[1]王毅,赖清泉,黄美铃,等. 磁共振体素内不相干运动在肺良恶性肿瘤的诊断效能及肺癌化疗疗效评估的应用[J].中国医学物理学杂志,2019,36(6):682-688.[doi:DOI:10.3969/j.issn.1005-202X.2019.06.012]
　WANG Yi,LAI Qingquan,HUANG Meiling,et al. Application of MR-IVIM in the diagnosis of benign and malignant lung tumors and the evaluation of chemotherapeutic efficacy in lung cancer[J].Chinese Journal of Medical Physics,2019,36(6):682-688.[doi:DOI:10.3969/j.issn.1005-202X.2019.06.012]
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 磁共振体素内不相干运动在肺良恶性肿瘤的诊断效能及肺癌化疗疗效评估的应用()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第6期
页码:
682-688
栏目:
医学影像物理
出版日期:
2019-06-25

文章信息/Info

Title:
 Application of MR-IVIM in the diagnosis of benign and malignant lung tumors and the evaluation of chemotherapeutic efficacy in lung cancer
文章编号:
1005-202X（2019）06-0682-07
作者:
 王毅1; 赖清泉1; 黄美铃2; 黄启明1
 1.福建医科大学附属第二医院CT/MRI室， 福建 泉州 362000； 2.福建医科大学附属第二医院放射科， 福建 泉州 362000
Author(s):
 WANG Yi1;  LAI Qingquan1;  HUANG Meiling2;  HUANG Qiming1
 1. Department of CT/MRI, the Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China; 2. Department of Radiotherapy, the Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, China
关键词:
 ; 肺癌; 磁共振成像; 体素内不相干运动
Keywords:
 ; Keywords: lung cancer;  magnetic resonance imaging;  intravoxel incoherent motion
分类号:
R318；R445.2；R734.2
DOI:
DOI:10.3969/j.issn.1005-202X.2019.06.012
文献标志码:
A
摘要:
 【摘要】目的：研究磁共振体素内不相干运动（IVIM）各参数在肺良恶性肿瘤的鉴别诊断效能，比较IVIM在肺癌化疗前后各参数变化，从而找到最佳评估参数。方法：30例肺癌及20例肺良性肿瘤患者分别接受肺部磁共振IVIM检查。30例肺癌患者均经RECIST评价标准评估为有效化疗且病灶缩小。在化疗前后分别进行肺部磁共振IVIM检查。测量肺癌及肺良性肿瘤IVIM各参数和肺癌化疗前后的IVIM各参数，包括表观扩散系数（ADC）、扩散系数、伪扩散系数和灌注分数。分析IVIM在鉴别肺癌及肺良性肿瘤的诊断效能，确定诊断的最佳临界值；并分析肺癌化疗前后IVIM各参数变化。结果：两位观察者测量的所有数据（扩散系数、ADC、伪扩散系数及灌注分数）的组内相关系数分别为0.825、0.793、0.704、0.697。肺癌扩散系数和ADC显著低于肺良性肿瘤，差异有统计学意义（P<0.05）；肺癌的伪扩散系数及灌注分数高于肺良性肿瘤，差异无统计学意义（P>0.05）。肺良恶性肿瘤扩散系数和ADC的ROC曲线下面积（AUC）分别为0.888、0.847，均超过0.500，具有较好的诊断价值。扩散系数的诊断效能高于ADC；扩散系数敏感性及特异性均高于ADC（88.8% vs 84.7%；75.2% vs 71.5%）。肺癌扩散系数和ADC的最佳临界值分别为（1.185×10-3）、（1.265×10-3） mm2/s。肺癌化疗后扩散系数及ADC高于化疗前；伪扩散系数及灌注分数低于化疗前。肺癌扩散系数和ADC评估化疗疗效的AUC分别为0.743、0.654，均超过0.500，有评估价值；且扩散系数的评估效能最大。结论：磁共振 IVIM中的扩散系数和ADC可作为鉴别肺部良恶性肿瘤的有效指标，扩散系数的诊断价值要优于ADC的诊断价值。扩散系数与ADC也可作为肺癌化疗疗效评估的一项辅助指标。
Abstract:
Abstract: Objective To study the efficacy of magnetic resonance-intravoxel incoherent motion (MR-IVIM) parameters in the differential diagnosis of benign and malignant lung tumors, and analyze the changes of IVIM parameters before and after chemotherapy for lung cancer, so as to find out the optimal evaluation parameters. Methods Thirty cases of lung cancer and 20 cases of benign lung tumor were scanned with pulmonary MR-IVIM. The evaluation of RECIST evaluation criteria showed that the chemotherapy for 30 patients with lung cancer was effective and the lesions shrank to varying degrees. Pulmonary MR-IVIM scans were performed before and after chemotherapy. The IVIM parameters of lung cancer and benign lung tumor, and the IVIM parameters before and after chemotherapy for lung cancer were measured. The IVIM parameters included apparent diffusion coefficient (ADC), tissue diffusivity, pseudo-diffusion coefficient and perfusion fraction. The diagnostic efficacy of IVIM in the differential diagnosis of lung cancer and benign lung tumor was analyzed, so as to determine the optimal critical value for diagnosis. Moreover, the change of IVIM parameters before and after chemotherapy was analyzed. Results The intraclass correlation coefficients of tissue diffusivity, ADC, pseudo-diffusion coefficient and perfusion fraction measured by two observers  were 0.825, 0.793, 0.704 and 0.697, respectively. The ADC and tissue diffusivity of lung cancer were significantly lower than those of benign lung tumor, with statistical differences (P<0.05), while the pseudo-diffusion coefficient and perfusion fraction of lung cancer were higher than those of benign lung tumor, without significant differences (P>0.05). The area under ROC curve of tissue diffusivity and ADC in the differential diagnosis of lung cancer and benign lung tumor were 0.888 and 0.847, respectively, which were larger than 0.500. Both tissue diffusivity and ADC were useful for differential diagnosis, and the diagnostic efficiency of tissue diffusivity was superior to that of ADC. The sensitivity and specificity of tissue diffusivity were higher than those of ADC (88.8% vs 84.7%; 75.2% vs 71.5%). The optimal critical values of tissue diffusivity and ADC in differential diagnosis were (1.185×10-3) and (1.265×10-3) mm2/s, respectively. Compared with those before chemotherapy, tissue diffusivity and ADC after chemotherapy were increased, while pseudo-diffusion coefficient and perfusion fraction were decreased. The area under ROC curve of tissue diffusivity and ADC of lung cancer were 0.743 and 0.654, respectively, which were larger than 0.500. Both tissue diffusivity and ADC were valuable in the evaluation of chemotherapeutic efficacy, and the evaluation efficiency of the former was better than that of the latter. Conclusion The tissue diffusivity and ADC in MR-IVIM can be used as effective indicators to differentiate benign and malignant lung tumors. The diagnostic value of tissue diffusivity is superior to that of ADC. Moreover, tissue diffusivity and ADC can also be used as auxiliary indexes to evaluate the chemotherapeutic efficacy in lung cancer.

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备注/Memo

备注/Memo:
 【收稿日期】2019-04-21
【基金项目】福建省卫生厅青年项目（41693）
【作者简介】王毅，硕士，主治医师，研究方向：肿瘤磁共振成像技术与诊断，E-mail: fjmuwang@sina.cn
【通信作者】赖清泉，主任医师，副教授，研究方向：肿瘤磁共振成像技术与诊断，E-mail: laiqingquan888@163.com
更新日期/Last Update: 2019-06-25