中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2013年
7期
622-628
,共7页
张妍%黄永波%王晞星%王峻
張妍%黃永波%王晞星%王峻
장연%황영파%왕희성%왕준
淋巴转移%癌,非小细胞肺%磁共振成像
淋巴轉移%癌,非小細胞肺%磁共振成像
림파전이%암,비소세포폐%자공진성상
Lymphatic metastasis%Carcinoma,non-small-cell lung%Magnetic resonance imaging
目的 比较全身MR-DWI(WB-DWI)、常规MRI和(或)CT(MRI-CT)及二者联合应用(WB-DWI+ MRI-CT)对非小细胞肺癌(NSCLC)淋巴结转移的检出能力.方法 对56例病理确诊的NSCLC患者行WB-DWI、胸部CT扫描,并于扫描后1周内对可疑淋巴结转移部位行常规MR扫描,必要时增强扫描.应用ROC曲线比较WB-DWI、MRI-CT及二者联合应用在NSCLC淋巴结转移中的诊断价值.应用x2检验比较全身WB-DWI、MRI-CT及二者联合应用对不同大小淋巴结的检出能力,应用方差分析比较ADC值在良恶性淋巴结鉴别诊断中的价值.结果 (1)WB-DWI、MRI-CT及二者联合应用3种方法对长径＜2 cm淋巴结(共123枚,三者分别检出109、98、117枚)的检出率差异具有统计学意义(x2=13.819,P＜0.01),二者联合应用优于单独应用MRI-CT(x2=13.324,P＜0.01),而对其余2组(长径2～3cm淋巴结共46枚,三者分别检出43、40、45枚；长径＞3 cm淋巴结共27枚,三者均全部检出),差异无统计学意义(x2=3.816,P＞0.05).(2)MRI-CT诊断效果优于单独应用WB-DWI,WB-DWI+ MRI-CT诊断NSCLC淋巴结转移的ROC曲线下面积(Az=0.978)、敏感度、特异度、准确性(分别为97.4％、88.9％、86.3％)均高于MRI-CT或WB-DWI.(3)NSCLC淋巴结转移组ADC值明显低于良性淋巴结组[(0.79±0.15) ×10-3和(1.59 ±0.15)×10-3mm2/s,F=332.813,P＜0.01].结论 WB-DWI是常规MRI-CT的有益补充,可以用于疑似NSCLC淋巴结转移患者的早期筛查,结合常规MRI-CT图像及ADC值测定,在NSCLC淋巴结转移诊断与鉴别诊断方面具有一定价值.
目的 比較全身MR-DWI(WB-DWI)、常規MRI和(或)CT(MRI-CT)及二者聯閤應用(WB-DWI+ MRI-CT)對非小細胞肺癌(NSCLC)淋巴結轉移的檢齣能力.方法 對56例病理確診的NSCLC患者行WB-DWI、胸部CT掃描,併于掃描後1週內對可疑淋巴結轉移部位行常規MR掃描,必要時增彊掃描.應用ROC麯線比較WB-DWI、MRI-CT及二者聯閤應用在NSCLC淋巴結轉移中的診斷價值.應用x2檢驗比較全身WB-DWI、MRI-CT及二者聯閤應用對不同大小淋巴結的檢齣能力,應用方差分析比較ADC值在良噁性淋巴結鑒彆診斷中的價值.結果 (1)WB-DWI、MRI-CT及二者聯閤應用3種方法對長徑＜2 cm淋巴結(共123枚,三者分彆檢齣109、98、117枚)的檢齣率差異具有統計學意義(x2=13.819,P＜0.01),二者聯閤應用優于單獨應用MRI-CT(x2=13.324,P＜0.01),而對其餘2組(長徑2～3cm淋巴結共46枚,三者分彆檢齣43、40、45枚；長徑＞3 cm淋巴結共27枚,三者均全部檢齣),差異無統計學意義(x2=3.816,P＞0.05).(2)MRI-CT診斷效果優于單獨應用WB-DWI,WB-DWI+ MRI-CT診斷NSCLC淋巴結轉移的ROC麯線下麵積(Az=0.978)、敏感度、特異度、準確性(分彆為97.4％、88.9％、86.3％)均高于MRI-CT或WB-DWI.(3)NSCLC淋巴結轉移組ADC值明顯低于良性淋巴結組[(0.79±0.15) ×10-3和(1.59 ±0.15)×10-3mm2/s,F=332.813,P＜0.01].結論 WB-DWI是常規MRI-CT的有益補充,可以用于疑似NSCLC淋巴結轉移患者的早期篩查,結閤常規MRI-CT圖像及ADC值測定,在NSCLC淋巴結轉移診斷與鑒彆診斷方麵具有一定價值.
목적 비교전신MR-DWI(WB-DWI)、상규MRI화(혹)CT(MRI-CT)급이자연합응용(WB-DWI+ MRI-CT)대비소세포폐암(NSCLC)림파결전이적검출능력.방법 대56례병리학진적NSCLC환자행WB-DWI、흉부CT소묘,병우소묘후1주내대가의림파결전이부위행상규MR소묘,필요시증강소묘.응용ROC곡선비교WB-DWI、MRI-CT급이자연합응용재NSCLC림파결전이중적진단개치.응용x2검험비교전신WB-DWI、MRI-CT급이자연합응용대불동대소림파결적검출능력,응용방차분석비교ADC치재량악성림파결감별진단중적개치.결과 (1)WB-DWI、MRI-CT급이자연합응용3충방법대장경＜2 cm림파결(공123매,삼자분별검출109、98、117매)적검출솔차이구유통계학의의(x2=13.819,P＜0.01),이자연합응용우우단독응용MRI-CT(x2=13.324,P＜0.01),이대기여2조(장경2～3cm림파결공46매,삼자분별검출43、40、45매；장경＞3 cm림파결공27매,삼자균전부검출),차이무통계학의의(x2=3.816,P＞0.05).(2)MRI-CT진단효과우우단독응용WB-DWI,WB-DWI+ MRI-CT진단NSCLC림파결전이적ROC곡선하면적(Az=0.978)、민감도、특이도、준학성(분별위97.4％、88.9％、86.3％)균고우MRI-CT혹WB-DWI.(3)NSCLC림파결전이조ADC치명현저우량성림파결조[(0.79±0.15) ×10-3화(1.59 ±0.15)×10-3mm2/s,F=332.813,P＜0.01].결론 WB-DWI시상규MRI-CT적유익보충,가이용우의사NSCLC림파결전이환자적조기사사,결합상규MRI-CT도상급ADC치측정,재NSCLC림파결전이진단여감별진단방면구유일정개치.
Objective To prospectively and directly compare the capability of whole-body DWI,MRI and/or CT (MRI-CT),and whole-body DWI with MRI-CT for assessment of lymphatic metastases in non-small cell lung cancer (NSCLC) patients.Methods The institutional review board approved this study; informed consent was obtained from patients.A total of 56 NSCLC patients underwent whole-body DWI and thoracic CT scan prospectively.Conventional MRI was performed in suspicious lymphatic metastases parts within one week after inspection.Final diagnosis of the lymphatic metastases in each patient was determined on the basis of results of all radiologic and follow-up examinations.Two chest radiologists independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases.Final diagnosis based on each of the methods was made by consensus of two readers.Receiver operating characteristic (ROC) analysis was used to compare the capability for lymphatic metastases assessment among whole-body DWI,MRI-CT and whole-body DWI with MRI-CT.The detection abilities of lymph nodes with different size were compared with x2 test.Value of apparent diffusion coefficient (ADC) in the differential diagnosis of benign and malignant lymph nodes was compared with the variance analysis.Results (1) Lymph nodes metastases were divided into 3 groups according to the length diameter (＜ 2,2-3,＞ 3 cm).A statistically significant difference (x2 =13.819,P ＜ 0.01) was found in detection of lymph nodes (＜ 2 cm) among whole-body DWI,MRI-CT and whole-body DWI with MRI-CT(within the 123 lymph nodes,109,98 and 117 were detected respectively),whole-body DWI with MRI-CT was superior to conventional MRI-CT(x2 =13.324,P＜0.01).There were no statistically significant difference between the other 2 groups (in the length diameter 2-3 cm group,43,40 and 45 of all 46 lymph nodes were detected respectively by whole-body DWI,MRI-CT and whole-body DWI with MRI-CT,x2 =3.816,P ＞ 0.05,while in the length diameter ＞ 3 cm group,all of the 27 lymph nodes were detected by each of them.(2) Conventional MRI-CT was superior to whole-body DWI in the diagnosis of lymph node metastasis in NSCLC.The area under ROC curve value of whole-body DWI with MRI-CT(Az =0.978),the sensitivity,specificity,accuracy (97.4％ 、88.9％ 、86.3％ respectively) were significantly higher than conventional MRI-CT or whole-body DWI.(3)The ADC value of malignant lymph nodes were significantly lower than those of benign [(0.79 ± 0.15) × 10-3 mm2/s vs (1.59--0.15) × 10-3 mm2/s,F =332.813,P ＜ 0.01].The sensitivity,specificity,accuracy were 100％ with the cut-off value of 1.06 × 10-3mm2/s.Conclusions Whole-body DWI is the beneficial supplements of MRI-CT and can be used as a earlier clinical technique in patients with suspected NSCLC lymph node metastasis.Combined with ADC value,it can be used for assessment and differential diagnosis of lymphatic metastases in NSCLC patients.
