摘要
目的探讨基于常规MRI及高清扩散加权成像(DWI)在鼻咽-颅底骨髓炎(NP-SBO)和局部区域进展期鼻咽癌(LA-NPC)鉴别诊断中的价值。方法回顾性分析2017年1月至2021年10月复旦大学附属眼耳鼻喉科医院经病理证实的27例NP-SBO和32例LA-NPC患者。记录治疗前临床特征、常规MRI特征, 并测量表观扩散系数(ADC)值(ADC最大轮廓和ADC小圆)。DWI采用长可变回波链分段读出(RESOLVE)序列。MRI特征包括病灶的偏侧性、边缘、T1WI信号、T2WI信号、强化程度、强化均匀性、脓肿、鼻咽黏膜线的完整度、骨质髓腔受累、咽后及颈部淋巴结肿大情况以及其他伴随征象。采用独立样本t检验、χ^(2)检验或Fisher确切概率法比较NP-SBO组与LA-NPC组间各特征和ADC值的差异, 采用多因素logistic回归筛选出鉴别NP-SBO与LA-NPC的独立预测因素, 建立常规MRI模型、ADC模型及两者联合诊断模型。计算受试者操作特征曲线下面积(AUC), 采用DeLong检验比较模型间鉴别诊断NP-SBO与LA-NPC的效能。结果 NP-SBO组与LA-NPC组间年龄、糖尿病、颅神经受损、强化均匀性、脓肿、鼻咽黏膜线、淋巴结受累、ADC值差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示ADC最大轮廓(OR为0.972, 95%CI 0.951~0.993, P=0.011)和常规MRI特征中的脓肿(OR为0.101, 95%CI 0.013~0.774, P=0.027)为鉴别NP-SBO和LA-NPC的独立预测因素。常规MRI模型(脓肿)、ADC模型(ADC最大轮廓)和两者联合模型鉴别NP-SBO与LA-NPC的AUC(95%CI)分别为0.634(0.499~0.756)、0.870(0.757~0.943)、0.925(0.829~0.979)。联合模型的AUC优于常规MRI模型(Z=4.77, P<0.001), 但与ADC模型比较差异无统计学意义(Z=1.87, P=0.062)。常规MRI模型的AUC低于ADC模型(Z=2.84, P=0.005)。结论常规MRI联合RESOLVE序列DWI可有效鉴别NP-SBO与LA-NPC, 尤其是脓肿联合病灶ADC最大轮廓值, 可进一步提高诊断效能。
Objective To investigate the value of conventional MRI and high resolution diffusion weighted imaging(DWI)for preoperative discrimination between nasopharyngeal-skull base osteomyelitis(NP-SBO)and locoregionally advanced nasopharyngeal carcinoma(LA-NPC).Methods From January 2017 to October 2021,27 patients of NP-SBO and 32 patients of LA-NPC were retrospectively analyzed at the Eye&ENT Hospital of Fudan University.The clinical characteristics and conventional MRI features were collected,and the apparent diffusion coefficient(ADC)values of polygonal(ADCpolygonal)and small circle were measured from readout segmentation of long variable echo-trains(RESOLVE)DWI.MRI features included laterality,margin,signal intensity of T1WI and T2WI,enhancement degree,component,abscess,deep mucosal white line,bone invasion,lymph nodes involvement and other accompany symphtoms.The independent sample t test,χ^(2) test or Fisher exact test were used to compare the features and ADC values of the NP-SBO and LA-NPC groups.The logistic regression was applied to select independent predictors in the distinguishing LA-NPC from NP-SBO.Then,the conventional MRI model,ADC model and conventional MRI in combination with ADC model were built.The area under the receiver operating characteristic curve(AUC)of models were compared using DeLong test.Results The age,diabetic status,cranial nerve deficits,inner component,abscess,deep mucosal white line,lymph nodes involvement and ADCpolygonal were significantly different between NP-SBO and LA-NPC groups(P<0.05).The logistic regression analysis showed that ADCpolygonal(OR=0.972,95%CI 0.951-0.993,P=0.011)and abscess(OR=0.101,95%CI 0.013-0.774,P=0.027)were the independent predictors in the discrimination of NP-SBO and LA-NPC.The AUC(95%CI)of conventional MRI model(abscess),ADC model(ADCpolygonal)and combination model were 0.634(0.499-0.756),0.870(0.757-0.943),and 0.925(0.829-0.979),respectively.The AUC of combination model was higher than that of conventional MRI model(Z=4.77,P<0.001),while there was no difference between combination model and ADC model(Z=1.87,P=0.062).The AUC of conventional MRI model was lower than that of ADC model(Z=2.84,P=0.005).Conclusion Conventional MRI in combination with RESOLVE DWI shows good performance in differentiating between NP-SBO and LA-NPC,especially for abscess in combination with ADCpolygonal value.
作者
王郑玥
林奈尔
于思慧
沙炎
Zhengyue Wang;Naier Lin;Sihui Yu;Yan Sha(Department of Radiology,Eye&ENT Hospital of Fudan University,Shanghai 200031,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2023年第3期259-265,共7页
Chinese Journal of Radiology
关键词
鼻咽肿瘤
骨髓炎
磁共振成像
表观扩散系数
Nasopharyngeal neoplasms
Osteomyelitis
Magnetic resonance imaging
Apparent diffusion coefficient
