【摘要】 目的探讨全身磁共振扩散加权成像(WB MR DWI)对初诊不明原因淋巴结肿大的鉴别诊断价值。方法经病理或临床证实的初诊淋巴结病变患者78例,其中淋巴瘤31例(淋巴瘤组),肿瘤转移性淋巴结病变30例(转移性淋巴结组),炎性淋巴结17例(炎性淋巴结组),所有患者均于治疗前行WB MR DWI检查,分别记录淋巴结病变个数并测量其表观扩散系数(ADC)值,应用独立样本t检验及受试者工作特征(ROC)曲线分析每两组病变的ADC值鉴别价值。结果淋巴瘤组、转移性淋巴结组及炎性淋巴结组平均ADC值分别为(1.197±0.388)×10-3mm2/s、(1.343±0.299)×10-3mm2/s和(1.677±0.466)×10-3mm2/s,淋巴瘤与转移性淋巴结组的平均ADC值均明显小于炎性组,淋巴瘤组的平均ADC值也小于转移性淋巴结组(P<0.01),应用ROC曲线得出鉴别淋巴瘤与转移性淋巴结、淋巴瘤与炎性淋巴结、转移性淋巴结与炎性淋巴结及良、恶性淋巴结的ADC值鉴别诊断阈值分别为1.085×10-3mm2/s、1.575×10-3mm2/s、1.655×10-3mm2/s和1.575×10-3mm2/s,敏感性和特异性分别为41.5%、80.9%,78.6%、64.5%,84.5%、57.1%和78.2%、64.5%。结论 WB MR DWI结合ADC值对初诊不明原因淋巴结肿大原因有一定鉴别诊断价值,但对淋巴瘤与转移性淋巴结的鉴别价值有限。更多还原

【Abstract】 Objective To investigate the application of whole body MR diffusion weighted imaging in differential diagnosis of lymphadenopathy.Methods A total of 78 patients with pathologically or clinically proved lymphadenopathy were enrolled in this study.The lesions included lymphoma( n = 31),metastatic lymphadenopathy( n = 30) and benign lymphnoditis( n = 17).Preoperative whole body MR diffusion weighted imaging was performed in all patients,and the number of lymphadenopathy lesions and ADC values were separately calculated.By using independent samples t test and Receiver operating characteristic( ROC) curve analysis,the differential significance of ADC values of each group was evaluated.Results The mean ADC values of lymphoma,lymph node metastasis and benign lymphnoditis were( 1.197 ± 0.388) × 10-3mm2/ s,( 1.343 ± 0.299) × 10-3mm2/ s and( 1.677 ± 0.466) × 10-3mm2/ s respectively.The mean ADC values of lymphoma group and lymph node metastasis group were significantly lower than those of benign lymphnoditis group;the mean ADC values of lymphoma group were also significantly lower than those of lymph node metastasis group( P < 0.01).ROC curve analysis indicated that the diagnostic thresholds for differentiating lymphoma from lymph node metastasis,lymphoma from lymphnoditis,lymph node metastasis from lymphnoditis and benign lymph node from malignant lymph node were1.085 × 10-3mm2/ s,1.575 × 10-3mm2/ s,1.655 × 10-3mm2/ s and 1.575 × 10-3mm2/ s respectively;and the sensitivity and specificity were 41.5% and 80.9%,78.6% and 64.5%,84.5% and 57.1%,78.2% and 64.5% respectively.Conclusion Combination use of whole body MR diffusion weighted imaging and ADC value has certain value in making differential diagnosis of lymphadenopathy with unknown reasons,although its value is limited for the differentiation of lymphoma with lymph node metastasis.更多还原