体素内不相干运动扩散加权成像鉴别早期鼻咽癌与鼻咽良性增生的价值

Value of intravoxel incoherent motion diffusion-weighted MRI for distinguishing early nasopharyngeal carcinoma from benign hyperplasia

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)在早期鼻咽癌(NPC)与鼻咽部良性增生鉴别中的价值。方法选取2018年5月至2019年5月在中山市中医院行MRI检查并进行IVIM-DWI成像的早期NPC患者(n=46)和鼻咽部良性增生患者(n=43)作为研究对象,所有患者均经病理组织学检查证实,记录所有患者的真实扩散系数(D)、灌注分数(f)、灌注相关扩散系数(D*)、表观扩散系数(ADC),比较两组各参数之间的差异;绘制ROC曲线并计算曲线下面积(AUC),评估各参数诊断性能。结果与鼻咽良性增生组相比,早期NPC组的D、ADC0~1000、ADC300~1000较低[(0.67±0.05)×10^(-3) mm^(2)/s vs.(0.90±0.11)×10^(-3) mm^(2)/s、(0.65±0.09)×10^(-3) mm^(2)/s vs.(1.00±0.15)×10^(-3) mm^(2)/s、(0.59±0.05)×10^(-3) mm^(2)/s vs.(0.76±0.10)×10^(-3) mm^(2)/s](P<0.001),而早期NPC组的D*则高于鼻咽良性增生组[(32.87±4.80)×10^(-3) mm^(2)/s vs.(21.87±5.21)×10^(-3) mm^(2)/s](P<0.001);两组之间f的差异无统计学意义(P=0.216)。D和ADC300~1000的AUC分别为0.985和0.988,D<0.75×10^(-3) mm^(2)/s鉴别早期NPC与鼻咽良性增生的灵敏度、特异度和准确度最高(100%、97.5%和96.9%)。结论IVMI-DWI在鉴别早期NPC和鼻咽良性增生中具有一定的价值,其中D和ADC300~1000鉴别诊断性能最佳。

Objective To investigate the value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)MRI in distinguishing nasopharyngeal carcinoma(NPC)from benign hyperplasia in early stage.Methods Forty-six patients with early-stage NPC and 43 patients with benign hyperplasia receiving IVIM-DWI whose lesions were confirmed by pathology were selected.The mean pure diffusion coefficient(D),pseudo-diffusion coefficient(D*),perfusion fraction(f)and apparent diffusion coefficient(ADC)values of two groups were recorded and compared.Receiver operating characteristics(ROC)with the area under the curve(AUC)was used to evaluatethe diagnostic efficiency.Results Compared with benign hyperplasia,early-stage NPC exhibited a significantly lower D mean([0.67±0.05]×10^(-3)mm^(2)/s vs.[0.90±0.11]×10^(-3)mm^(2)/s),ADC0-1000([0.65±0.09]×10^(-3)mm^(2)/s vs.[1.00±0.15]×10^(-3)mm^(2)/s),ADC300-1000([0.59±0.05]×10^(-3)mm^(2)/s vs.[0.76±0.10]×10^(-3)mm^(2)/s)and a higher D*mean([32.87±4.80]×10^(-3)mm^(2)/s vs.[21.87±5.21]×10^(-3)mm^(2)/s)(all P<0.001).There was no significant difference in the f value between the two groups(P=0.216).The cutoff value of D was 0.75×10^(-3)mm^(2)/s,with the sensitivity of 100%,specificity of 97.5%and accuracy of 96.9%.The AUC of ADC300-1000 was 0.988.Conclusions IVIM-DWI has potential to distinguish early-stage NPC from benign hyperplasia.D and ADC300-1000 mean are the appropriateparameters.