MRI多参数联合对腮腺腺淋巴瘤与多形性腺瘤的鉴别诊断价值

Diagnostic value of MRI multi-parameter combination in differentiating warthin’s tumor and pleomorphic adenoma

目的:探讨MRI多参数联合对腮腺腺淋巴瘤(Warthin’s tumor,WT)与多形性腺瘤(Pleomorphic adenoma,PA)的鉴别诊断价值。方法:回顾性选取经手术病理证实的WT 38例共45枚,判断及测量瘤体是否位于尾叶、纵横比、T_(1)WI瘤体最大信号与脊髓平均信号比值(T_(1)-max-SIR)、T_(2)WI瘤体平均信号与脊髓平均信号比值(T_(2)-SIR)及瘤体增强扫描二期与一期比值(T_(1)-e-SIR),并与37例37枚PA对比,绘制ROC曲线分析单参数的诊断效能,利用Logistic线性回归分析将5个参数进行线性拟合并绘制多因素ROC曲线,通过计算曲线下面积(AUC),比较单参数及多参数联合鉴别WT及PA诊断效能的差异。观测者间差异采用Cohen’s kappa coefficient分析。结果:位于尾叶的WT和PA分别占84.4%和18.9%(χ^(2)=35.207,P<0.05),WT和PA的纵横比、T_(1)-max-SIR、T_(2)-SIR、T_(1)-e-SIR分别为1.50±0.28和1.21±0.26(t=4.887,P<0.05)、1.72(1.45,2.11)和1.21(1.09,1.36)(Z=-5.633,P<0.05)、1.09±0.31和1.88±0.70(t=-6.823,P<0.05)、0.87(0.76,0.98)和1.17(1.07,1.39)(Z=-6.739,P<0.05)。瘤体位于尾叶、纵横比、T_(1)-max-SIR、T_(2)-SIR及T_(1)-e-SIR的AUC分别为0.828、0.788、0.863、0.860、0.891,5个征象联合诊断的AUC为0.988。两观测值间具有很好的一致性(Cohen’s kappa为0.754~0.911)。结论:瘤体位于尾叶、纵横比、T_(1)-max-SIR、T_(2)-SIR及T_(1)-e-SIR均能有效鉴别WT与PA,而多参数联合可进一步提高诊断效能。

Objective:To investigate the value of MRI multi-parameter combination in the differential diagnosis of warthin’s tumor(WT)and pleomorphic adenoma(PA).Methods:MRI data of 45 WT in 38 patients confirmed by pathology were retrospectively collected.Whether the tumor was located in tail lobe,anteroposterior/transverse diameter ratio,T_(1)WI maximum signal intensity of tumor to spinal cord signal intensity ratio(T_(1)-max-SIR),T_(1)WI average signal intensity of tumor to spinal cord signal intensity ratio(T_(1)-SIR)and signal intensity of enhanced phaseⅡto enhanced phaseⅠratio(T_(1)-e-SIR)were observed and measured,then these parameters of WT were compared with those of 37 PA in 37 patients.The diagnostic efficacy of each parameter for differentiating WT and PA was obtained by ROC curve analysis.Using Logistic linear regression analysis,the five parameters were linearly fitted and the multi-factor ROC curve was drawn.The difference of diagnostic efficacy between single parameter and multi-parameter combination in differentiating WT and PA were compared by the area under curve(AUC).The interobserver agreement between readers was analyzed by Cohen’s kappa coefficient.Results:WT and PA located in tail lobe accounted for 84.4%and 18.9%,respectively(χ^(2)=35.207,P<0.05).The anteroposterior/transverse diameter ratio,T_(1)-max-SIR,T_(1)-SIR,T_(1)-e-SIR of WT and PA were 1.50±0.28 and 1.21±0.26(t=4.887,P<0.05),1.72(1.45,2.11)and1.21(1.09,1.36)(Z=-5.633,P<0.05),1.09±0.31 and 1.88±0.70(t=-6.823,P<0.05),0.87(0.76,0.98)and 1.17(1.07,1.39)(Z=-6.739,P<0.05),respectively.The AUC of location in tail lobe,anteroposterior/transverse diameter ratio,T_(1)-max-SIR,T_(1)-SIR and T_(1)-e-SIR were 0.828,0.788,0.863,0.860 and 0.891,respectively.The AUC of five parameter combination was 0.988.Interobserver agreement was good between readers(k=0.754~0.911).Conclusion:Location in tail lobe,anteroposterior/transverse diameter ratio,T_(1)-max-SIR,T_(1)-SIR and T_(1)-e-SIR could effectively differentiate WT and PA,and the multi-parameter combination could further improve the diagnostic efficiency.