多参数磁共振成像鉴别颈部淋巴结良恶性的研究

目的:探讨多参数磁共振成像(mp MRI)在鉴别颈部淋巴结良恶性中的应用价值。方法:选取在医院行MR检查初诊颈部淋巴结病变的34例患者,将其经手术、穿刺病理或随访证实的95枚颈部淋巴结依据淋巴结病理结果分为良性淋巴结组(51枚)和恶性淋巴结组(44枚)。分析颈部良、恶性淋巴结MRI平扫影像特征、表观弥散系数(ADC)值及动态增强扫描时间-信号曲线类型、达峰时间等指标间的差异,绘制受试者工作特征(ROC)曲线,比较不同检查技术间的敏感性、特异性及ROC曲线下面积(AUC)。结果:恶性淋巴结组淋巴结平均长径、短径均大于良性淋巴结组,差异有统计学意义(t=2.287,t=2.637;P<0.05);恶性淋巴结组平均ADC值低于良性淋巴结组,差异有统计学意义(t=2.702,P<0.05);颈部良性淋巴结时间-信号曲线多为B型,恶性淋巴结则以A型为主;颈部良性淋巴结组的平均达峰时间明显早于恶性淋巴结组,差异有统计学意义(t=40.983,P<0.05)。mp MRI鉴别颈部淋巴结良、恶性的敏感性及特异性均高于弥散加权成像(DWI)、动态增强扫描序列。AUC的mp MRI>动态增强扫描>DWI成像,三者间差异有统计学意义(Z=5.247,P<0.001)。结论:mp MRI能够提供更加全面的形态学及血流动力学等信息,综合分析能够提高颈部淋巴结定性诊断的准确性。

Application of multi-parameter MRI in the differential diagnosis of benign and malignant cervical lymph nodes

Objective:To explore the application value of multi-parameter magnetic resonance imaging(MRI)in the differential diagnosis of benign and malignant cervical lymph nodes.Methods:34 patients with cervical lymph node lesion who were primarily confirmed by MR examination were selected,and a total of 95 cervical lymph nodes which were confirmed by surgery,puncture pathology or follow-up were collected.And they were divided into benign lymph node group(51 cases)and malignant lymph node group(44 cases).The differences of imaging features,apparent diffusion coefficient(ADC)value,the type of dynamic contrast-enhanced scan time-intensity curve(TIC)and the time to peak of MRI plain scan for cervical benign and malignant lymph nodes were analyzed.And the receiver operating characteristic(ROC)curve was drawn,and then the sensitivity,specificity and the area under curve(AUC)of different examination techniques were further compared.Results:The average long diameter and short diameter of lymph nodes of malignant lymph node group were significantly larger than those of benign lymph node group(t=2.278,t=2.637,P<0.05),respectively.The average ADC value of malignant lymph node group was significantly lower than that of benign lymph node group(t=2.702,P<0.05).Most of the TIC of cervical benign lymph nodes were type B,while that of malignant lymph nodes were type A.The average time to peak of cervical benign lymph node group was significantly earlier than that of malignant lymph node group(t=40.983,P<0.05).The diagnostic sensitivity and specificity of multi-parameter MRI were significantly higher than those of DWI and dynamic contrast-enhanced scan sequences in identifying the benign or malignant cervical lymph node,respectively.The AUC relationship among the three groups was as follows:multi-parameter magnetic resonance imaging>dynamic enhancement scan>DWI,and the difference of that among the three groups was significant(Z=5.247,P<0.001).Conclusion:Multi-parameter magnetic resonance imaging can provide more comprehensive morphological and hemodynamic information,and the comprehensive analysis can improve the accuracy of qualitative diagnosis of cervical lymph nodes.