MRI结合扩散加权成像对颈部淋巴结结核药物治疗效果的预测价值

目的：探讨MRI结合扩散加权成像(diffusion-weighted imaging，DWI)对颈部淋巴结结核药物治疗效果的预测价值。方法：纳入2017年1月至2021年12月湖南省胸科医院收治住院进行标准化抗结核药物治疗的160例颈部淋巴结结核初治患者。收集患者MRI资料进行临床分型，根据复查结果将患者分为疗效良好...

Predictive value of MRI combined with diffusion-weighted imaging on the effectiveness of drug therapy for cervical lymph node tuberculosis

Objective: To investigate the predictive value of MRI combined with diffusion-weighted imaging (DWI) on the effectiveness of drug therapy for cervical lymph node tuberculosis. Methods: A total of 160 cases of newly-treated patients with cervical lymph node tuberculosis who were admitted to Hunan Chest Hospital and received standardized anti-tuberculosis drug treatment from January 2017 to December 2021 were enrolled in the study.Their MRI data were collected for clinical classification. According to the re-examination results, the patients were divided into the good curative effect group (119 cases) and the poor curative effect group(41 cases).The differences of clinical classifications and MRI imaging data of the two groups were compared. Results: There were 20 cases (12.50%) with nodular hyperplasia, 79 cases (49.38%) with nodular necrosis, 46 cases (28.75%) with peri-lymph node inflammation, and 15 cases (9.37%) with peripheral abscess among 160 patients. The number (proportion) of nodular hyperplasia type, nodular necrosis type, peri-lymph node inflammation type and peripheral abscess type were 19 (15.97%), 67 (56.30%), 30 (25.21%) and 3 (2.52%) in the good curative effect group respectively, while the number (proportion) of corresponding subtypes were 1 (2.44%), 12 (29.27%), 16 (39.02%) and 12 (29.27%) in the poor curative effect group.There were statistical differences between the two groups (χ²=34.272, P<0.01). The lesions did not break through the capsule accounted for 72.27% (86/119) in the good curative effect group, which was significantly higher than that in the poor curative effect group (31.71%, 13/41), and the difference was statistically significant (χ²=21.267, P<0.01). The patients whose apparent diffusion coefficient (ADC) map showed mixed signals dominated by high signal (96.3%,77/80) usually got better curative effect, while the 39 cases whose ADC map showed obvious low signal had poor prognosis. The average ADC values of the good curative effect group and the poor curative effect group were (1.49±0.21)× 10^-3mm²/s and (1.06±0.19)×10^-3mm²/s respectively, and the difference was statistically significant (t=11.576, P<0.01). Conclusion: MRI combined with DWI had a certain predictive value for the effectiveness of anti-tuberculosis drug therapy in patients with cervical lymph node tuberculosis. Lesions that brook through the lymph node capsule or had limited diffusion were often indicative of poor prognosis.