不同b值弥散加权成像对肺结核分型诊断及对耐多药风险评估的预测

Diffusion weighted imaging with different b-values for the classification diagnosis of pulmonary tuberculosis and prediction of multidrug-resistance risk

目的:探究不同b值弥散加权成像(diffusion weighted imaging,DWI)对肺结核分型诊断及对耐多药风险评估的预测。方法:选取2020年10月至2023年5月于黑龙江省传染病防治院就诊的110例肺结核患者作为研究对象。对全部患者行不同b值(0、500、800、1000s/mm^(2))的DWI检查,比较不同b值下DWI诊断肺结核分型的效能。依据患者耐药检测结果,将110例患者分为耐多药组(47例)和药物敏感组(63例),比较两组患者的临床特征资料,通过logistic回归探究表观扩散系数与耐多药肺结核的关系。结果:b值为800s/mm^(2)时,诊断各肺结核分型的漏诊率(1.82%,2/110)和误诊率(3.64%,4/110)明显低于b值为0、500、1000s/mm^(2)时[漏诊率和误诊率分别为11.82%(13/110)和17.27%(19/110),9.09%(10/110)和13.64%(15/110),8.18%(9/110)和10.91%(12/110)],差异均有统计学意义(漏诊:χ^(2)=8.657,P=0.003;χ^(2)=5.641,P=0.018;χ^(2)=4.689,P=0.030。误诊:χ^(2)=10.925,P=0.000;χ^(2)=6.970,P=0.008;χ^(2)=4.314,P=0.038)。b值为800s/mm^(2)时的受试者工作特征曲线下面积、准确率和约登指数最高,分别为0.874、96.35%和0.788,均高于b值为0、500、1000s/mm^(2)时(分别为0.718、82.73%、0.612,0.735、86.36%、0.695,0.862、89.09%、0.724)。校正混杂因素后,表观扩散系数与耐多药风险仍存在独立相关性,表观扩散系数与耐多药风险呈负相关(r=-0.719,P<0.05)。结论:b值为800s/mm^(2)时DWI在肺结核分型鉴别诊断中效果更为显著,具有更高的准确率;表观扩散系数与耐多药风险呈负相关关系。

Objective:To investigate the diagnostic efficacy of diffusion weighted imaging(DWI)with different b-values in classifying tuberculosis(TB)and predicting multidrug-resistance(MDR)risk.Methods:This study enrolled 110 TB patients admitted to Heilongjiang Provincial Infectious Disease Prevention and Control Hospital between October 2020 and May 2023.All patients underwent DWI with various b-values(0,500,800,1000 s/mm^(2))to compare the diagnostic accuracy for TB classification at different b-values.Based on drug resistance test results,the 110 patients were divided into an MDR-TB group(47 cases)and a drug-sensitive TB group(63 cases).Clinical data and imaging features of the two groups were compared,and logistic regression was used to explore the relationship between apparent diffusion coefficient(ADC)and MDR-TB.Results:At a b-value of 800 s/mm^(2),the rates of missed diagnosis(1.82%,2/110)and misdiagnosis(3.64%,4/110)in diagnosing various classifications of TB were significantly lower than those at b-values of 0,500,and 1000 s/mm^(2)(the missed diagnosis rate and misdiagnosis rate were 11.82%(13/110)and 17.27%(19/110),9.09%(10/110)and 13.64%(15/110),8.18%(9/110)and 10.91%(12/110),respectively),the differences were statistically significant(missed diagnosis:χ^(2)=8.657,P=0.003;χ^(2)=5.641,P=0.018;χ^(2)=4.689,P=0.030;misdiagnosis:χ^(2)=10.925,P=0.000;χ^(2)=6.970,P=0.008;χ^(2)=4.314,P=0.038).The area under the curve,accuracy,and Youden index of the receiver operating characteristic curve with a b-value of 800 s/mm^(2) were the highest(0.874,96.35%,and 0.788,respectively),all higher than those with b-values of 0,500,and 1000 s/mm^(2)(0.718,82.73%,0.612,and 0.735,86.36%,0.695,and 0.862,89.09%,0.724,respectively).After adjusting confounding factors,ADC was independently correlated with MDR risk,showing a negative correlation(r=-0.719,P<0.05).Conclusion:DWI with a b-value of 800 s/mm^(2) demonstrates superior efficacy in diagnosing different TB classifications,with higher sensitivity and accuracy.ADC was negatively correlated with MDR risk.