核磁弥散加权成像和表观扩散系数在鉴别甲状腺良恶性结节方面的应用

李智林; 南杰; 崔雨田; 杜笑松; 郝慧超; 张剑锋; 张茜; 高泽慧

doi:10.13201/j.issn.1001-1781.2019.04.013

核磁弥散加权成像和表观扩散系数在鉴别甲状腺良恶性结节方面的应用

- 山西省肿瘤医院头颈外科(太原, 030013)
基金项目:
山西省卫计委科技攻关计划(No:201601065)

详细信息

通讯作者: 李智林,E-mail:20647613@qq.com

中图分类号: R739.6

收稿日期: 2018-10-12

Application of nuclear magnetic dispersion weighted imaging and apparent diffusion coefficient in the identification of benign and malignant thyroid nodules

- Department of Head and Neck Surgery, Shanxi Province Tumor Hospital, Taiyuan, 030013, China

More Information

Corresponding author: LI Zhilin, E-mail: 20647613@qq.com

Received Date: 12 October 2018

摘要

摘要: 目的:以术后组织病理结果为参考标准,确定不同b值下的弥散加权成像(DWI)和表观扩散系数(ADC)在鉴别甲状腺良恶性结节中的诊断作用。方法:收集2017-01-2018-06期间山西省肿瘤医院头颈外科经超声诊断为甲状腺结节的64例患者,共80处结节,均采用飞利浦3.0T超导型磁共振成像系统进行T1加权、T2加权、DWI横轴位扫描成像,b值分别取300、500、800和1 000 s/mm²。以术后组织病理结果为参考标准,对所有受试者的甲状腺结节ADC值进行计算和比较,并绘制所有b值的受试者工作特征(ROC)曲线,计算曲线下面积,得到区分甲状腺良恶性结节的阈值。结果:共80处结节,排除1例弥漫B细胞非霍奇金淋巴瘤、2例甲状旁腺囊肿、1例纯囊性患者,共纳入76处(33处为恶性、43处为良性)结节。在b值为300、500、800和1 000 s/mm²时,恶性结节的平均ADC值分别为(1.498±0.210)×10^-3mm²/s、(1.311±0.190)×10^-3mm²/s、(1.134±0.170)×10^-3mm²/s、(0.972±0.150)×10^-3mm²/s;良性结节的平均ADC值分别为(2.207±0.390)×10^-3mm²/s、(1.928±0.430)×10^-3mm²/s、(1.702±0.410)×10^-3mm²/s、(1.557±0.420)×10^-3mm²/s。同一b值下,恶性结节的平均ADC值低于良性结节,差异有统计学意义(t=9.279、7.641、7.301、7.569,P=0.000、0.000、0.000、0.000)。良、恶性结节的平均ADC值,均随着b值升高而降低,差异有统计学意义(良、恶性组的F=210.091、353.822;P=0.000、0.000)。不同b值下ROC曲线下面积分别为0.927、0.884、0.878、0.901,95%CI分别为0.862~0.993、0.804~0.956、0.794~0.962、0.829~0.972。在b值为300 s/mm²时,曲线下面积最大,说明其是区分甲状腺良恶性结节的最佳指标,区分良恶性结节的诊断阈值为1.802×10^-3mm²/s,特异性、敏感性、准确性、阳性预测值及阴性预测值分别为95.00%、86.11%、90.79%、93.94%及88.37%。结论:DWI是一种无创诊断工具,可用于鉴别良恶性甲状腺结节;可以在术前有助于明确诊断并减少不必要的手术负担。
- 弥散加权成像 /
- 表观扩散系数 /
- 甲状腺结节
Abstract: Objective: To determine the diagnostic role of diffusion-weighted imaging(DWI) and apparent diffusion coefficient(ADC) under different b values in differentiating benign and malignant thyroid nodules by using postoperative histopathological results were taken as the reference standard. Method: From January 2017 to June 2018, 64 patients with thyroid nodules diagnosed by ultrasound in the head and neck surgery of Shanxi Cancer Hospital were collected, and a total of 80 nodules were collected. The Philips 3.0 T superconducting magnetic resonance imaging system was used for T1 weighting, T2 weighting, and DWI horizontal axis scanning imaging. The b values were 300, 500, 800 and 1 000 s/mm², respectively. Taking postoperative histopathological results as the reference standard, the ADC values of thyroid nodules of all subjects were calculated and compared, and the working characteristics(ROC) curves of all subjects with b values were drawn, the area under the curve was calculated, and the threshold value of differentiating benign and malignant thyroid nodules was obtained. Result: A total of 80 nodules, 33 malignant and 43 benign were excluded, including 1 diffuse b-cell non-hodgkin's lymphoma, 2 parathyroid cysts, and 1 pure cystic patient. A total of 76 nodules were included. When b values were 300, 500, 800 and 1 000 s/mm², the average ADC values of malignant nodules were(1.498±0.210) ×10^-3mm²/s,(1.311±0.190) ×10^-3mm²/s,(1.134±0.170) ×10^-3mm²/s,(0.972±0.150) ×10^-3mm²/s. The mean ADC values of benign nodules were(2.207±0.390) ×10^-3mm²/s,(1.928±0.430) ×10^-3mm²/s,(1.702±0.410) ×10^-3mm²/s,(1.557±0.420) ×10^-3mm²/s. At the same b value, the average ADC value of malignant nodules was lower than that of benign nodules, and the difference was statistically significant(t values were 9.279, 7.641, 7.301, 7.569, P values were 0.000, 0.000, 0.000, 0.000, 0.000). The average ADC values of the benign and malignant nodules decreased with the increase of b value, and the difference was statistically significant(the F values of the benign and malignant groups were 210.091 and 353.822, respectively, P values are 0.000, 0.000). Under different b values, the area(AUC) of ROC curve is 0.927, 0.884, 0.878, 0.901, and 95%CI are 0.862-0.993, 0.804-0.956, 0.794-0.962 and 0.829-0.972, respectively. When b value is 300 s/mm², AUC is the largest, indicating that it is the best indicator to distinguish benign and malignant thyroid nodules. The diagnostic threshold of benign and malignant nodules is 1.802×10^-3mm²/s. Specificity, sensitivity, accuracy, positive predictive value, and negative predictive value were 95.00%, 86.11%, 90.79%, 93.94% and 88.37%, respectively.Conclusion: DWI is a noninvasive diagnostic tool used to identify benign and malignant thyroid nodules. It can help to make a definite diagnosis before surgery and reduce the unnecessary burden of surgery.
- diffusion-weighted imaging /
- apparent diffusion coefficient /
- thyroid nodule

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