【摘要】 目的 探讨扩散加权成像（DWI）纹理分析在鉴别鼻腔鼻窦内翻性乳头状瘤（SNIP）起源部位与周边部位中的价值。方法 回顾性分析44例经病理证实的SNIP患者的临床和影像学资料。参考手术记录判断SNIP起源部位和周边部位，基于DWI分别在两部位勾画感兴趣区进行纹理分析，获取平均值(ADC_mean)、第10百分位数(ADC_10%)、第90百分位数(ADC_90%)、偏度、峰度以及熵等定量参数。采用Mann-Whitney U检验或配对样本t检验比较SNIP起源部位和周边部位间的DWI纹理分析参数差异。采用多因素Logistic回归分析确定最佳诊断参数，并采用受试者工作特征（ROC）曲线评估其鉴别诊断性能。采用组内相关系数（ICC）评估各纹理参数测量的观察者间一致性。结果 SNIP起源部位的ADC_mean、ADC_10%、ADC_90%及熵明显低于周边部位（P<0.05）。多因素Logistic回归分析显示，ADC_90%[比值比（OR）=3.976，置信区间（95%CI）=1.927～8.202,P<0.001]和熵（OR=1.931,95%CI=1.032～3.614,P=0.04）与SNIP起源部位相关。ADC_90%与熵的联合模型在区分起源部位和周边部位方面显示出最优的鉴别效能[曲线下面积（AUC）=0.861,95%CI=0.781～0.940]。结论 DWI纹理分析参数，尤其是ADC_90%和熵，对鉴别SNIP起源部位与周边部位具有重要的指导价值。更多还原

【Abstract】 Objective To investigate the value of texture analysis of diffusion-weighted imaging（DWI） in differentiating the origin site from the peripheral region of sinonasal inverted papilloma（SNIP）. Methods Clinical and imaging data of 44 patients with pathologically confirmed SNIP were retrospectively analyzed.The origin and periphery of SNIP were determined based on surgical records.Regions of interest（ROIs） were manually delineated on DWI at both sites to perform texture analysis,and quantitative parameters including mean apparent diffusion coefficient(ADC_mean),10th percentile(ADC_10%),90 th percentile(ADC_90%),skewness,kurtosis,and entropy were obtained.The Mann-Whitney U test or paired ttest was used to compare differences in DWI texture analysis parameters between the origin and periphery of SNIP.Multivariate Logistic regression analysis was performed to identify the optimal diagnostic parameters,and their discriminatory performance was assessed using receiver operating characteristic（ROC） curve analysis.Interobserver agreement for texture parameter measurements was evaluated using the intraclass correlation coefficient（ICC）. Results The origin site exhibited significantly lower ADC_mean,ADC_10%,ADC_90%,and entropy than the peripheral region（all P < 0.05）.Multivariate Logistic regression analysis showed that ADC_90% [odds ratio（OR）= 3.976,95% confidence interval（CI）: 1.927-8.202,P < 0.001]and entropy（OR = 1.931,95% CI: 1.032-3.614,P = 0.040） were associated with the SNIP origin site.The combined model of ADC_90% and entropy demonstrated optimal discriminatory efficacy in differentiating the origin from the peripheral region [area under the curve（AUC）= 0.861,95% CI: 0.781-0.940]. Conclusions DWI texture analysis-derived parameters,especially ADC_90% and entropy,provide significant diagnostic value in differentiating the origin site from the peripheral region of SNIP.更多还原