孤立性肺结节体素内不相干运动扩散加权磁共振成像研究

目的:探讨体素内不相干运动扩散加权磁共振成像（intravoxel incoherent motion diffusion weighted imaging，IVIM-DWI）在孤立性肺结节(solitary pulmonary nodules，SPN)中的应用价值。方法:对57例有明确病理诊断的孤立性肺结节分为良性结节组（n=16）与恶性结节组（n=41），恶性结节分为小细胞肺癌（small cell lung cancer，SCLC）组（n=10）和非小细胞肺癌（non-small cell lung cancer，NSCLC）组（n=28）。对不同组扩散加权成像（diffusion weighted imaging，DWI）和IVIM-DWI图像进行分析，测量其ADC值、D值、D*值和f值。分析不同组之间各参数的差异性，评估各衍生参数的诊断效能。结果:ADC、D和f值在良恶性结节间差异有显著性。ADC值和D值在SCLC与NSCLC之间差异有显著性。良性结节与恶性结节，ADC、D及f值受试者工作特征（receiver operating characteristic，ROC）曲线下面积分别为0.822、0.864、0.736，D值显示出最高的诊断效能。SCLC与NSCLC，ADC、D值ROC曲线下面积分别为0.843、0.814，ADC值有最高的诊断效能。结论:IVIM-DWI可以对SPN良恶性作鉴别诊断，不仅能反映组织的扩散信息，还能反映其灌注信息，对孤立性肺结节的评估有重要指导意义。

The study of intravoxel incoherent motion diffusion weighted imaging in solitary pulmonary nodules

Objective:To explore the application value of intravoxel incoherent motion diffusion weighted imaging （IVIM-DWI) in solitary pulmonary nodules (SPN).Methods:57 cases of solitary pulmonary nodules with clear pathological diagnosis were divided into benign nodule group (n=16) and malignant nodule group (n=41).Malignant nodules were divided into two groups:small cell lung cancer (SCLC) group (n=10) and non-small cell lung cancer (NSCLC) group (n=28).The diffusion weighted imaging (DWI) and IVIM-DWI images of different groups were analyzed，their ADC，D，D* and f values were measured.The difference of each parameter in different group was analyzed，and the diagnostic effectiveness of the derived parameters was evaluated.Results:ADC，D and f values in benign nodule group and malignant nodule group were significantly different.ADC and D values in SCLC and NSCLC group were significantly different.Receiver operating characteristic (ROC) curves analyses showed that the area under curve (AUC) of ADC，D and f value between benign and malignant group were 0.822，0.864 and 0.736，the D value had the highest diagnostic efficacy.AUC of ADC and D value between SCLC and NSCLC group were 0.843 and 0.814，the ADC value had the higher diagnostic efficacy.Conclusion:IVIM-DWI can distinguish the benign and malignant of SPN.It not only can reflect the diffusion information of tissue，but also reflect the infusion information，which had important guiding significance for the assessment of SPN.