MRI 特征在腹膜后纤维化和淋巴瘤鉴别诊断中的应用。

Utility of MRI features for differentiation of retroperitoneal fibrosis and lymphoma.

机构信息

Department of Radiology, NYU Langone Medical Center, 550 First Ave, TCH-HW202, New York, NY 10016, USA.

出版信息

AJR Am J Roentgenol. 2012 Jul;199(1):118-26. doi: 10.2214/AJR.11.7822.

DOI:10.2214/AJR.11.7822

PMID:22733902

Abstract

OBJECTIVE

The objective of our study was to retrospectively compare the MRI features of retroperitoneal fibrosis (RPF) and lymphoma presenting as confluent retroperitoneal soft tissue.

MATERIALS AND METHODS

MRI studies of 31 patients (18 men, 13 women; mean age, 58.4 ± 15.8 [SD] years; 22 with RPF and nine with lymphoma) were evaluated. Two radiologists independently and in consensus evaluated all cases for an array of subjective imaging features. A third radiologist measured the size (i.e., the greatest dimension in the transverse plane) and apparent diffusion coefficient (ADC) value of the tissue. Features of RPF and lymphoma were compared using the Fisher exact test, Mann-Whitney test, and receiver operating characteristic (ROC) curve analysis. Interreader concordance was also calculated.

RESULTS

The mean age of patients with lymphoma was significantly greater than that in cases of RPF (72.4 ± 13.3 [SD] vs 52.7 ± 13.2 years, respectively; p = 0.003). The MRI features significantly more common in patients with RPF were pelvic extension (p = 0.004) and medial ureteral bowing (p < 0.001). The MRI features significantly more common in cases of lymphoma were predominantly suprarenal location, perirenal extension, anterior aortic displacement, heterogeneity, and the presence of additional nodes (p < 0.001-0.043). Size was significantly greater in patients with lymphoma than in those with RPF (mean ± SD, 33.9 ± 17.3 vs 11.0 ± 5.7 mm; p < 0.001) and had an area under the curve (AUC) of 0.960; a size larger than 15 mm had sensitivity of 100% and specificity of 86.4% for the diagnosis of lymphoma. The ADC was significantly lower in lymphoma than in RPF (mean ± SD, 0.92 ± 0.17 vs 1.40 ± 0.38 × 10(-3) mm(2)/s; p = 0.003) and had an AUC of 0.904. An ADC of 0.955 × 10(-3) mm(2)/s or less had sensitivity of 83.3% and specificity of 89.5% for the diagnosis of lymphoma. Interreader concordance for subjective features was very good to excellent (range, 80.6-100%).

CONCLUSION

MRI features may be helpful in distinguishing between RPF and lymphoma.

摘要

目的

本研究的目的是回顾性比较腹膜后纤维化（RPF）和淋巴瘤的 MRI 特征，这些特征表现为融合性腹膜后软组织。

材料和方法

评估了 31 名患者（18 名男性，13 名女性；平均年龄 58.4 ± 15.8 [SD] 岁；22 名 RPF 患者和 9 名淋巴瘤患者）的 MRI 研究。两名放射科医生独立并一致地对所有病例进行了一系列主观影像学特征评估。第三名放射科医生测量了组织的大小（即横断面上的最大尺寸）和表观扩散系数（ADC）值。使用 Fisher 确切检验、Mann-Whitney 检验和受试者工作特征（ROC）曲线分析比较 RPF 和淋巴瘤的特征。还计算了读者间的一致性。

结果

淋巴瘤患者的平均年龄明显大于 RPF 患者（分别为 72.4 ± 13.3 [SD] 和 52.7 ± 13.2 岁；p = 0.003）。RPF 患者中更常见的 MRI 特征是骨盆延伸（p = 0.004）和内侧输尿管弯曲（p < 0.001）。在淋巴瘤患者中更常见的 MRI 特征是主要位于肾上极、肾周延伸、主动脉前移位、异质性和存在额外的淋巴结（p < 0.001-0.043）。淋巴瘤患者的大小明显大于 RPF 患者（平均值 ± SD，33.9 ± 17.3 与 11.0 ± 5.7 mm；p < 0.001），曲线下面积（AUC）为 0.960；大小大于 15 mm 时，诊断淋巴瘤的敏感性为 100%，特异性为 86.4%。淋巴瘤的 ADC 明显低于 RPF（平均值 ± SD，0.92 ± 0.17 与 1.40 ± 0.38 × 10(-3) mm(2)/s；p = 0.003），AUC 为 0.904。ADC 为 0.955 × 10(-3) mm(2)/s 或更低时，诊断淋巴瘤的敏感性为 83.3%，特异性为 89.5%。主观特征的读者间一致性非常好到极好（范围为 80.6-100%）。