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目的研究MRI弥散加权成像对鼻咽癌(NPC)T分期的应用价值。方法选取2015年4月至2017年2月我院对鼻咽部病变行常规MRI及DWI检查的患者50例为研究对象,其中病理证实为鼻咽癌30例,良性病变20例,另以同期入院体检的健康志愿者20例为对照组,分析鼻咽部良恶性病变影像特点,比较鼻咽癌患者原发灶、受累肌肉、受累斜坡的表观扩散系数值(ADC)与对照组差异,应用ROC曲线分析各ADC诊断阈值诊断鼻咽癌的敏感性、特异性,同时分析MRI及DWI诊断鼻咽癌T分期的准确率。结果 NPC原发灶及受累肌肉内瘤灶在T1WI序列呈等低信号,T2WI轴位显示两侧鼻咽部软组织对称性增厚,边界清,呈稍高信号,DWI则见鼻咽部软组织呈稍高信号,ADC图呈低信号,与鼻咽良性病灶相比在信号特征、增强方式、生长方式、累及范围方面有不同特征;NPC原发灶、受累肌肉、受累斜坡ADC值[(0.746±0.085)×10~(-3)mm~2/s、(0.765±0.091)×10~(-3)mm~2/s、(0.762±0.089)×10~(-3)mm~2/s]明显低于对照组(P<0.05);NPC原发灶、受累肌肉、受累斜坡的ADC诊断阈值分别为0.832×10~(-3)mm~2/s、0.860×10~(-3)mm~2/s、0.557×10~(-3)mm~2/s,其诊断灵敏度依次为93.2%、86.1%、98.6%,特异度依次为85.9%、66.9%、65.4%;MRI及DWI联合诊断鼻咽癌T分期的准确率90.00%高于单独MRI 56.67%或DWI 66.67%(P<0.05)。结论MRI及弥散加权成像结合有助于对鼻咽癌良恶性病变进行鉴别,可较好显示鼻咽癌原发瘤与其邻近受累结构,对鼻咽癌T分期评估具有较高应用价值。
Objective To investigate the value of MRI diffusion-weighted imaging in the detection of NPC staging. Methods From April 2015 to February 2017, 50 cases of nasopharyngeal lesions underwent conventional MRI and DWI in our hospital from January 2015 to April 2017 were enrolled. Among them, 30 cases of nasopharyngeal carcinoma and 20 cases of benign lesions were confirmed by pathology. Twenty healthy volunteers admitted to hospital were selected as the control group. The characteristics of the benign and malignant nasopharyngeal lesions were analyzed. The differences of apparent diffusion coefficient (ADC) and control group between the primary tumor, affected muscle and affected slopes were compared. ROC curves were used to analyze the diagnostic threshold of each ADC to diagnose the sensitivity and specificity of nasopharyngeal carcinoma. Meanwhile, the accuracy of MRI and DWI in diagnosing nasopharyngeal carcinoma T staging was analyzed. Results The primary lesions and intramuscular lesions of NPC showed low signal intensity on the T1WI sequence. The T2WI axis showed thickening of symmetrical nasopharyngeal soft tissue on both sides with clear boundary and a slightly higher signal. DWI showed soft tissue of the nasopharynx Compared with nasopharyngeal benign lesions, the signal intensity, the mode of enhancement, the mode of growth and the range of coverage of the nasopharyngeal lesions were slightly higher than those of the nasopharyngeal lesions. The ADC value of the primary tumor, affected muscle and affected slope [(0.746 ± 0.085) × 10 ~ (-3) mm ~ 2 / s, (0.765 ± 0.091) × 10 ~ (-3) mm ~ 2 / s and (0.762 ± 0.089) × 10 ~ (-3) mm ~ 2 / s ] Were significantly lower than those in the control group (P <0.05). The diagnostic thresholds of ADC in the primary tumor, affected muscle and affected slope were 0.832 × 10 -3 mm 2 / s and 0.860 × 10 -3, The diagnostic sensitivities were 93.2%, 86.1%, 98.6%, specificity of 85.9%, 66.9%, 65.4%, respectively. The MRI and DWI The accuracy of the combined diagnosis of T stage of nasopharyngeal carcinoma was 90.00% higher than 56.67% of MRI alone or DWI 66.67% (P <0.05). Conclusions The combination of MRI and diffusion weighted imaging is helpful to differentiate benign and malignant nasopharyngeal carcinomas, and it can better show the primary tumor of nasopharyngeal carcinoma and its adjacent structures. It is of great value in evaluating the T stage of nasopharyngeal carcinoma.