MRI在局灶性机化性肺炎和周围型肺癌鉴别诊断中的应用

Application of MRI in the Differential Diagnosis of Focal Organizing Pneumonia and Peripheral Lung Cancer

目的:探讨磁共振成像(MRI)对局灶性机化性肺炎(FOP)和周围型肺癌(PLC)的鉴别诊断价值。方法:回顾性分析2022年12月-2023年12月在本院就诊的60例PLC患者临床资料,将其作为PLC组,另取60例FOP患者作为FOP组。比较两组一般资料[年龄、性别、体质量指数(BMI)、吸烟史]和MRI征象[形态学特征(毛刺征、分叶征、空泡征、胸膜凹陷征、脓肿形成情况、纵隔淋巴结肿大情况),病变的表观扩散系数(ADC)值,病灶最大径及位置];采用ROC曲线分析相关参数对PLC患者的诊断价值。结果:PLC组患者毛刺征、分叶征、空泡征、脓肿形成、纵隔淋巴结肿大占比均较FOP组大,且ADC值较FOP组小,差异有统计学意义(P<0.05)。ROC曲线分析结果显示,存在毛刺征(AUC=0.658)值和纵隔淋巴结肿大(AUC=0.642),ADC值过低(AUC=0.758)对PLC的发生具有诊断价值,三者联合(AUC=0.767)诊断价值更高(P<0.05)。结论:存在毛刺征和纵隔淋巴结肿大,ADC值过低可以作为筛选PLC和FOP的诊断条件,且三者联合诊断价值更高。

Objective:To explore the value of magnetic resonance imaging(MRI)in the differential diagnosis of focal organizing pneumonia(FOP)and peripheral lung cancer(PLC).Methods:A retrospective analysis was performed on the clinical data of 60 patients with PLC(PLC group)and 60 patients with FOP(FOP group)in the hospital between December 2022 and December 2023.The general data[age,gender,body mass index(BMI),smoking history]and MRI signs[morphological characteristics(spicule sign,lobulation sign,vacuole sign,pleural indentation sign,abscess formation,mediastinal lymph node enlargement),apparent diffusion coefficient(ADC),maximum diameter and sites of lesions]were compared between the two groups.The diagnostic value of relevant parameters in PLC patients was analyzed by ROC curves.Results:The proportions of spicule sign,lobulation sign,vacuole sign,abscess formation and mediastinal lymph node enlargement in PLC group were higher than those in FOP group,while the ADC value was lower in the PLC group compared to the FOP group(P<0.05).The results of ROC curves analysis showed that spicule sign(AUC=0.658),mediastinal lymph node enlargement(AUC=0.642)and low ADC(AUC=0.758)were of diagnostic value for PLC,and diagnostic value of combined detection was higher(AUC=0.767,P<0.05).Conclusion:Spicule sign,mediastinal lymph node enlargement and low ADC can be applied as indexes in the differential diagnosis of PLC and FOP,and diagnostic value of combined detection is higher.