PROPELLER Duo DW-MRI鉴别鼻腔鼻窦内翻性乳头状瘤与鼻腔鼻窦鳞状细胞癌的价值

Value of PROPELLER DUO diffusion-weighted MRI in differentiating sinonasal inverted papilloma and squamous cell carcinoma

目的通过周期性旋转重叠平行线采集和增强处理重组(PROPELLER)Duo DW-MRI对鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)与鼻腔鼻窦鳞状细胞癌MR定量分析,评估表面弥散系数(apparent diffusion coefficient,ADC)值对鉴别二者的价值。方法 回顾性分析经手术病理证实的SNIP 61例、鼻腔鼻窦鳞状细胞癌41例患者的脂肪抑制PROPELLER Duo DW-MRI资料(b值0、1000 s/mm^2),采用病变最大层面感兴趣区(ROI)和局部ROI(ADC值最小区域,圆形,面积30 mm2)两种方法分别测量ADC值(简称最大层面ADC值、最小ADC值)。采用独立样本t 检验比较两种肿瘤ADC值有无差异,通过ROC曲线分析ADC值对鉴别二者的能力。结果两种测量方法获取的鼻腔鼻窦鳞状细胞癌的最大层面ADC值、最小ADC值均低于SNIP(P 均=0.000),最大层面ADC值大于最小ADC值(P =0.000)。以1.46×10^-3mm^2/s为临界值,最大层面ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的ROC曲线下面积为0.979;以1.40×10^-3mm^2/s为临界值,最小ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的ROC曲线下面积为0.948,最大层面ADC值鉴别鼻腔鼻窦鳞状细胞癌与SNIP的能力高于最小ADC值(P =0.018)。结论 PROPELLER Duo DW-MRI在SNIP与鼻腔鼻窦鳞状细胞癌的鉴别诊断中具有重要价值。

OBJECTIVE To evaluate the value of periodically rotated overlapping parallel lines with enhanced reconstruction(PROPELLER) Duo diffusion weighted MR imaging(DW-MRI) in the differentiation between inverted papilloma and squamous cell carcinoma in the sinonasal region. METHODS PROPELLER Duo DW-MRI was performed in 61 patients with sinonasal inverted papilloma(SNIP) and 41 patients with squamous cell carcinoma on 3 T MRI scanner. Apparent diffusion coefficients(ADCs) were obtained with b factor of 0 and1000 s/mm^2 and two different sampling strategies(whole section and partial section) of regions of interest(ROI).Difference in ADCs between the two entities was evaluated by independent samples t test. RESULTS ADCs of sinonasal squamous cell carcinoma were significantly lower than those of inverted papilloma(P=0.000). Using a whole section ADC value of 1.46×10^-3 mm^2/s and a partial ADC value of 1.40×10^-3 mm^2/s as the threshold value effectively differentiated SNIP from squamous cell carcinoma with area under the receiver operating characteristic curve(AUC)of 0.979 and 0.948, respecvtively. Significant difference was found in diagnostic ability between the two different sampling strategies of ROIs(P=0.018). CONCLUSION PROPELLER DUO DW-MRI can effectively differentiate SNIP from squamous cell carcinomas.