3T DW-MRI鉴别鼻腔鼻窦腺样囊性癌与嗅神经母细胞瘤的价值

Effectiveness of 3T diffusion-weighted MRI in differentiating sinonasal adenoid cystic carcinomas and olfactory neuroblastomas

目的:评价3TDW-MRI对鼻腔鼻窦腺样囊性癌(ACCs)和嗅神经母细胞瘤(ONBs)的鉴别诊断价值。方法:经病理证实的20例ACCs患者和15例ONBs患者均行3.0TDW-MRI扫描,采用周期性旋转重叠平行采集和增强后处理重建(Duo PROPELLER)加脂肪抑制技术,两组b值(b=0,700和b=0,1000s/mm2)。采用独立样本t检验比较ACCs与ONBs的ADC值的差异,并通过ROC曲线分析获得ADC值的诊断效能。结果:鼻腔鼻窦ONBs的ADCb(0,700)=(1.132±0.269)×10-3 mm2/s、ADCb(0,1000)=(0.927±0.222)×10-3 mm2/s,ACCs的ADCb(0,700)=(1.531±0.338)×10-3 mm2/s、ADCb(0,1000)=(1.340±0.331)×10-3 mm2/s,鼻腔鼻窦ACCs的ADC值显著高于ONBs(P=0.000)。以ADCb(0,700)=1.106×10-3 mm2/s为临界值,鉴别两类肿瘤的敏感度、特异度、阳性预测值、阴性预测值及符合率分别为90.5%、66.7%、73.3%、87.5%和78.6%;以ADCb(0,1000)=0.936×10-3 mm2/s为临界值,鉴别两类肿瘤的敏感度、特异度、阳性预测值、阴性预测值及符合率分别为95.2%、66.7%、74.1%、93.3%、81.0%。ADCb(0,700)和ADCb(0,1000)对两类肿瘤的鉴别诊断效能的差异无统计学意义(P>0.05)。结论:DW-MRI可以对鼻腔鼻窦腺样囊性癌与嗅神经母细胞瘤进行定量分析,能有效提高对这两类肿瘤的鉴别诊断准确性。

Objective：To assess the value of 3T diffusion-weighted MRI （DW-MRI） in differentiating adenoid cystic carcinomas （ACCs） from olfactory neuroblastomas （ONBs） of sinonasal tract, Methods： Periodically rotated overlapping parallel lines with enhanced reconstruction （PROPELLER） DUO DW-MRI with fat suppression technique at 3T MR scan- ner was performed in 20 patients with sinonasaI ACCs and 15 patients with ONBs. All the cases were confirmed histologi- cally. Apparent diffusion coefficients （ADCs） were obtained with two sets of b-values （b=0 and 700s/mm^2, b--0 and 1000s/mm^2 ）. Difference in ADCs between sinonasal ACCs and ONBs was analyzed using 2-independent samples t-test. Di agnostic efficacy of ADCs for discriminating between the two diseases was evaluated and compared using receiver operating characteristic curve analysis. Results：The ADCb（0,700） and ADCb（0,1000） of sinonasal ONBs were （1. 132± 0. 269） × 10 ^-3and （0. 927±0. 222）× 10^-3mm^2/s,and those of ACCs were （1. 531 ±0. 338）× 10^-3 and （1. 340± 0. 331）× 10^-3mm^2/s, the ADCs of ACCs were higher than those of ONBs with significantly statistical difference （P= 0. 000）. Using ADCb（0,700） value of 1. 106 × 10 a mm^2/s as the threshold value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for differentiating sinonasal ONBs and ACCs were 90.5% ,66.7% ,73.3% ,87.5% and 78.6%,respectively. Setting ADCb（0,1000） value of 0. 936 ×10^-3mm^2/s as the threshold value, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for differentiating sinonasal ONBs and ACCs was 95. 2%, 66.7 %, 74. 1%, 93.3% and 81.0% ,respectively. There was no significant difference in diagnostic efficacy between the two b-values settings （P〉 0.05）. Conclusion： PROPELLER Duo DW-MRI can make quantitative analysis on sinonasal adenoid cystic carcinomas （ACCs） and olfactory neuroblastomas （ONBs）,thus can effectively improve the accuracy of differential diagnosis.