扩散加权成像在舌癌术前诊断及分期的应用价值

目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值在舌癌术前诊断及分期中的应用价值。材料与方法 34例舌癌患者治疗前行常规MRI及DWI检查,其中32例患者行手术治疗。将常规MRI分期、DWI分期与病理分期进行对照,比较两种方法对舌癌分期的准确性的差异。结果 (1)对病灶大小及浸润范围的估计,DWI较常规MRI更准确,有统计学意义(P0.05);(2)DWI序列通过测ADC值诊断53枚淋巴结转移,平均ADC值0.91×10~(–3) mm~2/s,低于非转移淋巴结(1.65×10~(–3) mm~2/s),有统计学意义(P0.01);DWI序列诊断转移性淋巴结的灵敏度89.3%,特异性98.0%,正确度98.8%;常规MRI诊断45枚淋巴结转移,灵敏度71.0%,特异性96.0%,正确度88.9%;对比两种检查方法,无统计学意义;(3)常规MRI序列对6例病例造成过度诊断,正确率为82.0%;DWI将1例IVA期病例过度诊断为IVB期,正确率为97.0%,对比两种检查方法,无统计学意义。结论DWI能准确显示舌癌病灶范围,测量分析ADC值可以为诊断舌癌淋巴结转移提供有效信息,与常规MR联合应用,有助于提高舌癌的术前诊断及分期的准确性。

The value of diffusion-weighted MRI in the preoperative diagnosis and staging of tongue carcinoma

objective: To investigate the potential value of diffusion weighted imaging (DWI) and the apparent diffusion coefficient (ADC) for preoperative diagnosisandstagingofpatientswithtonguecarcinoma.Materials and Methods:Thirty-four patients with tongue carcinoma underwent DWI in addition to routine MR imaging before therapy, of which 32 patients underwent surgical treatment. The staging accuracy by routine MRI and DWI was compared with surgical pathology as the reference standard. Results:(1) Estimating of lesion size and extent of infiltration, DWI-MRI was more accurate than routine MRI (P<0.05). (2) Routine MRI diagnosed 45 lymph nodes metastasis and the calculated sensitivity, specificity, accuracy was 71.0%,96.0%, 88.9%. DWI-MRI detected 53 lymph nodes metastasis, and the obtained sensitivity, specificity, accuracy was 89.3%, 89.3%,98.0%98.8%. There was no statistical significance between them. The mean ADC values of metastasis lymph nodes and benign nodes were 0.91 × 10–3 mm2/s and 1.65 × 10–3 mm2/s, respectively (P<0.01). (3) Routine MRI made over diagnosis of 6 cases and DWI-MRI only 1 case. The accuracy of routine MRI was 82.0%and DWI was 97.0%. Compared with the two methods, there was no statistical significance between them. Conclusions:DWI was of certain advantages in displaying the range of lesion and the ADC value measurement could provide useful information for diagnosis of lymph node metastasis for tongue cancer. DWI could improve preoperative diagnosis and staging accuracy for the tongue cancer.
Conclusions:DWI was of certain advantages in displaying the range of lesion and the ADC value measurement could provide useful information for diagnosis of lymph node metastasis for tongue cancer. DWI could improve preoperative diagnosis and staging accuracy for the tongue cancer.