DWI联合CT对肺内良恶性病变的鉴别诊断价值

The diagnostic value of diffusion-weighted imaging combined with CT scan in differentiating between benign and malignant lesions of the lung

目的:探讨DWI联合CT对肺内良、恶性病变的鉴别诊断价值。方法:搜集经病理或治疗后随诊证实的肺内病变共68例,其中恶性病变46例,良性病变22例,所有患者均在接受治疗及病理检查前行CT平扫+增强扫描及DWI检查,记录b值为800 s/mm2时病变的平均表观扩散系数值(ADC值),分析良、恶性病变的ADC值差异,计算ROC曲线下面积,判断ADC值的最佳阈值及鉴别诊断效能,对比分析单独使用CT与CT联合DWI的诊断效能。结果:肺内良性病变的平均ADC值为(1.712±0.293)×10^-3mm^2/s,恶性病变的平均ADC值为(1.219±0.138)×10^-3mm^2/s,良、恶性病变的平均ADC值差异有统计学意义(P<0.05)。ADC值的最佳诊断阈值为1.522×10^-3mm^2/s时,ROC曲线的曲线下面积最大(0.942),对肺内良、恶性病变鉴别诊断的敏感度为72.7%,特异度为100%,诊断符合率为91.2%;CT对肺内良恶性病变的诊断符合率为88.2%,CT与DWI联合的诊断符合率为95.6%。结论:DWI联合CT可提高对肺内良、恶性病变的鉴别诊断符合率。

Objective:To explore the diagnostic value of diffusion-weighted imaging combined with CT scan in differentiating between pulmonary benign and malignant lesions.Methods:A total of 68 cases of pulmonary lesions confirmed by pathology or follow-up after treatment were collected,including 46 cases of malignant lesions and 22 cases of benign lesions.All patients underwent plain&enhanced CT scan and MR scan before treatment and pathological examination.The average apparent diffusion coefficient value(ADC value)of lesion was recorded when b-value was 800s/mm2,and the difference of ADC value between benign and malignant lesions was analyzed.The area under the ROC curve was calculated to determine the optimal threshold of ADC value and its efficacy for differential diagnosis.The diagnostic efficacy of CT alone and CT combined with DWI was compared.Results:The mean ADC value was(1.712±0.293)×10^-3mm^2/s in pulmonary benign lesions and(1.219±0.138)×10^-3mm^2/s in pulmonary malignant lesions.There were significant differences in the mean ADC values of benign and malignant lesions(P<0.05).When the optimal diagnostic threshold of ADC value was 1.522×10^-3mm^2/s,the maximum area under the ROC curve was 0.942.The sensitivity,specificity and diagnostic accordance rate of the differential diagnosis of pulmonary benign and malignant lesions was 72.7%,100%and 91.2%,respectively.The diagnostic accordance rate of CT alone in pulmonary benign and malignant lesions was 88.2%,and that of CT combined with DWI was 95.6%.Conclusion:DWI combined with CT can increase the accordance rate for differential diagnosis of benign and malignant lesions of the lung.