多模态磁共振成像技术对腮腺Warthin瘤与多形性腺瘤的鉴别价值

Value of multimodal magnetic resonance imaging in differentiating Warthin tumor from pleomorphic adenoma of parotid gland

目的:探讨多模态磁共振成像(MRI)技术对腮腺Warthin瘤与多形性腺瘤的鉴别价值。方法:回顾性分析2017年10月至2021年5月经病理学证实的腮腺Warthin瘤62例(66个病灶)和多形性腺瘤47例(49个病灶)患者的资料,所有患者术前均行常规MRI、扩散加权成像(DWI)、动态对比增强(DCE)检查。比较腮腺Warthin瘤与多形性腺瘤患者临床特征,表观扩散系数(ADC)值,DCE-MRI参数值,采用受试者工作特征(ROC)曲线分析ADC值和DCE-MRI参数值在腮腺Warthin瘤与多形性腺瘤中的鉴别价值。结果:腮腺Warthin瘤与多形性腺瘤病灶最大截面积、部位、形状、边界比较,差异均无统计学意义(P>0.05),两组男女比例差异有统计学意义(P<0.001),腮腺Warthin瘤病灶囊变数明显少于多形性腺瘤患者(P<0.001);腮腺Warthin瘤病灶ADC值明显低于多形性腺瘤(P<0.001)。两组患者速率常数(Kep)、对比剂浓度曲线下初始面积(iAUC)差异均无统计学意义(P>0.05),腮腺Warthin瘤容量转移常数(Ktrans)明显高于多形性腺瘤(P<0.001),血管外细胞外间隙容积比(Ve)明显低于多形性腺瘤(P<0.001)。ROC曲线分析显示,ADC、Ktrans、Ve的最佳截断点分别为1.00×10-3 mm2/s,0.19 min-1,0.42,灵敏度分别为81.82%,83.33%,84.85%,特异度分别为73.47%,77.55%,69.39%,曲线下面积(AUC)分别为0.814,0.741,0.760,三者联合诊断的特异度、AUC分别为95.92%和0.866。结论:多模态MRI技术用于腮腺Warthin瘤与多形性腺瘤鉴别诊断具有较高的临床应用价值。

Objective:To explore the value of multimodal magnetic resonance imaging(MRI)technology in distinguishing parotid Warthin tumor and pleomorphic adenoma.Methods:The data of patients with pathologically confirmed Warthin tumors of the parotid gland(62 cases,66 lesions)and pleomorphic adenomas(47 cases,49 lesions)admitted to the hospital from October 2017 to May 2021 retrospectively analyzed,all patients underwent routine MRI,diffusion weighted imaging(DWI),and dynamic contrast enhancement(DCE)examinations before surgery.Clinical characteristics,apparent diffusion coefficient(ADC)values and DCE-MRI parameter values of patients with Warthin tumor and pleomorphic adenoma of the parotid gland were compared.In addition,the receiver operating characteristic(ROC)curve was used to analyze the differential value of ADC value and DCE-MRI parameter value in parotid Warthin tumor and pleomorphic adenoma.Results:There were no significant difference in maximum cross-sectional area of the lesion,lesion location,lesion shape,and lesion boundary between patients with Warthin tumor of the parotid gland and pleomorphic adenoma(P>0.05),the difference in the ratio of male to female in the two groups was statistically significant(P<0.001),patients with Warthin tumor of the parotid gland were less cystic than those with pleomorphic adenoma(P<0.001).The ADC value of patients with Warthin tumor of the parotid gland was lower than that of patients with pleomorphic adenoma(P<0.001).There were no statistically significant difference in the rate constant(Kep)and initial area under the contrast agent concentration curve(iAUC)between patients with Warthin tumor of the parotid gland and pleomorphic adenoma(P>0.05).The volume transfer constant(Ktrans)value of patients with Warthin tumor of the parotid gland was higher than that of patients with pleomorphic adenoma(P<0.001),the extravascular extracellular space volume ratio(Ve)of patients with Warthin tumor of the parotid gland was lower than that of patients with pleomorphic adenoma(P<0.001).ROC analysis shows that the best cut-off points for ADC,Ktrans,and Ve were 1.00×10-3 mm2/s,0.19 min-1,0.42,the sensitivity were 81.82%,83.33%,84.85%,the specificity were 73.47%,77.55%,69.39%,and the area under the curve(AUC)were 0.814,0.741,0.760,respectively.The specificity and AUC of the combination of the three were 95.92%and 0.866,respectively.Conclusion:Multimodal MRI technology has high clinical application value for the differential diagnosis of parotid Warthin tumor from pleomorphic adenoma.