头颈部鳞状细胞癌复发性肿瘤与治疗后改变的鉴别：高b值扩散加权成像的应用
Differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma: application of high b-value diffusion-weighted imaging.
作者信息
Hwang I, Choi S H, Kim Y-J, Kim K G, Lee A L, Yun T J, Kim J-h, Sohn C-H
机构信息
Department of Radiology Seoul National University College of Medicine, Seoul, Korea.
出版信息
AJNR Am J Neuroradiol. 2013 Dec;34(12):2343-8. doi: 10.3174/ajnr.A3603. Epub 2013 Jun 27.
BACKGROUND AND PURPOSE
High b-value DWI has been expected to have an additional diagnostic role and demonstrated some promising results in head and neck cancer. The aim of this study was to evaluate the diagnostic performance of DWI at a high b-value (b=2000 s/mm(2)) compared with a standard b-value (b=1000 s/mm(2)) and the ratio of ADC values of high and standard b-values for their ability to differentiate between recurrent tumor and posttreatment changes after the treatment of head and neck squamous cell carcinoma.
MATERIALS AND METHODS
A total of 33 patients diagnosed with head and neck squamous cell carcinoma were enrolled in the present study; all had contrast-enhancing lesions on follow-up MR imaging. All patients underwent single-shot echo-planar DWI at b=1000 s/mm(2) and b=2000 s/mm(2), and corresponding ADC maps were generated (ADC1000 and ADC2000, respectively). The mean ADC1000, ADC2000, and ADCratio (ADCratio = ADC2000/ADC1000 × 100) values were evaluated within a manually placed ROI with contrast-enhanced T1-weighted images as references. For the statistical analysis, we performed a Student t test and multivariate logistic regression.
RESULTS
The mean ADC1000 in recurrent tumor was significantly lower than that in posttreatment changes (P < .001), whereas the mean ADC2000 resulted in no significant difference (P = .365). The mean ADCratio was significantly higher in recurrent tumor than that in posttreatment changes (73.5 ± 7.2% vs 56.9 ± 8.8%, respectively; P < .001). Multivariate logistic regression analysis revealed that the ADCratio was the only independently differentiating variable (P = .024). The sensitivity, specificity, and accuracy of ADCratio were 95.0%, 69.2%, and 84.8%, respectively, by use of the optimal cutoff value of 62.6%.
CONCLUSIONS
We suggest that the ADCratio calculated from the ADC1000 and ADC2000 is a promising value for the differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma.
背景与目的
高b值扩散加权成像（DWI）有望发挥额外的诊断作用，并且在头颈部癌中已显示出一些有前景的结果。本研究的目的是评估与标准b值（b = 1000 s/mm²）相比，高b值（b = 2000 s/mm²）DWI的诊断性能，以及高b值与标准b值的表观扩散系数（ADC）值之比在鉴别头颈部鳞状细胞癌治疗后复发肿瘤与治疗后改变方面的能力。
材料与方法
本研究共纳入33例诊断为头颈部鳞状细胞癌的患者；所有患者在随访磁共振成像中均有强化病变。所有患者均接受了b = 1000 s/mm²和b = 2000 s/mm²的单次激发回波平面DWI检查，并生成了相应的ADC图（分别为ADC1000和ADC2000）。以增强T1加权图像为参考，在手动放置的感兴趣区内评估平均ADC1000、ADC2000和ADC比值（ADC比值 = ADC2000/ADC1000×100）值。对于统计分析，我们进行了Student t检验和多因素逻辑回归分析。
结果
复发肿瘤的平均ADC1000显著低于治疗后改变（P <.001），而平均ADC2000无显著差异（P =.365）。复发肿瘤的平均ADC比值显著高于治疗后改变（分别为73.5±7.2%和56.9±8.8%；P <.001）。多因素逻辑回归分析显示，ADC比值是唯一的独立鉴别变量（P =.024）。使用最佳截断值62.6%时，ADC比值的敏感性、特异性和准确性分别为95.0%、69.2%和84.8%。
结论
我们认为，由ADC1000和ADC2000计算得出的ADC比值在鉴别头颈部鳞状细胞癌复发肿瘤与治疗后改变方面是一个有前景的值。
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