磁共振弥散加权成像在甲状腺结节性病变诊断中的价值

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (4): 344-350.

磁共振弥散加权成像在甲状腺结节性病变诊断中的价值

王浩^{1, 2}, 宋彬², 张蓓³, 魏冉², 丁毅², 王培军⁴

1.同济大学医学院影像医学与核医学系,上海 200092;
2.上海市闵行区中心医院放射科,上海 201199;
3.上海交通大学医学院附属瑞金医院放射科,上海 200025;
4.同济大学附属同济医院放射科,上海 200065

收稿日期:2014-04-16 出版日期:2014-07-10 发布日期:2014-08-20
通讯作者: 王培军,E-mail: tongjipjwang@vip.sina.com
作者简介:王浩（1980-）,男,在职研究生,主治医师,E-mail:wanghao801128@hotmail.com
基金资助:
上海市闵行区科学技术委员会自然科学基金(2013MHZ016)

The diagnostic value of diffusion weighted MR imaging in thyroid nodular lesions

WANG Hao^{1, 2}, SONG Bin², ZHANG Bei³, WEI Ran², DING Yi², WANG Pei-jun

Received:2014-04-16 Online:2014-07-10 Published:2014-08-20
Supported by:
Supported by Natural Science Funds of Shanghai Minhang District Committee of Science and Technology(2013MHZ016)

摘要/Abstract

摘要： 目的探讨磁共振弥散加权成像（diffusion weighted imaging, DWI）在甲状腺结节性病变诊断中的价值。方法：按照前瞻性设计,对临床拟诊为甲状腺结节性病变的100例患者,采用自旋平面回波弥散加权成像（spin-echo echo-planar imaging,SE EPI）序列扫描,b值取800 s/mm²,测量病变区的ADC值,应用SPSS17.0软件包中的t检验比较良、恶性病变ADC值的差异,并采用接收者工作特征曲线（receiver operating characteristic curve,ROC）确定良、恶性病变的ADC界值。结果：100例患者中,共检出结节155个,位于左叶67个,右叶80个,峡部8个;其中良性结节91个（结节性甲状腺肿87例,占56.13%;腺瘤4例,占2.58%）,恶性结节64个（乳头状癌55例,占35.48%;滤泡癌3例,占1.94%;不典型增生6例,占3.87%）;恶性结节的ADC值[（1.295±0.281）×10^-3 mm²/s明显低于良性结节[(2.033±0.387)×10^-3 mm²/s,差异有显著性（P=0.000）;根据ROC曲线确定良恶性界值为1.550×10^-3mm²/s,诊断敏感度和特异度分别为93.4%和82.8%,曲线下面积值为0.945。结论：甲状腺恶性结节性病变的平均ADC值低于良性,DWI序列在甲状腺结节性病变的鉴别诊断中具有重要价值。

关键词: 甲状腺结节, 弥散加权成像, 表观扩散系数

Abstract: PURPOSE: To evaluate the diagnostic value of diffusion-weighted MR Imaging (DWI) in benign and malignant thyroid lesions. METHODS: A prospective study was conducted in 100 consecutive patients with thyroid nodules who underwent DWI of the thyroid gland. Diffusion-weighted MR images were acquired with b factors of 800 s/mm² by using spin echo echo-planar imaging DWI (SE EPI). ADC maps were reconstructed. The ADC values of the thyroid nodules were calculated and correlated with the results of histopathologic examination. The mean ADCs were compared between malignant and benign nodules. The threshold of ADC value for identifying malignant nodules was determined using a receiver operating characteristic (ROC) curve. The data was analyzed with SPSS 17.0 software package. RESULTS: In all patients, one hundred and fifty-five nodules were detected by MR imaging. Sixty-seven nodules were in left lobe, eighty in right lobe and the remaining 8 nodules in isthmus of thyroid gland. Among them nodular goiter were found in 87 cases, papillary carcinoma in 55 cases, follicular adenoma in 4 cases and follicular carcinoma in 3 cases. The mean ADCs of malignant nodules were significantly lower than that of benign lesions (1.295±0.281×10-3mm²/s) vs (2.033±0.387×10^-3 mm²/s). The sensitivity and specificity of the ADCs for identifying malignant nodules using a threshold of 1.550×10^-3mm²/s was 93.4% and 82.8% , respectively. CONCLUSION: The ADC value as measured tool by MR DWI is an effective parameter for distinguishing malignant from benign thyroid nodules.

Key words: Diffusion weighted imaging, Nodular thyroid lesions, Apparent diffusion coefficient value

中图分类号:

R736.1

王浩, 宋彬, 张蓓, 魏冉, 丁毅, 王培军. 磁共振弥散加权成像在甲状腺结节性病变诊断中的价值[J]. 中国口腔颌面外科杂志, 2014, 12(4): 344-350.

WANG Hao, SONG Bin, ZHANG Bei, WEI Ran, DING Yi, WANG Pei-jun. The diagnostic value of diffusion weighted MR imaging in thyroid nodular lesions[J]. China J Oral Maxillofac Surg, 2014, 12(4): 344-350.

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