分析磁共振成像在诊断眼眶原发性淋巴瘤的敏感性及特异性

An analysis on sensitivity and specificity of MRI in the diagnosis of orbital primary lymphoma

目的:探索磁共振成像(MRI)在诊断眼眶原发性淋巴瘤的敏感性及特异性。方法:回顾性分析49例眼眶增生性疾病患者的临床资料,按照临床治疗后随访或手术组织病理检查诊断结果将27例原发性淋巴瘤患者纳入观察组,22例良性增生患者纳入对照组。两组均行MRI检查,比较两组T_1加权像(T_1WI)、T_2加权像(T_2WI)和弥散加权成像(DWI)信号强度及流空效应发生情况的差异,计算表观弥散系数(ADC)值和信号强度比值(CER),分析其诊断的灵敏度和特异度,对ADC值、CER值及其联合诊断效果进行受试者工作特征(ROC)曲线分析,根据ROC曲线下面积(AUC)比较其诊断价值。结果:观察组中10例(占37.04%)发生流空效应,对照组中20例(占90.91%)发生流空效应,两组比较差异有统计学意义(x^2=14.82,P<0.05)。观察组ADC值[(0.75±0.11)×10^(-3) mm^2/s]明显小于对照组[(1.32±0.27)×10^(-3) mm^2/s],差异有统计学意义(t=9.29,P<0.05)。观察组CER值(1.37±0.13)明显低于对照组(1.78±0.25),差异有统计学意义(t=6.96,P<0.05)。ADC值诊断灵敏度最高(88.89%),"ADC值+CER值"、"ADC值+CER值+流空效应"诊断的特异度均高达100%;ROC曲线分析,ADC值、CER值、"ADC值+CER值"及"ADC值+CER值+流空效应"的AUC均>0.8,其中ADC值诊断的曲线下面积最高[0.944(0.649,0.840)],诊断价值亦最高。结论:MRI在眼眶原发性淋巴瘤诊断中具有较高价值,其中ADC值的诊断效果显著,联合CER值和流空效应发生情况能有效提高患者诊断特异度,可在临床诊断中参考使用。

Objective:To explore the sensitivity and specificity of magnetic resonance imaging(MRI)in the diagnosis of orbital primary lymphoma.Methods:The clinical data of 49 patients with orbital proliferative disease were analyzed retrospectively.And all of them were divided into observation group(27 cases with primary lymphoma)and control group(22 cases with benign hyperplasia)according to the results of follow-up post clinical treatment or surgical histopathology.And all of them received the examination of MRI,and the differences of signal intensity and flow emptying effects of T1 weighted imaging(T1WI),T2 weighted imaging(T2WI)and diffusionweighted imaging(DWI)between the two groups were compared and analyzed.And then,the apparent diffusion coefficient(ADC)and contrast enhancement ratio(CER)were calculated,and the sensitivity and specificity of the diagnosis of orbital primary lymphoma were analyzed.Besides,the receiver operating characteristic(ROC)curve of ADC value,CER value and the effects of their combined diagnosis were analyzed,and their diagnosis values were compared according to area under curve(AUC)of ROC.Results:The occurrence rate of flow emptying effects of observation group(10 cases,37.04%)was significantly lower than that of control group(20 cases,90.91%)(x^2=14.82,P<0.05).And the ADC value of observation group[(0.75±0.11)×10^-3 mm^2/s]was significantly lower than that of control group[(1.32±0.27)×10^-3 mm^2/s](t=9.29,P<0.05).And the CER value of observation group(1.37±0.13)was significantly lower than that of control group(1.78±0.25)(t=6.96,P<0.05).The sensitivity of ADC values was highest(88.89%),and the diagnostic specificities of"ADC value+CER value"and"ADC value+CER value+flow emptying effect"were up to 100%.ROC curve analysis showed all of the AUCs of ADC value,CER value,"ADC value+CER value"and"ADC value+CER value+flow emptying effect"were higher than 0.8,and the AUC of ADC value is the highest[0.944(0.649,0.840)].Therefore,its diagnostic value was highest.Conclusion:MRI has a higher value in the diagnosis of primary orbital lymphoma,and the diagnostic effect of ADC value is significant.And ADC value combined with the value of CER and flow emptying effect can effectively increase the diagnostic specificity of patients,and it is worth to be used in clinical diagnosis as a reference.