CAJ | 학술논문

目的探讨基于体素内不相干运动(IVIM)理论MR DWI技术在鼻咽癌(NPC)应用的可行性,进一步探讨真实扩散系数(D值)、灌注相关扩散系数(D*值)及灌注分数(f值)在首发鼻咽癌的诊断价值.方法选择2011年12月至2013年1月临床怀疑鼻咽癌患者40例,男26例、女14例,中位年龄52岁.患者均行3.0 TMR扫描,IVIM DWI采用13个b值(0、10、20、30、50、80、100、150、200、300、400、600、800 s/mm2).患者MR检查后0～11d(平均间隔3d)均行鼻咽部活检；根据不同病理结果分为2组,A组为NPC组(男17例、女9例,中位年龄54岁),B组为鼻咽慢性增生性炎症(NPH)组(男9例、女5例,中位年龄35岁).IVIM参数值D值、D*值及f值的比较采用非参数Mann-Whitney检验法.结果 40例中完成IVIM DWI的患者共36例(其中,A组26例中完成24例,B组14例中完成12例).A组D值为(0.70±0.13)×10-3 mm2/s,和B组(0.78±0.05)×10-3mm2/s相比,差异有统计学意义(U=2.05,P＜0.05).A组的f值为(16.25±1.46)％,B组为(26.20±3.90)％,差异有统计学意义(U=11.16,P＜0.01)；而D*值A组为(161.8 ±23.56)×10-3 mm2/s,B组为(55.28±17.05)×10-3 mm2/s,A组较B组显著增高(U=13.90,P＜0.01).结论 IVIM DWI技术在鼻咽癌的应用是切实可行的,不同D值对鼻咽癌及鼻咽部慢性炎症具有一定的鉴别价值,D*值在鼻咽部良恶性疾病鉴别诊断方面具有潜在的重要价值.
목적 탐토기우체소내불상간운동(IVIM)이론MR DWI기술재비인암(NPC)응용적가행성,진일보탐토진실확산계수(D치)、관주상관확산계수(D*치)급관주분수(f치)재수발비인암적진단개치.방법 선택2011년12월지2013년1월림상부의비인암환자40례,남26례、녀14례,중위년령52세.환자균행3.0 TMR소묘,IVIM DWI채용13개b치(0、10、20、30、50、80、100、150、200、300、400、600、800 s/mm2).환자MR검사후0～11d(평균간격3d)균행비인부활검；근거불동병리결과분위2조,A조위NPC조(남17례、녀9례,중위년령54세),B조위비인만성증생성염증(NPH)조(남9례、녀5례,중위년령35세).IVIM삼수치D치、D*치급f치적비교채용비삼수Mann-Whitney검험법.결과 40례중완성IVIM DWI적환자공36례(기중,A조26례중완성24례,B조14례중완성12례).A조D치위(0.70±0.13)×10-3 mm2/s,화B조(0.78±0.05)×10-3mm2/s상비,차이유통계학의의(U=2.05,P＜0.05).A조적f치위(16.25±1.46)％,B조위(26.20±3.90)％,차이유통계학의의(U=11.16,P＜0.01)；이D*치A조위(161.8 ±23.56)×10-3 mm2/s,B조위(55.28±17.05)×10-3 mm2/s,A조교B조현저증고(U=13.90,P＜0.01).결론 IVIM DWI기술재비인암적응용시절실가행적,불동D치대비인암급비인부만성염증구유일정적감별개치,D*치재비인부량악성질병감별진단방면구유잠재적중요개치.
Objective To investigate the feasibility of diffusion-weighted(DWI) MRI on basis of the intravoxel incoherent motion (IVIM) in nasopharyngeal carcinoma (NPC),and the diagnostic value of pure molecular diffusion coefficient (D),perfusion-related diffusion coefficient (D *) and perfusion fraction (f) in first onset NPC.Methods From December 2011 to January 2013,40 consecutive patients (26 men,14 women; median age,52 years) with suspected NPC were examined on a 3.0 T MR scanner.DW imaging was performed by using a single-shot echo-planar sequence with 13 b-values (0,10,20,30,50,80,100,150,200,300,400,600,800 s/mm2).MR imaging was compared with endoscopy and biopsy for the detection of NPC.Mean interval time between MR imaging examination and subsequent nasopharyngeal biopsy was 3 days (range,0-11 days).The subjects were divided into 2 groups according to the pathological results,group A was subjects with NPC (17 men,9 women; median age,35) and group B was ones with nasopharyngeal chronic hyperplastic inflammation(NPH) (9 men,5 women; median age,35).The D,D * and f were measured and compared in patients with first onset NPC and nasopharyngeal hyperplasia (Mann-Whitney test).Results IVIM DWI was successful in 24/26 with NPC and 12/14 with NPH.D value was significantly lower in A group compared with B group [mean,(0.70 ± 0.13) ×10-3 mm2/s vs (0.78 ± 0.05) × 10-3 mm2/s ; U =2.05,P ＜ 0.05],as was f value [mean,(16.25 ±1.46) ％ vs (26.20 ± 3.90) ％ ; U =11.16,P ＜ 0.01].However,D* value was significantly higher in Agroupas compared with B group[mean,(161.8 ±23.56) × 10-3 mm2/s vs (55.28 ± 17.05) × 10-3 mm2/s; U =13.90,P ＜0.01].Conclusions IVIM DWI is a feasible technique for investigating first onset NPC and D value has a certain value in differentiating NPC and NPH.D* value has an important potential value in distinguishing benign and malignant NPC.