表观扩散系数值鉴别鼻腔鼻窦小圆细胞与非小圆细胞肿瘤的价值

Value of apparent diffusion coefficient in the differential diagnosis of small round cell malignant tumors of nasal and paranasai sinus

目的探讨ADC值对鼻腔鼻窦小圆细胞恶性肿瘤（SRCMT）及非小圆细胞恶性肿瘤（Non_SRCMT）的鉴别诊断价值。方法回顾性分析2008至2015年经手术病理证实的143例鼻腔鼻窦SRCMT和Non-SRCMT患者资料。所有患者均行DWI检查，b值采用0、1000s／mm2，对每个病变进行ADC值定量分析。采用独立样本t检验比较2种肿瘤间ADC值的差异并绘制ROC，计算曲线下面积（Az）。与病理结果对照，确定诊断阈值，评价其诊断效能，并与病理结果行一致性分析。采用单因素方差分析比较不同病理类型SRCMT间ADC值。结果98例SRCMT中，20例横纹肌肉瘤（RMS）、19例非霍奇金淋巴瘤（NHL）、14例恶性黑色素瘤（MM）、14例神经内分泌癌（NEC）、12例Ewing肉瘤或原始神经外胚层肿瘤（EWS或PNET）、11例髓外浆细胞瘤（EMP）、8例嗅神经母细胞瘤（ON）。45例Non-SRCMT中28例鳞状细胞癌（SCC）、17例腺样囊性癌（ACC）。SRCMT的平均ADC值[（0．66±0．12）×10^-3mm2／s1与Non-SRCMT的ADC值[（1．02±0．16）×10^-3mm2／s]相比，差异有统计学意义（t=14．97，P〈0．01）。SRCMT患者根据ADC值分为3组：NHL、MM、NEC、EMP为一组，RMS、EWS、PNET为一组，ON为一组。3组间ADC值差异有统计学意义（F=39．743，P〈0．01），任意2组间ADC值差异均有统计学意义（P均〈0．05）。以SRCMT和Non—SRCMT的ADC值作为临界点鉴别两者并绘制ROC，曲线下面积为0．975。以0．82×10^-3mm2／s为阈值，与病理结果对照，诊断SRCMT的敏感度、特异度和准确度分别为97．8％（44／45）、89．8％（88／98）和92．3％（132／143），与病理结果行一致性检验，Kappa值为0．831。结论ADC值可有效评估鼻腔鼻窦SRCMT。

Objective To investigate the diagnostic value of ADC in the evaluation of small round cell malignant tumors（SRCMT） of nasal and paranasal sinus. Methods This study included 143 patients with surgically confirmed SRCMT and Non-SRCMT of nasal and paranasal sinus between 2008 and 2015, all patients underwent diffusion weighted MRI at 3.0 T with a b factor of 0 and 1 000 s/mm2. Quantitative analysis of ADC values was performed. Difference in ADC values between SRCMT and Non-SRCMT was evaluated using the independent samples t test. One-way analysis of variance（ANOVA） test was performed to compare the ADC values of SRCMT. Receiver operating curves （ROC） were developed to determine the cutoff points to differentiate SRCMT from Non-SRCMT. Results There were 98 SRCMT, of which 20 lesions were rhabdomyosareoma（RMS）, 19 lesions were non-Hodgkin＇s lymphoma（NHL）, 4 lesions were malignant melanoma（MM）, 14 lesions were neuroendocrine carcinoma（NEC）, 12 lesions were Ewing sarcoma or primitive neuroectodermal tumor（EWS or PNET）, 11 lesions were extramedullary plasmacytoma（EMP）, and 8 lesions were olfactory neuroblastoma（ON）. There were 45 Non-SRCMT, of which 28 lesions were squamous cell carcinoma（SCC） and 17 lesions were adenoid cystic carcinoma（ACC）. The mean ADC value of SRCMT[（0.66± 0.12）× 10^3mm2/s] was significantly different （t= 14.97, P〈0.01） from Non-SRCMT [（1.02±0.16）×10^-3mm2/s]. All of 7 kinds of SRCMT were divided into 3 groups according to ADC values： NHL,MM, NEC,EMP;RMS,EWS,PNET; ON.There was statistically significant difference among all 3 groups（F=39.743, P〈0.01）, and the differences between any 2 groups were still statistically significant. The area under the ROC of ADC values diagnosing SRCMT was 0.975. Compared with pathological results, an ADC value of 0.82 × 10^-3mm2/s was used as the threshold for diagnosing SRCMT with a sensitivity of 97.8% （44/45）, specificity of 89.8%（88/98）, and accuracy of 92.3%（132/143）. ADC value had high correlations compared with pathological results （Kappa value was 0.831）. Conclusion The ADC value is a non-invasive imaging parameter that can be used to effectively assess SRCMT of nasal and paranasal sinus.