3.0 T MRI动态增强对腮腺肿瘤良恶性的鉴别及其ADC值与病理分级的相关性研究

Identification of Benign and Malignant Parotid Tumors by 3.0 T MR Dynamic Enhancement and Correlation between ADC Value and Pathological Grade

目的探讨3.0 T动态增强磁共振成像(DCE-MRI)半定量、定量分析对腮腺肿瘤良恶性的鉴别及其表观扩散系数(ADC)值与病理分级的相关性。方法回顾性分析2017年5月至2018年5月广东医科大学附属医院收治的腮腺肿瘤患者56例(共计74个肿块),对所有患者的MRI以及扩散加权成像(DWI)资料进行整合。对各肿块的ADC值、时间信号强度曲线(TIC)类型以及定量参数值进行统计分析,并通过受试者工作特征(ROC)曲线来计算诊断恶性肿瘤的各参数阈值,从而总结3.0 T DCE-MRI对腮腺肿瘤良恶性鉴别的异同点。结果良性肿瘤中的多形性腺瘤中86.67%(13/15)呈A型曲线,13.23%(2/15)呈C型曲线;腺淋巴瘤中有73.07%(19/26)呈B型曲线,另26.93%(7/26)呈C型曲线。恶性肿瘤中90.00%(9/10)呈C型曲线,10.00%(1/10)呈B型曲线。对良恶性腮腺肿瘤的TIC类型行χ2检验,P<0.05。选择TIC C型作为恶性肿瘤的诊断标准,其敏感度、特异度、准确度分别为76%、90%、78%。将多形性腺瘤、腺淋巴瘤、恶性肿瘤的ADC进行计算,分别为(1.467±0.920)×10-3mm2/s、(0.764±1.175)×10-3mm2/s、(1.081±0.097)×10-3mm2/s,行Kruskal-Wallis检验与χ2检验,P<0.05。恶性肿瘤、多形性腺癌、腺淋巴瘤以及其他良性肿瘤行χ2检验,结果发现,速率常数(Kep)值与血管外细胞外容积分数(Ve)值在各类肿瘤间差异具有统计学意义(P<0.05)。结论 3.0 T DCE-MRI对腮腺肿瘤良恶性的鉴别有着较高的临床价值,且可以根据ADC值对恶性肿瘤与多形性腺瘤、腺淋巴瘤进行鉴别诊断,因此应在临床上进一步推广应用。

Objective To investigate the differential diagnosis and differential analysis of 3.0 T MRI dynamic enhancement(DCE-MRI)for the differential diagnosis of benign and malignant tumors and the correlation between ADC value and pathological grade.Methods A retrospective analysis of 56 patients with a tumor of the parotid gland admitted to the Affiliated Hospital of Guangdong Medical University from May 2017 to May 2018(a total of 74 tumors)was performed.All patients were integrated with MRI and DWI data.The ADC value,time-signal intensity curve(TIC)type and quantitative parameter value of each tumor were statistically analyzed,and the threshold value of each parameter for diagnosis of malignant tumor was calculated by ROC curve,and the 3.0 T MRI dynamic enhancement was used to improve the benign and malignant tumors of the parotid gland.Identification of similarities and differences.Results 86.67%(13/15)of the pleomorphic adenomas in benign tumors showed a type A curve,13.23%(2/15)showed a C-shaped curve,and 73.07%(19/26)showed a B-shaped curve in adenolymphoma.Another 26.93%(7/26)showed a C-shaped curve.90.00%(9/10)of malignant tumors showed a C-shaped curve,and 10.00%(1/10)showed a B-shaped curve.The TIC type of benign and malignant salivary gland tumors was examined byχ2 test,P<0.05.The TIC C type was selected as the diagnostic criteria for malignant tumors,and its sensitivity,specificity,and accuracy were 76%,90%,and 78%,respectively.The ADCs of pleomorphic adenomas,adenomas,and malignant tumors were calculated as(1.467±0.920)×10-3mm2/s,(0.764±1.175)×10-3mm2/s,(1.081±,respectively).0.097)×10-3mm2/s,Kruskal-Wallis test andχ2 test,P<0.05.Malignant tumors,pleomorphic adenocarcinoma,adenolymphoma and other benign tumors were examined byχ2 test.The results showed that the difference between Kepvalue and Vevalue was statistically significant(P<0.05).Conclusion The dynamic enhancement of 3.0 T MRI has a high clinical value in the differential diagnosis of benign and malignant tumors.It can be used for the differential diagnosis of malignant tumors and pleomorphic adenomas and adenolymphomas according to ADC values.Therefore,it should be further promoted and applied in clinical practice.