵中的作用。结果:斜坡受侵组ADC、SI%及PV值高于放疗后斜坡改变组及斜坡正常组,差异有统计学意义(P<0.05),放疗后斜坡改变组TTP值高于斜坡受侵组及斜坡正常组,差异有统计学意义(P<0.05);斜坡正常组以TIC I型曲线为主,放疗后斜坡改变组以I型及III型曲线为主,斜坡受侵组以IV及V型曲线为主;诊断NPC病人斜坡受侵的最佳阈值为ADC值大于0.45×10-3mm2/s,TIC曲线Ⅳ型、V型,强化百分数SI%>121.1,强化峰值(PV)>1 050,达峰时间(TTP)<92.5 s;DWI(ADC值)及MRI动态增强诊断斜坡受侵能力:DCE-MRI敏感性与DWI相差不大,DCE-MRI准确性高于DWI。结论:DWI及DCE-MRI诊断鼻咽癌斜坡受侵均有较高的敏感性和准确性,两者联合检查效果更好。

Objective：To investigate clinical application value of MRI magnetic diffusion weighted imaging （DWI） and MRI dynamic contrast enhancement （DCE-MRI） to diagnose nasopharyngeal carcinoma （NPC） invading slope.Methods：Ninety-three patients with nasopharyngeal carcinoma and 16 healthy volunteers were divided into healthy slope group （group A）,slope invasion group （group B） and slope change after radiotherapy group （group C） ; testing DWI （ADC values） and DCE-MRI parameters （including SI%,PV,TTP and TIC curve） ; assessing the function of ADC and DCE value in diagnosing slope invasion.Results：ADC,SI% and PV values of group B were higher than group A and group C,differences were statistically significant （P 〈 0.05）,TTP value of group C was higher than that of group A and group B,differences were statistically significant（P 〈 0.05） ; Group A mainly presented TIC Ⅰ type curve,group C presented type Ⅰ and Ⅲ curve,group B presented type Ⅳ and Ⅴ curve ; premium thresholds in diagnosing NPC patients with slope invasion were ADC values 〉 0.45 × 10^-3mm^2/s,TIC curve as type Ⅳ and Ⅴ,SI% 〉121.1,PV 〉1050,TTP 〈92.5.DWI （ADC values） and DCE-MRI for diagnosing slope invasion：DCE-MRI sensitivity was equal to DWI,DCE-MRI was more accurate than DWI.Conclusions：DWI and DCE-MRI are more accurate and sensitive in diagnosing nasopharyngeal carcinoma （NPC） invading slope,combined diagnosing will be more effective.