ADC值评估原发性干燥综合征唾液腺淋巴结炎性的应用价值

Application of ADC values to assess inflammatory lymph nodes in the drainage area of the salivary glands of patients with primary Sjogren's syndrome

目的探讨原发性干燥综合征(primary Sj?gren’s syndrome,pSS)患者治疗前后唾液腺引流区淋巴结的表观扩散系数(apparent diffusion coefficient,ADC)值和形态变化及其在反映pSS患者疾病炎性活动程度的潜在可能性。材料与方法收集23例pSS患者,分别于治疗前、规律治疗12周后行常规头颈部MRI与扩散加权成像(diffusion weighted imaging,DWI)检查,经过后处理得到ADC图像。与15例健康志愿者对照,使用t检验比较pSS患者治疗前后、健康志愿者各区淋巴结的形态及ADC值。结果pSS患者治疗前Ⅰb、Ⅱa、Ⅱb区淋巴结短径均大于健康志愿者[Ⅰb(t=2.293,P=0.028)、Ⅱa(t=2.397,P=0.022)、Ⅱb(t=1.409,P=0.030)],治疗12周后唾液腺引流各区淋巴结短径均较治疗前减小[Ⅰa(t=4.391,P<0.001)、Ⅰb(t=3.439,P=0.002)、Ⅱa(t=3.458,P=0.002)、Ⅱb(t=4.667,P=0.001)]。pSS患者治疗前Ⅰb、Ⅱa区淋巴结ADC值小于健康志愿者[Ⅰb(t=3.337,P=0.002)、Ⅱa(t=2.207,P=0.038)],治疗12周后Ⅰa、Ⅰb、Ⅱa区淋巴结ADC值大于治疗前[Ⅰa(t=3.674,P=0.001)、Ⅰb(t=2.198,P=0.039)、Ⅱa(t=2.484,P=0.004)]。结论Ⅰb、Ⅱa、Ⅱb区淋巴结短径在鉴别pSS患者与健康志愿者可能具有应用价值,唾液腺引流各区淋巴结短径在鉴别pSS患者自身治疗前后可能具有应用价值;Ⅰb、Ⅱa区淋巴结ADC值在鉴别pSS患者与健康志愿者可能具有应用价值,Ⅰa、Ⅰb、Ⅱa区淋巴结ADC值在鉴别pSS患者自身治疗前后可能具有应用价值。

Objective:To investigate the apparent diffusion coefficient(ADC)and morphology of lymph nodes in the drainage area of salivary glands among patients with primary Sjögren's syndrome(pSS)before and after treatment and healthy volunteer,and its potential in reflecting the degree of inflammatory activity of the disease in patients with pSS.Materials and Methods:A total of 23 patients with pSS were collected to undergo routine head and neck MRI and diffusion weighted imaging(DWI)before and after 12 weeks of regular treatment,respectively.ADC images were obtained after post-processing.Then 15 healthy volunteers were collected as controls during the same period.Using t-test to compare the morphology and ADC values of the lymph nodes in each level among the pSS patients before and after treatment,and healthy volunteers.Results:The short diameters of lymph nodes in levelⅠb,Ⅱa,andⅡb in patients with pSS before treatment were larger than those of healthy volunteers[Ⅰb(t=2.293,P=0.028),Ⅱa(t=2.397,P=0.022),Ⅱb(t=1.409,P=0.030)],and the short diameters of lymph nodes in all salivary gland drainage levels were smaller after 12 weeks of treatment[Ⅰa(t=4.391,P<0.001),Ⅰb(t=3.439,P=0.002),Ⅱa(t=3.458,P=0.002),Ⅱb(t=4.667,P=0.001)].ADC values of lymph nodes in levelⅠb andⅡa in pSS patients before treatment were smaller than those of healthy volunteers[Ⅰb(t=3.337,P=0.002),Ⅱa(t=2.207,P=0.038)],and they became larger than those of lymph nodes in levelⅠa,Ⅰb,andⅡa after 12 weeks of treatment[Ⅰa(t=3.674,P=0.001),Ⅰb(t=2.198,P=0.039),Ⅱa(t=2.484,P=0.004)].Conclusions:The short diameters of lymph nodes in levelⅠb,Ⅱa andⅡb may be of great value in identifying patients with pSS and healthy volunteers,and the short diameters of lymph nodes in all levels may be of great value in identifying patients with pSS before and after treatment;the ADC values of lymph nodes in levelⅠb andⅡa may be of great value in identifying patients with pSS and healthy volunteers,and the ADC values of lymph nodes in level Ia,Ⅰb andⅡa may be of great value in identifying patients with pSS before and after treatment.