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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (4): 251-256.

• 论著 • 上一篇    下一篇

体素内不相干运动弥散加权成像对儿童腹部良恶性肿瘤诊断价值

乔中伟   

  1. 复旦大学附属儿科医院
  • 收稿日期:2017-09-19 修回日期:2017-09-19 出版日期:2017-08-25 发布日期:2017-08-25
  • 通讯作者: 乔中伟

Value of intravoxel incoherent motion diffusion-weighted magnetic resonance imaging in differentiating benign and malignant pediatric abdominal tumors

  • Received:2017-09-19 Revised:2017-09-19 Online:2017-08-25 Published:2017-08-25

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摘要：

目的：运用体素内不相干运动（IVIM）弥散加权（DW）MRI的方法，探讨IVIM双指数参数鉴别儿童腹部良恶性肿瘤的价值。方法：以儿童腹部肿瘤手术病理为金标准，术前1周内行IVIM DW-MRI检查为待测标准，对怀疑腹部肿瘤、不能完全确诊为良性肿瘤者行常规MRI（T1W、T2W和增强T1W）和DW序列。根据病理分为恶性组、良实性组、交界性组和良囊性组。选取b值范围0~800 s·mm-2，通过软件计算得到ADC值，使用肿瘤轮廓法勾画肿瘤的感兴趣区（ROI），计算D、D*和f值。结果：85例腹部肿瘤患儿（98个肿瘤）进入本文分析。男43例；平均年龄4.4岁；恶性组（52例，62块），交界性组（7例，7块），良实性组（21例，24块），良囊性组（5例，5块）；ROI平均值12.9（1.3~26.1）cm2。ADC、D和D* 均体现在恶性组最低，交界性组、良实性组和良囊性组依次升高，差异均有统计学意义；ADC、D和D* 在恶性与非恶性肿瘤（实性+囊性）差异均有统计学意义；鉴别恶性和良实性肿瘤Cutoff（×10-6mm2·s-1）分别为1 367、1 056和1 605，ADC鉴别的特异度高（85.5%），D值鉴别的灵敏度高（83.3%），鉴别恶性和实性肿瘤（良实性+交界性）、恶性和非恶性肿瘤（良实性+交界性+良囊性）Cutoff（×10-6mm2·s-1）分别为1 173、1 014和1 634；鉴别恶性和实性肿瘤（良实性+交界性）ADC和D值特异度较好（87.1%和83.9%），鉴别恶性和非恶性肿瘤（良实性+交界性+良囊性），ADC、D和D*值特异度均良好（88.9%、86.1%和80.6%）。结论：IVIM DW-MRI中的ADC和D值对鉴别儿童腹部良恶性肿瘤有较好的诊断价值。

Abstract:

Objective: To investigate the value of IVIM double exponential parameters in differentiating the benign and malignant pediatric abdominal tumors by use of the method of IVIM DW-MRI. Methods: Taking the pathology of pediatric abdominal tumor operation specimens as the golden standard, patients were assigned to malignant group, benign solid group, borderline group and benign cystic group, and the IVIM DW-MRI detection was performed as the standard to be detected within one week before the operation, and routine MRI (T1W, T2W, CE-T1W) and DWI sequence examination were performed for the suspected abdominal tumor, which could not be confirmed as the benign tumor. Then the b value range of 0~800 s·mm-2 was chosen, and the ADC value was obtained by the software calculation, and the tumor size was delineated by use of ROI tumor profile method, and the D, D* and f values were calculated.Results: 85 cases of children with abdominal tumor (98 masses) were included in the analysis of this study and there were 43 cases of male patients with the average age of 4.4 years old; malignant group (52 cases, 62 masses), borderline group (7 cases, 7 masses), benign solid group (21 cases, 24 masses), benign cystic group (5 cases, 5 masses); and the average value of ROI was 12.9(1.3~26.1)cm2. And for ADC, D and D* values, they showed the lowest in the malignant group and increased successively in the borderline group, benign solid group and benign cystic group, which had statistically significant difference; the differences of ADC, D and D* values between the malignant group and non-malignant (benign solid, borderline and benign cystic) groups had statistical significance; the cutoff identifying malignant and benign solid tumors was 1 367, 1 056 and 1 605 ×10-6mm2·s-1, respectively, and the identifying specificity for ADC was higher (85.5%), and the identifying sensitivity for D value was higher (83.3%), and the cutoff identifying malignant and solid tumors (benign solid plus borderline), malignant and non-malignant (benign solid plus borderline plus benign cystic) was 1 173, 1 014 and 1 634×10-6mm2·s-1, respectively; the specificity for ADC and D values identifying malignant and solid tumors (benign solid plus borderline) was better (87.1% and 83.9%), and the specificity for ADC, D and D* values identifying malignant and non-malignant (benign solid plus borderline plus benign cystic) was all better (88.9%,86.1% and 80.6%). Conclusion: The ADC and D values in the IVIM DW-MRI had good diagnostic value in identifying pediatric abdominal benign and malignant tumors.