Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
PLoS One. 2013 Jul 9;8(7):e68622. doi: 10.1371/journal.pone.0068622. Print 2013.
Diffusion-weighted magnetic resonance imaging (DWI) has been introduced in head and neck cancers. Due to limitations in the performance of laryngeal DWI, including the complex anatomical structure of the larynx leading to susceptibility effects, the value of DWI in differentiating benign from malignant laryngeal lesions has largely been ignored. We assessed whether a threshold for the apparent diffusion coefficient (ADC) was useful in differentiating preoperative laryngeal carcinomas from precursor lesions by turbo spin-echo (TSE) DWI and 3.0-T magnetic resonance.
We evaluated DWI and the ADC value in 33 pathologically proven laryngeal carcinomas and 17 precancerous lesions.
The sensitivity, specificity, and accuracy were 81.8%, 64.7%, 76.0% by laryngostroboscopy, respectively. The sensitivity, specificity, and accuracy of conventional magnetic resonance imaging were 90.9%, 76.5%, 86.0%, respectively. Qualitative DWI analysis produced sensitivity, specificity, and accuracy values of 100.0, 88.2, and 96.0%, respectively. The ADC values were lower for patients with laryngeal carcinoma (mean 1.195±0.32×10(-3) mm(2)/s) versus those with laryngeal precancerous lesions (mean 1.780±0.32×10(-3) mm(2)/s; P<0.001). ROC analysis showed that the area under the curve was 0.956 and the optimum threshold for the ADC was 1.455×10(-3) mm(2)/s, resulting in a sensitivity of 94.1%, a specificity of 90.9%, and an accuracy of 92.9%.
Despite some limitations, including the small number of laryngeal carcinomas included, DWI may detect changes in tumor size and shape before they are visible by laryngostroboscopy. The ADC values were lower for patients with laryngeal carcinoma than for those with laryngeal precancerous lesions. The proposed cutoff for the ADC may help distinguish laryngeal carcinomas from laryngeal precancerous lesions.
磁共振弥散加权成像（DWI）已应用于头颈部肿瘤。由于喉部 DWI 的性能受限，包括由于喉的复杂解剖结构导致的敏感性效应，DWI 在区分良性和恶性喉病变方面的价值在很大程度上被忽视了。我们评估了通过涡轮自旋回波（TSE）DWI 和 3.0-T 磁共振，表观弥散系数（ADC）的阈值是否可用于区分术前喉癌与癌前病变。
我们评估了 33 例经病理证实的喉癌和 17 例癌前病变的 DWI 和 ADC 值。
通过喉镜检查，灵敏度、特异性和准确性分别为 81.8%、64.7%和 76.0%。常规磁共振成像的灵敏度、特异性和准确性分别为 90.9%、76.5%和 86.0%。定性 DWI 分析的灵敏度、特异性和准确性分别为 100.0%、88.2%和 96.0%。喉癌患者的 ADC 值较低（平均 1.195±0.32×10(-3) mm(2)/s），而喉癌前病变患者的 ADC 值较高（平均 1.780±0.32×10(-3) mm(2)/s；P<0.001）。ROC 分析显示曲线下面积为 0.956，ADC 的最佳阈值为 1.455×10(-3) mm(2)/s，灵敏度为 94.1%，特异性为 90.9%，准确性为 92.9%。
尽管存在一些局限性，包括纳入的喉癌数量较少，但 DWI 可能在喉镜检查之前检测到肿瘤大小和形状的变化。喉癌患者的 ADC 值低于喉癌前病变患者。所提出的 ADC 截止值有助于区分喉癌与喉癌前病变。
