全身弥散加权成像对乳腺癌淋巴结转移的诊断价值

The value of whole body diffusion weighted imaging in the diagnosis of the metastasis of lymph-node of breast cancer

目的探讨磁共振全身弥散加权成像(WB-DWI)诊断乳腺癌淋巴结转移的应用价值。方法筛选乳腺癌淋巴结转移患者21例和健康志愿者26例的全身弥散加权成像资料进行分析。把全身淋巴结转移部位分为颈部、两侧腋窝、锁骨上下区、纵隔、肺门、腹腔、腹膜后、盆腔8个区域,根据淋巴结短径的大小分为(≤1.0 cm、1.0 cm^1.5 cm、1.5 cm^2.0 cm、≥2.0 cm)四组。测量转移淋巴结、正常淋巴结的ADC值并进行分析;把WB-DWI诊断的转移淋巴结与临床确诊的转移淋巴结进行对比分析,得出WB-DWI诊断不同部位、不同短径组转移淋巴结的准确率。结果在b=800 s/mm2的图像中,转移淋巴结与正常淋巴结间的ADC值差异具有统计学意义(P<0.05),不同短径组之间转移淋巴结的ADC值差异无统计学意义(P>0.05)。WB-DWI诊断乳腺癌淋巴结转移的平均准确率达94.3﹪,能够满足临床诊断要求。结论 WBDWI通过淋巴结信号的改变及ADC值的测量,诊断乳腺癌淋巴结转移具有明显优势。

Objective To investigate the clinical value of using whole body diffusion weighted imaging（WB-DWI）in the diagnosis of the lymph-node metastasis of breast cancer. Methods 26 healthy volunteers and 21 breast cancer patients with metastatic lymph nodes were scanned using WB-DWI. Lymph node metastasis were divided into eight groups according to the location, including cervical part, axillary fossa, clavicular region, mediastinum, hilum of lung, peritoneal cavity, retroperitoneal area and cavitas pelvis. At the same time all metastatic lymph nodes were divided into four groups according to short diameter of lymph node as ≤ 1.0 cm, 1.0 cm-1.5 cm, 1.5 cm-2.0 cm, ≥ 2.0 cm. The ADC value between metastatic lymph nodes and normal lymph nodes were compared and the results were compared with the clinical diagnosis. The accuracy was calculated in each regions and shortest diameter groups. Results In the imaging of b = 800 s/mm2, the difference of the ADC value between metastatic and normal lymph nodes was statistically significant（P 0.05）. The differences of the ADC values between metastatic lymph nodes of different shortest diameter were not statistically significant（P 0.05）. The accuracy of metastatic lymph node reached to 94.3 ﹪ which was high enough for clinical applications. Conclusions WB-DWI has been shown as a promising technique for the diagnosis of metastatic lymph nodes.