DWI和动态增强MRI在舌鳞状细胞癌诊断中的应用价值

目的 探讨DWI和动态增强MRI在舌鳞状细胞癌诊断中的应用价值。方法 回顾性分析经手术及病理证实的65例舌鳞状细胞癌患者，有颈部淋巴结转移的38例，无淋巴结转移的27例；其中55例患者行动态增强扫描。测量并比较有无淋巴结转移组间病变大小及表观扩散系数（apparent diffusion coefficient，ADC），分析病变的时间-信号强度曲线类型（time-intensity curve，TIC）；同时比较不同T分期和病理分级舌鳞状细胞癌的ADC值差异。结果 65例舌鳞状细胞癌患者长径均值（28.2 ±11.7） mm，短径均值（17.7 ±9.4） mm，厚度均值（26.8 ±11.9） mm，ADC均值(1.029 ±0.142)×10^-3 mm²/s，有无颈部淋巴结转移组之间，病变的长径、短径、厚度以及ADC值的差异均有统计学意义。跨中线生长者更易发生淋巴结转移。55例行增强扫描的癌灶中，TIC曲线类型Ⅰ型（速升平台型）42例，Ⅱ型（速升流出型）13例。早期（T1+T2）舌癌组ADC值（1.090 ±0.113）×10^-3 mm²/s，晚期（T3+T4）舌癌组ADC值（1.001 ±0.147）×10^-3 mm²/s，组间差异有统计学意义。高分化、中分化及低分化鳞癌的ADC值分别为（1.101 ±0.101）×10^-3 mm²/s、（0.992 ±0.139）×10^-3 mm²/s和（0.819 ±0.125）×10^-3 mm²/s组间差异有统计学意义；以1.011×10^-3 mm²/s和0.928×10^-3 mm²/s分别为诊断高分化及低分化舌鳞癌的临界点，两者的敏感度及特异度分别为85.7%、63.3%和81.4%、83.3%。结论 DWI和动态增强MRI可较好反映舌鳞状细胞癌的特点，在对其定性、病理分级、分期及预测淋巴结转移等方面具有重要价值。

The value of DWI and dynamic contrast-enhanced MRI in the diagnosis of tongue squamous cell carcinoma

Objective To explore the value of diffusion-weighted imaging (DWI) and dynamic contrast enhanced MRI in the diagnosis of tongue squamous cell carcinoma.Methods Retrospective analysis of 65 patients with surgically and pathologically proven tongue squamous cell carcinoma, 38 with neck lymph node metastasis and 27 without lymph node metastasis; 55 of 65 patients underwent dynamic contrast enhanced scanning. The size and apparent diffusion coefficient (ADC) of lesions between groups with or without lymph node metastasis were measured and compared. The time-intensity curves (TIC) of the lesions were analyzed and the parameters of tongue squamous cell carcinoma with different T stages and pathological grades were compared.Results The mean length diameter of tongue squamous cell carcinoma of 65 patients was (28.2 ±11.7) mm, the mean short diameter was (17.7 ±9.4) mm, the mean thickness was (26.8 ±11.9) mm, and the ADC mean value was (1.029 ±0.142)×10^?3 mm²/s. Between the groups with and without cervical lymph node metastasis, the differences of length diameter, short diameter, thickness and ADC value were statistically significant. Lymph node metastases are more likely to occur in patients with squamous cell carcinoma growing across the midline. Among the 55 cases with enhanced scanning, there were 42 cases of TIC curve type I (rapid ascending platform) and 13 cases of type II (rapid ascending outflow). ADC value (1.090 ±0.113)×10^?3 mm²/s in the early (T1+T2) tongue cancer group and ADC value (1.001 ±0.147)×10^?3 mm²/s in the advanced (T3+T4) tongue cancer group means statistically significant differences between the groups. The ADC values of highly differentiated, moderately differentiated and poorly differentiated squamous cell carcinoma were (1.101 ±0.101) 1×10^?3 mm²/s, (0.992 ±0.139)×10^?3 mm²/s and (0.819 ±0.125)×10^?3 mm²/s, respectively, with statistically significant differences between the groups. 1.011×10^?3 mm²/s and 0.928×10×10^?3 mm²/s were served as cut-off points for the diagnosis of highly differentiated and poorly differentiated tongue squamous cell carcinoma, with sensitivity and specificity of 85.7%, 63.3% and 81.4%, and 83.3%, respectively.Conclusions DWI and dynamic contrast enhanced MRI can better reflect the characteristics of tongue squamous cell carcinoma, which is of great value in its characterization, pathological grading, staging and prediction of lymph node metastasis.