全身扩散加权成像在恶性淋巴结病变中的诊断价值

Diagnostic value of whole body diffusion weighted imaging in malignant lymphadenopathy

目的探讨全身DWI(WB-DWI)在淋巴瘤与淋巴结转移瘤之间诊断及鉴别诊断的价值与意义。材料与方法筛选出经临床确诊的淋巴瘤患者25例,淋巴结转移瘤患者20例,同时选取15例健康志愿者作为对照组,均行WB-DWI及T2抑脂轴面扫描,记录所有异常淋巴结及正常对照组淋巴结的ADC值,将淋巴瘤组与正常组间、淋巴结转移瘤组与正常组间、淋巴瘤组与转移瘤组间ADC值进行两两比较,探讨ADC值在恶性淋巴结病变的诊断与鉴别诊断中是否具有显著性差异。试图根据受试者工作特征曲线(ROC曲线)分析确定淋巴瘤与淋巴结转移瘤间的最佳鉴别诊断阈值(OT)。结果淋巴瘤组ADC值为(0.70±0.13)mm2/1000 s,淋巴结转移组ADC值为(0.94±0.14)mm2/1000 s,正常对照组ADC值为(1.23±0.24)mm2/1000 s,经独立样本t检验,淋巴瘤组与淋巴结转移组间ADC值具有统计学意义(t=-16.395,P<0.05),淋巴瘤组与正常对照组间ADC值具有统计学意义(t=-14.876,P<0.05),淋巴结转移组与正常对照组间ADC值具有统计学意义(t=-7.851,P<0.05)。通过ROC曲线,得出在ADC值0.79时,AZ值=0.910,其对应灵敏度90.3%,特异度80.6%,此时准确指数最高,诊断效能最佳。结论全身DWI在全身恶性淋巴结病变的诊断中具有良好的应用前景,通过ADC值的定量分析能为两者的鉴别提供参考依据。

Objective： To study the value and significance of the body diffusionweighted imaging in the diagnosis and differential diagnosis between lymphoma and lymph node metastases. Material and Methods： Select 25 cases of clinically diagnosed lymphoma patients,20 patients with lymph node metastases,and 15 healthy volunteers as control group,all lines of WB-DWI imaging and T2 fat suppression shaft can scan,record ADC values of all abnormal lymph nodes and the lymph nodes in the normal control group,the lymphoma group and the normal group,lymph node metastasis group and the normal group,lymphoma group and metastasis between groups ADC value two two comparison,to investigate whether the ADC value has signifi cant differences in the diagnosis and differential diagnosis of malignant lymph node lesions. Try to determine the best differential diagnosis OT between lymphoma and lymph node metastasis under the receiver-operating characteristic curve（ROC curve） analysis. Results： Lymphoma group ADC value was（0.70±0.13） mm2/1000 s,lymph node metastasis group ADC value was（0.94±0.14） mm2/1000 s,normal control group ADC value was（1.23±0.24） mm2/1000 s,with the independent sample t test,lymphoma group with lymph node metastasis between groups ADC value with statistical significance（t=-16.395,P〈0.05）,lymphoma group and normal control group ADC value with statistical significance（t=-14.876,P〈0.05）,lymph node metastasis group and normal control group with statistical significance（t=-7.851,P〈0.05）. By ROC curve we obtained that when the ADC value was 0.79,AZ value was 0.910,which corresponds to the sensitivity 90.3%,specificity 80.6%,this time accurate index was the highest and the diagnostic effi cacy best. Conclusions： Whole body diffusion weighted imaging has a good application prospect in diagnosis of systemic malignant lymphadenopathy,through quantitative analysis of ADC value can provide the reference basis for the distinction between the two.