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目的:探讨磁共振体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weighted MR Imaging,IVIM-DWI)在肺癌所致肺不张的影像诊断中的初步应用。方法:选取独立肺段肺不张病变患者43例,其中肺癌致肺不张31例(肺癌组),局部炎症致肺不张12例(炎症组)。所有患者在药物治疗或手术前均行3.0T磁共振IVIM-DWI检查,b值取0、50、100、200、400、600、800、1000 s/mm~2,分别测量灌注分数(perfusion fraction,f)、真实扩散系数(diffusion coefficient,D)以及关注相关扩散系数(diffusion coefficient from the perfused compartment,D*),对上述参数值进行相关统计学分析,并依据受试者工作特征曲线(Receiver Operating Characteristic,ROC)对各参数的评价效能进行分析。结果:肺癌组的D值、D*值以及f值分别为(0.64±0.16)×10~(-3)mm~2/s、(19.77±6.16)×10~(-3)mm~2/s以及(29.62±9.74)%,而炎症组的D值、D*值以及f值分别为(0.67±0.14)×10~(-3) mm~2/s、(21.14±8.32)×10~(-3)mm~2/s以及(47.62±11.46)%;经比较,肺癌组D值、D*值与炎症组无统计学差异(P>0.05),而二者f值差异显著,有统计学意义(P<0.01)。f值最佳阈值为38.42%,此时曲线下面积(Area Under Curve,AUC)为0.94,诊断肺癌的特异度为0.89,敏感度为0.93,阳性预测值为0.92,阴性预测值为0.89。结论:磁共振IVIM-DWI技术在肺癌所致肺不张的影像诊断中具有一定的应用价值。
Objective: To investigate the preliminary application of intravoxel incoherent motion diffusion weighted MR imaging (IVIM-DWI) in the imaging diagnosis of lung cancer with atelectasis. Methods: Forty-three patients with lung atelectasis were selected, including 31 cases of lung atelectasis (lung cancer group) and 12 cases of atelectasis (inflammation group). All patients underwent 3.0T MRI IVIM-DWI before medication or surgery. The values of b were 0, 50, 100, 200, 400, 600, 800 and 1000 s / mm 2, respectively. Perfusion fraction , f), the diffusion coefficient (D) and the diffusion coefficient from the perfused compartment (D *), and the statistical analysis of the above parameters was carried out. The receiver operating characteristic curve Operating Characteristic, ROC) to evaluate the effectiveness of each parameter. Results: The D value, D * value and f value of lung cancer group were (0.64 ± 0.16) × 10 -3 mm 2 / s, (19.77 ± 6.16) × 10 -3 mm 2 / s, and (29.62 ± 9.74)%, respectively, while the values of D, D * and f in inflammatory group were (0.67 ± 0.14) × 10 -3 mm 2 / s and (21.14 ± 8.32) (3) mm ~ 2 / s and (47.62 ± 11.46)%, respectively. There was no significant difference in D value and D * value between lung cancer group and inflammation group (P> 0.05) Statistical significance (P <0.01). The best threshold of f value was 38.42%. The area under curve (AUC) was 0.94. The specificity of diagnosis of lung cancer was 0.89, the sensitivity was 0.93, the positive predictive value was 0.92, and the negative predictive value was 0.89. Conclusion: MRI IVIM-DWI technique has certain value in the diagnosis of pulmonary atelectasis.