T_(2)mapping及RESOLVE-DWI在腮腺肿瘤鉴别诊断中价值

Values of T_(2)mapping and RESOLVE-DWI to the differential diagnosis of parotid gland tumors

目的应用T_(2)mapping及RESOLVE-DWI定量分析腮腺肿瘤特征,探讨T_(2)值、表观弥散系数(ADC)值及二者联合鉴别诊断腮腺肿瘤的价值。方法2018年6月—2021年7月郑州大学第一附属医院诊治腮腺肿瘤患者166例,其中多形性腺瘤76例,Warthin瘤29例,基底细胞腺瘤11例,恶性肿瘤50例,治疗前均行T_(2)mapping及RESOLVE-DWI检查,测量4类肿瘤T_(2)值、ADC值并进行比较;绘制ROC曲线,评估T_(2)值、ADC值及二者联合鉴别诊断腮腺肿瘤的效能,AUC比较采用DeLong检验。结果(1)2名医师测量腮腺肿瘤T_(2)值、ADC值一致性较好(ICC=0.940,95%CI:0.919~0.956,P<0.001;ICC=0.919,95%CI:0.670~0.966,P<0.001)。(2)Warthin瘤、基底细胞腺瘤、恶性肿瘤T_(2)值[(87.38±31.30)、(113.50±22.97)、(97.13±43.37)ms]及ADC值[(0.72±0.10)×10^(-3)、(1.14±0.23)×10^(-3)、(0.94±0.35)×10^(-3)mm^(2)/s]均低于多形性腺瘤[(143.26±51.65)ms、(1.40±0.30)×10^(-3)mm^(2)/s](P<0.05);基底细胞腺瘤T_(2)值高于Warthin瘤(P<0.05),恶性肿瘤T_(2)值与Warthin瘤、基底细胞腺瘤比较差异均无统计学意义(P>0.05);基底细胞腺瘤、恶性肿瘤ADC值均高于Warthin瘤(P<0.05),恶性肿瘤ADC值与基底细胞腺瘤比较差异无统计学意义(P>0.05)。(3)T_(2)值、ADC值及二者联合鉴别诊断腮腺多形性腺瘤与Warthin瘤的AUC分别为0.893(95%CI:0.817~0.945,P<0.001)、0.999(95%CI:0.963~1.000,P<0.001)、0.999(95%CI:0.964~1.000,P<0.001),多形性腺瘤与基底细胞腺瘤的AUC分别为0.691(95%CI:0.583~0.786,P=0.008)、0.728(95%CI:0.622~0.818,P=0.004)、0.725(95%CI:0.619~0.815,P=0.006),多形性腺瘤与恶性肿瘤的AUC分别为0.839(95%CI:0.763~0.898,P<0.001)、0.867(95%CI:0.795~0.921,P<0.001)、0.885(95%CI:0.816~0.935,P<0.001),Warthin瘤与基底细胞腺瘤的AUC分别为0.865(95%CI:0.720~0.952,P<0.001)、0.966(95%CI:0.854~0.998,P<0.001)、0.959(95%CI:0.844~0.997,P<0.001),Warthin瘤与恶性肿瘤的AUC分别为0.631(95%CI:0.515~0.737,P=0.044)、0.695(95%CI:0.581~0.794,P=0.001)、0.693(95%CI:0.579~0.792,P=0.001)。ADC值和二者联合鉴别诊断腮腺多形性腺瘤与Warthin瘤的AUC均大于T_(2)值(Z=2.336,P=0.020;Z=2.348,P=0.019),ADC值与二者联合的AUC比较差异无统计学意义(Z=0.707,P=0.480);T_(2)值、ADC值及二者联合鉴别诊断腮腺多形性腺瘤与基底细胞腺瘤、多形性腺瘤与恶性肿瘤、Warthin瘤与基底细胞腺瘤、Warthin瘤与恶性肿瘤的AUC两两比较差异均无统计学意义(P>0.05)。结论T_(2)mapping、RESOLVE-DWI可定量评估腮腺肿瘤特征,T_(2)值、ADC值及二者联合鉴别诊断腮腺肿瘤的效能基本相当,其中鉴别多形性腺瘤与Warthin瘤的效能最高。

Objective To analyze the features of parotid gland tumors with T_(2)mapping and RESOLVE-DWI,and to investigate the values of single and combined application of T_(2)mapping and apparent diffusion coefficient(ADC)to the differential diagnosis of parotid gland tumors:Methods A total of 166 patients with parotid gland tumors were diagnosed and treated in the First Hospital of Zhengzhou University from June 2018 to July 2021,including pleomorphic adenoma in76 patients,Warthin tumors in 29,basal cell adenomas in 11 and malignancies in 50.T_(2)mapping and RESOLVE-DWI were performed beforetherapy to measure and compare the T_(2)and ADC values of these four types of tumors.ROC curves were plotted to evaluate the efficiencies of single and combined application of T_(2)and ADC values on the differential diagnosis of parotid gland tumors.The AUCs were compared with the DeLong test.Results(1)A good consistency was achieved in the T_(2)and ADC values measured by two physicians(ICC=0.940,95%CI:0.919-0.956,P<0.001;ICC=0.919,95%CI:0.670-0.966,P<0.001).(2)The T_(2)and ADC values were lower in Warthin tumors[(87.38±31.30)ms,(0.72±0.10)×10^(3)mm^(2)/s],basal cell adenomas[(113.50±22.97)ms,(1.14±0.23)×10^(3)mm^(2)/s]and malignant tumors[(97.13±43.37)ms,(0.94±0.35)×10^(3)mm^(2)/s]than those in pleomorphic adenomas[(143.26±51.65)ms,(1.40±0.30)×10^(3)mm^(2)/s](P>0.05),the T_(2)value was higher in basal cell adenomas than that in Warthin tumors(P<0.05),and the T_(2)value showed no significant difference in malignant tumors compared with that in Warthin tumors and basal cell adenomas(P>0.05).The ADC value was higher in basal cell adenomas and malignant tumors than that in Warthin tumors(P<0.05),and showed no significant difference between malignant tumors and basal cell adenomas(P>0.05).(3)The AUCs of single and combined application of T_(2)and ADC values for differentiating pleomorphic adenomas from Warthin tumors were 0.893(95%CI:0.817-0.945,P<0.001),0.999(95%CI:0.963-1.000,P<0.001)and 0.999(95%CI:0.964-1.000,P<0.001),for differentiating pleomorphic adenomas from basal cell adenomas were 0.691(95%CI:0.583-0.786,P=0.008),0.728(95%CI:0.622-0.818,P=0.004)and 0.725(95%CI:0.619-0.815,P=0.006),for differentiating pleomorphic adenomas from malignant tumors were 0.839(95%CI:0.763-0.898,P<0.001),0.867(95%CI:0.795-0.921,P<0.001)and 0.885(95%CI:0.816-0.935,P<0.001),for differentiating Warthin tumors from basal cell adenomas were 0.865(95%CI:0.720-0.952,P<0.001),0.966(95%CI:0.854-0.998,P<0.001)and 0.959(95%CI:0.844-0.997,P<0.001),and for differentiating Warthin tumors from malignant tumors were 0.631(95%CI:0.515-0.737,P=0.044),0.695(95%CI:0.581-0.794,P=0.001)and 0.693(95%CI:0.579-0.792,P=0.001).The AUCs of ADC and combination of T_(2)and ADC were greater than that of T_(2)for differentiating pleomorphic adenomas from Warthin tumors(Z=2.336,P=0.020;Z=2.348,P=0.019),and the AUC of ADC showed no significant difference from that of combination of them two(Z=0.707,P=0.480).Multiple comparison showed no significant differences in AUCs for differentiating pleomorphic adenomas from basal cell tumors,pleomorphic adenomas from malignant tumors,Warthin tumors from basal cell tumors and Warthin tumors from malignant tumors(P>0.05).Conclusions T_(2)mapping and RESOLVE-DWI can quantitatively assess the features of parotid gland tumors.The single and combined application of T_(2)and ADC values achieve similar efficiencies.The efficiency on differentiating pleomorphic adenomas from Warthin tumors the highest.