增强CT结合磁共振扩散加权成像在胸腺瘤诊断中的应用价值

Application value of enhanced CT combined with diffusion�weighted MRI in the diagnosis of thymoma

目的分析增强电子计算机断层扫描(CT)结合磁共振扩散加权成像(MRI-DWI)在胸腺瘤诊断中的价值。方法回顾性分析2017年1月—2022年12月在南通大学附属医院经病理诊断确诊的胸腺瘤及胸腺癌患者204例。其中,低危胸腺瘤组患者98例,高危胸腺瘤组患者62例,胸腺癌组患者44例。所有患者行增强CT及MRI-DWI检查。比较3组患者增强CT、MRI-DWI指标情况,分析增强CT联合MRI-DWI诊断胸腺癌的价值;比较高危胸腺瘤组及低危胸腺瘤组增强CT、MRI-DWI量化指标情况,分析增强CT联合MRI-DWI诊断高危胸腺瘤的价值。结果胸腺癌组边界不清楚占比高于低危胸腺瘤组、高危胸腺瘤组(P<0.05),高危胸腺瘤组边界不清楚占比高于低危胸腺瘤组(P<0.05);胸腺癌组最大增强CT值、增强前后CT最大差值、表观扩散系数(ADC)值均低于低危胸腺瘤组、高危胸腺瘤组(P<0.05),高危胸腺瘤组最大增强CT值、增强前后CT最大差值、ADC值低于低危胸腺瘤组(P<0.05)。ROC曲线分析结果显示,最大增强CT值、增强前后CT最大差值、ADC值及三者联合诊断胸腺癌的敏感性分别为68.19%(95%CI:0.451,0.853)、72.73%(95%CI:0.496,0.884)、77.27%(95%CI:0.542,0.913)、81.82%(95%CI:0.590,0.940),特异性分别为71.25%(95%CI:0.599,0.806)、77.50%(95%CI:0.665,0.858)、76.25%(95%CI:0.652,0.848)、92.50%(95%CI:0.838,0.96.9),曲线下面积分别为0.711(95%CI:0.604,0.817)、0.702(95%CI:0.594,0.810)、0.703(95%CI:0.586,0.821)、0.892(95%CI:0.824,0.960)。高危胸腺瘤组的最大增强CT值、增强前后CT最大差值均低于低危胸腺瘤组(P<0.05),两组平扫CT值比较,差异无统计学意义(P>0.05)。高危胸腺瘤组的ADC值低于低危胸腺瘤组(P<0.05)。ROC曲线分析结果显示,最大增强CT值、增强前后CT最大差值、ADC值及三者联合诊断高危胸腺瘤的敏感性分别为67.74%(95%CI:0.485,0.827)、70.97%(95%CI:0.518,0.851)、74.19%(95%CI:0.551,0.875)、83.87%(95%CI:0.655,0.939),特异性分别为79.59%(95%CI:0.652,0.893)、73.47%(95%CI:0.587,0.846)、71.43%(95%CI:0.565,0.830)、85.71%(95%CI:0.721,0.936),曲线下面积分别为0.709(95%CI:0.603,0.816)、0.701(95%CI:0.588,0.814)、0.722(95%CI:0.608,0.836)、0.900(95%CI:0.835,0.965)。结论最大增强CT值、增强前后CT最大差值联合ADC值诊断高危胸腺瘤及胸腺癌效能良好,具有一定临床价值。

Objective To analyze the value of contrast-enhanced computed tomography(CT)combined with diffusion-weighted magnetic resonance imaging(MRI-DWI)in the diagnosis of thymoma.Methods A retrospective analysis was conducted on 204 patients diagnosed with thymoma and thymic carcinoma at the Affiliated Hospital of Nantong University from January 2017 to December 2022.Among them,there were 98 patients in the low-risk thymoma group,62 patients in the high-risk thymoma group,and 44 patients in the thymic carcinoma group.All patients underwent contrast-enhanced CT and MRI-DWI examinations.The parameters of contrast-enhanced CT and MRI-DWI in the three groups of patients were compared,and the value of contrast�enhanced CT combined with MRI-DWI in diagnosing thymic carcinoma was analyzed.The quantitative parameters of contrast-enhanced CT and MRI-DWI in the high-risk thymoma group and low-risk thymoma group were compared,and the value of contrast-enhanced CT combined with MRI-DWI in diagnosing high-risk thymoma was analyzed.Results The proportion of unclear boundaries in the thymic carcinoma group was higher than that in the low-risk thymoma group and the high-risk thymoma group(P<0.05),and the proportion of unclear boundaries in the high-risk thymoma group was higher than that in the low-risk thymoma group(P<0.05).The maximum enhancement CT value,the maximum difference before and after enhancement,and the apparent diffusion coefficient(ADC)value in the thymic carcinoma group were lower than those in the low-risk thymoma group and the high-risk thymoma group(P<0.05),and those in the high-risk thymoma group were lower than those in the low�risk thymoma group(P<0.05).The results of ROC curve analysis showed that the sensitivity of the maximum enhancement CT value,the maximum difference before and after enhancement,ADC value,and the combined diagnosis of thymic carcinoma were 68.19%(95%CI:0.451,0.853),72.73%(95%CI:0.496,0.884),77.27%(95%CI:0.542,0.913),and 81.82%(95%CI:0.590,0.940),respectively,and the specificity were 71.25%(95%CI:0.599,0.806),77.50%(95%CI:0.665,0.858),76.25%(95%CI:0.652,0.848),and 92.50%(95%CI:0.838,0.969),respectively,with AUCs of 0.711(95%CI:0.604,0.817),0.702(95%CI:0.594,0.810),0.703(95%CI:0.586,0.821),and 0.892(95%CI:0.824,0.960).The maximum enhancement CT value and the maximum difference before and after enhancement in the high-risk thymoma group were lower than those in the low-risk thymoma group(P<0.05),and there was no significant difference in the plain CT value between the two groups(P>0.05).The ADC value in the high-risk thymoma group was lower than that in the low-risk thymoma group(P<0.05).The results of ROC curve analysis showed that the sensitivity of the maximum enhancement CT value,the maximum difference before and after enhancement,ADC value,and the combined diagnosis of high-risk thymoma were 67.74%(95%CI:0.485,0.827),70.97%(95%CI:0.518,0.851),74.19%(95%CI:0.551,0.875),and 83.87%(95%CI:0.655,0.939),respectively,and the specificity were 79.59%(95%CI:0.652,0.893),73.47%(95%CI:0.587,0.846),71.43%(95%CI:0.565,0.830),and 85.71%(95%CI:0.721,0.936),respectively,with AUCs of 0.709(95%CI:0.603,0.816),0.701(95%CI:0.588,0.814),0.722(95%CI:0.608,0.836),and 0.900(95%CI:0.835,0.965).Conclusion The maximum enhancement CT value,the maximum difference before and after enhancement combined with ADC value have good efficacy in the diagnosis of high-risk thymoma and thymic carcinoma,and have certain clinical value.