表观扩散系数在原发性肌骨肿瘤中的应用价值

目的 探讨磁共振扩散加权成像（DWI）及表观扩散系数（ADC）值在原发性肌骨肿瘤中的应用价值.方法 回顾分析经组织病理证实的61例原发性肌骨肿瘤患者,术前行磁共振常规及DWI检查,DWI选取SE-EPI序列,b值取0、700s/mm2,在T1WI增强横轴位图像上分别测量肿瘤实质区ADC、肿瘤整体ADC及邻近正常横纹肌ADC值,用统计学软件分析各组间ADC值差异.结果 良性肿瘤34例,恶性肿瘤27例：①良、恶性组肿瘤DWI图像信号高低差异无统计学意义;②正常横纹肌、良恶性组实质区平均ADC值分别为：（1.65 ±0.76） ×10-3、（1.58±0.82）×10-3、（1.28±0.32） ×10-3 mm2·s-1,三组间差异无统计学意义（F=4.687,P＞0.05）;良恶性组整体ADC值分别为：（1.58 ±0.74）×10-3 mm2·s-1、（1.35 ±0.39） ×10-3mm2·s-1,差异无统计学意义（t=1.19,P＞0.05）;③9例富含粘液肿瘤实质区平均ADC值（2.32 ±0.19）×10-3mm2·s-1,52例其他肿瘤实质区平均ADC值（1.36±0.37） ×10-3 mm2·s-1,两者差异有统计学意义（t=0.704,P＜0.05）.结论 无论是肿瘤实质区平均ADC值还是整体ADC值皆不能直接用于肌骨系统良恶性肿瘤的鉴别诊断,较高ADC值（大于2.0 ×10-3 mm2·s-1）对诊断富含粘液基质类型的肌骨肿瘤有一定诊断价值.

Application Value of the Apparent Diffusion Coefficient in Primary Musculoskeletal Tumors

Objective To investigate the diagnostic value of DWI and to analyze difference of the apparent diffusion coefficient（ADC） value in musculoskeletal tumors.Methods 61 cases with primary musculoskeletal tumors were examined by conventional 3.0 T MRI and DWI scan before operation.SE-EPI sequence was used in DWI and b value was taken as 0,700 s/mm2.The average ADC value of normal muscle,tumor parenchyma ADC value and tumor overall mean ADC value were measured on the T1 WI contrast enhanced images.The difference of ADC between benign and malignant musculoskeletal tumors were evaluated.Results 34 benign tumors and 27 malignant tumors were included in this research.①There was no statistically significant difference in the DWI image signal of benign and malignant tumors.②The average ADC values of adjacent normal muscle,benign tumor parenchyma and malignant tumor parenchyma were （1.65 ± 0.76） × 10-3mm2 ·s-1,（1.58 ±0.82） ×10-3 mm · s-1,（1.28 ±0.32） ×10-3 mm2 · s-1 respectively,without statistically significant difference among three groups（F =4.687,P 〉0.05） ;the overall ADC value of benign and malignant tumors were （1.58 ±0.74） × 10-3 mm2 · s-1,（1.35 ±0.39） × 10-3 mm2 · s-1 respectively,without statistically significant difference between the two groups （t =1.19,P 〉 0.05）.③The ADC values of 9 myxoid-containing tumors and 52 nature area of other tumors were （2.32 ±0.19） × 10-3 mm2 · s-1,（1.36 ±0.37）× 10-3 mm2 · s-1 respectively,with statistically significant difference between the two groups （t =0.704,P 〈0.05）.Conclusion Both of the tumor parenchyma mean ADC value or the overall ADC values can be directly used in the differential diagnoses for musculoskeletal tumors.The ADC value of higher than 2.0 × 10-3mm2 · s-1 has diagnostic value for myxoid-containing tumors at a certain extent.