实用医学杂志 ›› 2021, Vol. 37 ›› Issue (19): 2530-2534.doi: 10.3969/j.issn.1006⁃5725.2021.19.019

• 医学检查与临床诊断 • 上一篇    下一篇

不同区域的ADC值、rADC值对原发性中枢神经系统淋巴瘤诊断与鉴别及其与Ki-67相关性

耿磊1 孙毅1 赵妍1 万金鑫1 许磊1 叶永盛1 汪秀玲2 徐凯2   

  1. 1 蚌埠医学院附属连云港市第二人民医院(江苏大学附属连云港医院)(连云港市第二人民医院)(连云港 市肿瘤医院)医学影像科(江苏连云港222000);2 徐州医科大学附属医院医学影像科(江苏徐州221002)


  • 出版日期:2021-10-10 发布日期:2021-10-10
  • 通讯作者: 孙毅 E⁃mail:sunyi2009@sina.com
  • 基金资助:
    蚌埠医学院科技发展基金项目(编号:BYKY18188);江苏大学临床医学科技发展基金资助(编号:JLY20180158);连云港市第二人民医院中青年人才成长基金科研课题计划(编号:TQ201906);江苏省卫生健康委 2020 年度医学科研项目(编号:Z2020144)

Application of ADC values and rADC values in the diagnosis and differentiation of primary central ner⁃ vous system lymphoma and its correlation with Ki ⁃67

GENG Lei*,SUN Yi,ZHAO Yan,WAN Jinxin,XU Lei,YE Yongsheng,WANG Xiuling,XU Kai.   

  1. Department of Medical Imaging,the Second People′s Hospital of Lianyungang,Lianyungang 222000,China

  • Online:2021-10-10 Published:2021-10-10
  • Contact: SUN Yi E⁃mail:sunyi2009@sina.com

摘要:

目的 探讨肿瘤不同区域表观扩散系数(apparent diffusion coefficient,ADC)值、相对表观扩 散系数(rADC)值在原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)与高 级别胶质瘤(high⁃grade glioma,HGG)鉴别诊断及其与增殖细胞核抗原(Ki⁃67)相关性中的应用价值。 方法 收集 30 PCNSL 35 HGG 患者临床及影像学资料,所有病例均经临床及病理证实,分析比较两 组肿瘤不同区域 ADC 值的差异,绘制 ROC 曲线,比较 ADC rADC 值对两组肿瘤的诊断效能;分析 PCNSL 组肿瘤实质 ADC 值、rADC 值与 Ki⁃67 的相关性。结果 PCNSL 组肿瘤实质、近、远侧瘤周、对侧脑白质的 ADC 值总体差异有统计学意义(F = 278.758,P < 0.001),两两比较有统计学意义(均 P < 0.05)。PCNSL HGG 组实质 ADC 值和近、远侧瘤周 ADC 值变化趋势分别为:先升后降抛物线型与折线上升型。PCNSL 肿瘤实质与远侧瘤周 ADC 值、rADC 值均显著低于 HGG 组(P < 0.001),而 PCNSL 组近侧瘤周 ADC 值、rADC 值均显著高于 HGG 组(P < 0.001);肿瘤实质 rADC 值=1.045 时,鉴别诊断 PCNSL HGG 的敏感度、特异 度、准确率分别为96.7%、85.7%、90.8%,曲线下面积最大(AUC=0.964),诊断效能最高。ADC 值、rADC 值与 Ki⁃67 的表达呈负相关。结论 不同区域的 ADC 值测量技术为 PCNSL HGG 的诊断与鉴别提供可靠依据,同时为无创性判断肿瘤及瘤周的微观浸润状态提供病理基础及分子影像学依据,亦可从分子水平反 PCNSL 的增殖活性。

关键词:

 , 淋巴瘤; 胶质瘤; 中枢神经系统; 磁共振成像; 表观扩散系数; 增殖细胞核抗原

Abstract:

Objective To explore the application value of ADC and rADC values in the differential diagno⁃ sis of PCNSL and HGG as well as the correlation with Ki⁃67 in different tumor regions. Methods Clinical and imaging data of 30 cases of PCNSL and 35 cases of HGG were collected,the characteristics of MRI and DWI of 30 cases of PCNSL and 35 cases of HGG confirmed by clinical and pathology were analyzed. The differences of ADC values in different regions of the two groups of tumors were compared,and ROC curves were drawn to analyze and compare the diagnostic efficacy of ADC and rADC values in the two groups of tumors.The correlation was analyzed between tumor parenchymal ADC and rADC and Ki⁃67 in PCNSL group. Results There were statistically signifi⁃ cant differences in ADC values of tumor parenchyma,proximal peritumor,distal peritumor and contralateral white matter in PCNSL(F = 278.758,P < 0.001). Pair comparison showed statistically significant differences(P < 0.05). The parenchymal ADC values,ADC values around the proximal tumor and ADC values around the distal tumor in the PCNSL and HGG groups showed a parabola pattern of rising first and then falling,and a broken line pattern of rising.The ADC value and rADC value of tumor parenchyma and distal peritumor ADC value and rADC value of PCNSL were significantly lower than those of HGG group(P < 0.001),while the ADC value and rADC value of proximal peritumor ADC value and rADC value of PCNSL were significantly higher than those of HGG group(P<0.001). When the rADC value of tumor parenchymal was 1.045,the sensitivity,specificity and accuracy of differ⁃ ential diagnosis of PCNSL and HGG were 96.7%,85.7% and 90.8%,respectively. The area under the rADC value curve was the largest(AUC = 0.964),and the diagnostic efficiency was the highest.Ki⁃67 expression was negatively correlated with ADC and rADC values. Conclusion The measurement techniques of ADC value and rADC value provide pathological basis and molecular imaging basis for noninvasive determination of tumor and peri⁃tumor micro⁃ invasion state,provide reliable basis for the diagnosis and differentiation of PCNSL and HGG,and also reflect the value⁃added activity of PCNSL at the molecular level.

Key words:

lymphoma glioma central nervous system magnetic resonance imaging apparent diffusion coefficient Ki?67 ,