WB-DWI对肺癌及其转移灶和淋巴结受累的诊断分析

Diagnostic and Analysis of Lung Cancer, Metastasis and Lymph Node Involvement by Whole-Body Diffusion Weighted Imaging

目的探讨磁共振全身弥散加权成像(whole body diffusion weighted imaging,WB-DWI)对肺癌及其转移灶、淋巴结受累的诊断价值。方法选取2018年1月~2019年12月于本院就诊的肺癌患者260例,所有患者均行WBDWI诊断,以手术、穿刺活检以及临床随访结果为金标准,分析两种检查手段在肺癌及其转移灶、淋巴结受累诊断中的价值。结果经手术、穿刺活检以及临床随访结果确诊,260例肺癌的患者中50例患者出现转移病灶,共145处,其中累及淋巴结120处。淋巴结累及部位包括颈部25处、纵隔42处、腹腔25处、盆腔28处。WB-DWI检查肺癌转移病灶累及淋巴结的准确性为93.79%(136/145)、灵敏度为95.83%(115/120)、特异度为84.00%(21/25)、阳性预测值96.64%(115/119)、阴性预测值为80.77%(21/26);经一致性Kappa度量,WB-DWI诊断累及淋巴结的转移病灶结果和手术、穿刺活检、临床随访结果一致性较高(Kappa=0.786,P=0.000);转移病灶累及淋巴结者表观扩散系数(apparent diffusion coeffi cient,ADC)值低于未累及淋巴结者,指数化表观弥散系数(exponential apparent diffusion coeffi cient,eADC)高于未累及淋巴结者,差异有统计学意义(P<0.05)。结论WB-DWI在肺癌转移灶累及淋巴结诊断中的价值较为显著,有助于制定更为准确、高效、安全的治疗方案。

Objective To explore the diagnostic value of magnetic resonance whole-body diffusion weighted imaging(WB-DWI)for lung cancer,metastasis and lymph node involvement.Methods A total of 260 lung-cancer patients who were treated in our hospital from January 2018 to December 2019 were selected.All patients were diagnosed by WBDWI.The surgical,puncture biopsy and clinical follow-up results were used as the gold-standard.Analyzed the value in the diagnosis of metastasis and lymph node involvement.Results After surgery,biopsy and clinical follow-up,the diagnosis was confirmed.Among the 260 patients with lung cancer,50 patients had metastatic lesions,a total of 145 lesions,including 120 lymph nodes.The lymph node involved sites included 25 in the neck,42 in the mediastinum,25 in the abdominal cavity and 28 in the pelvic cavity.The accuracy of WB-DWI to detect lymph node involvement in lung cancer metastasis was 93.79%(136/145),sensitivity was 95.83%(115/120),specificity was 84.00%(21/25),positive predictive value was 96.64%(115/119),the negative predictive value was 80.77%(21/26).According to the consistent Kappa measurement,the results of WB-DWI diagnosis of lymph node metastasis and surgical,puncture biopsy,clinical follow-up results were highly consistent(Kappa=0.786,P=0.000),the metastatic lesions involving lymph nodes had lower apparent diffusion coefficient(ADC)values than those without lymph nodes involvement,and the exponential apparent diffusion coefficient(eADC)was higher than those without lymph nodes involvement,the difference was statistically significant(P<0.05).Conclusion The value of WB-DWI in the diagnosis of lung cancer metastasis involving lymph nodes is significant,which helps to formulate more accurate,efficient and safe treatment plans.