MR DWI及ADC值在鼻咽癌患者颈部淋巴结性质鉴别诊断中的应用

doi:10.11958/20250046

摘要/Abstract

摘要：

目的探究磁共振扩散加权成像（MR DWI）及表观扩散系数（ADC）对鼻咽癌患者颈部淋巴结性质的鉴别诊断价值。方法纳入98例鼻咽癌患者，其中经病理证实淋巴结恶性者65例，淋巴结良性者33例；病理诊断前均行MRI常规平扫、DWI检查，记录良恶性淋巴结的ADC值，采用受试者工作特征（ROC）曲线评估其诊断价值，并比较MRI、ADC值鉴别鼻咽癌良恶性淋巴结的诊断效能。结果 65例恶性淋巴结中42例伴有液化坏死，13例伴有包膜外侵犯，良性淋巴结在DWI上大部分无信号，恶性淋巴结呈明显的高信号或者混合信号。良性淋巴结ADC值为（1.724±0.365）×10^-3 mm²/s，高于恶性组的（1.022±0.210）×10^-3 mm²/s（P<0.01）。ROC曲线分析结果显示，ADC值诊断良恶性淋巴结的曲线下面积为0.843（95%CI：0.782~0.904），截断值为1.363×10^-3 mm²/s，此时鉴别诊断良恶性淋巴结的敏感度、特异度分别为0.856、0.849，约登指数为0.705。ADC值低于截断值时，鉴别鼻咽癌患者颈部淋巴结的准确度、敏感度和特异度分别为0.878、0.892和0.848，优于MRI（P<0.05）。结论鼻咽癌患者恶性淋巴结DWI上呈高信号，ADC值较低，ADC值对患者颈部淋巴结良恶性的鉴别诊断具有较高效能。

关键词: 鼻咽癌, 淋巴结, 磁共振成像, DWI, ADC

Abstract:

Objective To explore the value of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in magnetic resonance imaging (MRI) in differential diagnosis of benign and malignant cervical lymph nodes in patients with nasopharyngeal carcinoma. Methods Clinical data of 98 patients diagnosed with nasopharyngeal carcinoma were retrospectively analyzed. This cohort included 65 patients with pathologically confirmed malignant lymph nodes and 33 patients with benign lymph nodes. Prior to pathological diagnosis, all patients underwent routine MRI scans and DWI. ADC values of both benign and malignant lymph nodes were recorded. The diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, the diagnostic efficacy of MRI and ADC values in distinguishing benign and malignant lymph nodes of nasopharyngeal carcinoma was compared. Results Of the 65 patients with malignant lymph nodes, 42 cases were accompanied by liquefactive necrosis, and 13 cases were accompanied by extracapsular invasion. Most benign lymph nodes showed no signal on DWI sequence, while malignant lymph nodes showed obvious high signal or mixed signals. The ADC value of benign lymph nodes was (1.724±0.365)×10^-3 mm²/s, which was higher than that of malignant nodes (1.022±0.210)×10^-3 mm²/s (P<0.01). The ROC curve analysis results showed that the area under the curve of ADC value for diagnosing benign and malignant lymph nodes was 0.843(95%CI: 0.782-0.904), with a cutoff value of 1.363×10^-3 mm²/s. At this point, the sensitivity and specificity for differentiating benign and malignant lymph nodes were 0.856 and 0.849, respectively, and Youden index was 0.705. When the ADC value was lower than the cutoff value, the accuracy, sensitivity and specificity for differentiating cervical lymph nodes in nasopharyngeal carcinoma patients were 0.878, 0.892 and 0.848, respectively, which were superior to MRI (P<0.05). Conclusion The DWI images of malignant lymph nodes in patients with nasopharyngeal carcinoma show high signal and low ADC, and ADC has high efficiency in the differential diagnosis of benign and malignant cervical lymph nodes.

Key words: nasopharyngeal carcinoma, lymph nodes, magnetic resonance imaging, diffusion weighted imaging, apparent diffusion coefficient

中图分类号:

R739.63

图/表 4

图1 恶性淋巴结MRI及病理变现患者男，53岁。A、B、C分别为MRI中的T2WI、DWI及ADC图，可见左侧颈部咽后区小淋巴结（黄色箭头），短径约为4.0 mm，DWI呈低信号，ADC=1.679×10-3 mm2/s；D为术中所取标本对应病理图（可见乳头状癌细胞乳头状排列）。

Fig.1 MRI and pathological findings of malignant lymph nodes

图2 良性淋巴结MRI和病理表现患者女，50岁。A、B、C分别为MRI中的T2WI、DWI及ADC图，可见右侧颈部Ⅱ区小淋巴结（黄色箭头），短径约为5.1 mm，DWI无明显信号，ADC=1.062×10-3 mm2/s；D为术中所取标本对应病理图（未见明显癌细胞）。

Fig.2 MRI and pathological findings of benign lymph nodes

图3 ADC对鼻咽癌颈部淋巴结良恶性鉴别诊断的ROC曲线

Fig.3 ROC curve of ADC for differential diagnosis of benign and malignant cervical lymph nodes in nasopharyngeal carcinoma

表1 不同检查方式定性诊断与病理组织学诊断情况（例）

Tab.1 Qualitative diagnosis and histopathological diagnosis of different examination methods

方法	病理组织学诊断结果		合计
方法	恶性	良性	合计
MRI平扫
恶性	48	13	61
良性	17	20	37
ADC
恶性	58	5	63
良性	7	28	35
合计	65	33	98

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