IVIM参数在脊柱转移瘤与脊柱结核鉴别诊断中的价值

Values of IVIM Parameters in the Differential Diagnosis of Metastases and Tuberculosis in the Spine

目的探讨3.0 T MR体素内不相干运动(IVIM)对于脊柱转移瘤与脊柱结核、脊柱转移瘤原发灶鉴别诊断的应用价值。方法搜集经穿刺或手术病理证实为脊柱转移瘤(71例,其中肺癌43例,乳腺癌14例,肾癌14例)和脊柱结核(25例)患者的影像资料,用后处理软件测量感兴趣区(ROI)的标准表观扩散系数(ADC_(max))、真性扩散系数(ADC_(slow))、灌注相关扩散系数(ADC_(fsxt))、灌注分数(f)、扩散分布指数(DDC)、扩散异质性指数(α)。采用独立样本t检验或方差分析来比较脊柱转移瘤与脊柱结核、不同原发灶转移瘤的各参数是否具有统计学差异。将各参数代入Logistic回归模型,筛选出有意义的参数,使用受试者工作特征曲线(ROC)分析评估其单独及联合鉴别诊断的效能。结果脊柱转移瘤组的ADC;值高于脊柱结核组(P<0.05),f值低于脊柱结核组(P<0.05)。Logistic回归模型筛选后进入模型的指标为ADC;和f值,模型诊断的准确率为91.7%。在ROC分析中,ADC;和f单独鉴别二者的AUC值分别为0.903和0.859,联合应用ADC;和f鉴别二者的曲线下面积(AUC)值为0.947。在不同的转移瘤类型中,肺癌的ADC;、ADC;及DDC值显著低于乳腺癌和肾癌(P<0.05),肺癌的α值显著高于肾癌(P<0.05)。结论 IVIM参数有助于鉴别脊柱转移瘤与脊柱结核,并对于鉴别脊柱转移瘤原发灶有一定的应用价值。

Objective To investigate the value of 3.0 T MR intravoxel incoherent motion(IVIM) for the differential diagnosis of spinal metastases, spinal tuberculosis and primary lesions of spinal metastases. Methods The imaging data of 71 patients with spinal metastases(43 lung cancer, 14 breast cancer, 14 kidney cancer) and 25 patients with spinal tuberculosis were collected. Parameters of ADC_(max),ADC_(slow),ADC_(fsxt),f, DDC and α from IVIM were measured. The independent samples t-test or ANOVA was used to compare the statistical difference. Substituted each parameter into Logistic regression model, identified meaningful parameters, and evaluated their joint diagnostic performance using ROC analysis. Results The ADC;values in the spinal metastases group were higher than those in the spinal tuberculosis group(P< 0.05),while the f values were lower(P< 0.05).ADC;and f were found to conform to the Logistic regression model, and the accuracy was 91.7%.In the ROC analysis, the AUC of ADC;and f were 0.903 and 0.859,respectively, and the AUC for the combined application of ADC;and f was 0.947.The ADC;,ADC;and DDC values of lung cancer were significantly lower than those of breast cancer and renal cancer(P< 0.05),and the α value of lung cancer was significantly higher than that of kidney cancer(P< 0.05). Conclusion IVIM parameters are helpful in differentiating spinal metastases from spinal tuberculosis, and have some application in differentiating different metastatic tumor types.