眼眶淋巴增生性疾病（OLPDs）：磁共振成像在鉴别眼眶淋巴瘤与良性眼眶淋巴增生性疾病中的价值
Orbital lymphoproliferative disorders (OLPDs): value of MR imaging for differentiating orbital lymphoma from benign OPLDs.
作者信息
Haradome K, Haradome H, Usui Y, Ueda S, Kwee T C, Saito K, Tokuuye K, Matsubayashi J, Nagao T, Goto H
机构信息
From the Departments of Ophthalmology (K.H., Y.U., S.U., H.G.).
Department of Radiology (H.H.), Nihon University School of Medicine, Tokyo, Japan
出版信息
AJNR Am J Neuroradiol. 2014 Oct;35(10):1976-82. doi: 10.3174/ajnr.A3986. Epub 2014 May 29.
BACKGROUND AND PURPOSE
Accurate discrimination of orbital lymphoma from benign orbital lymphoproliferative disorders is crucial for treatment planning. We evaluated MR imaging including DWI and contrast-enhanced MR imaging for differentiating orbital lymphoma from benign orbital lymphoproliferative disorders.
MATERIALS AND METHODS
Forty-seven histopathologically proved orbital lymphoproliferative disorders (29 orbital lymphomas and 18 benign orbital lymphoproliferative disorders) were evaluated. Two board-certified radiologists reviewed visual features on T1-weighted, fat-suppressed T2-weighted, diffusion-weighted, and contrast-enhanced MR images. For quantitative evaluation, ADC and contrast-enhancement ratio of all lesions were measured and optimal cutoff thresholds and areas under curves for differentiating orbital lymphoma from benign orbital lymphoproliferative disorders were determined using receiver operative characteristic analysis; corresponding sensitivities and specificities were calculated.
RESULTS
Multivariate logistic regression analysis showed that ill-defined tumor margin (P = .003) had a significant association with orbital lymphoma whereas the "flow void sign" (P = .005) and radiologic evidence of sinusitis (P = .0002) were associated with benign orbital lymphoproliferative disorders. The mean ADC and contrast-enhancement ratio of orbital lymphomas were significantly lower than those of benign orbital lymphoproliferative disorders (P < .01). An ADC of less than 0.612 × 10(-3) mm(2)/s and a contrast-enhancement ratio of less than 1.88 yielded areas under curves of 0.980 and 0.770, sensitivity of 94.1% and 95.5%, and specificities of 93.3% and 80.0% for predicting orbital lymphoma, respectively.
CONCLUSIONS
Some characteristic MR imaging features and quantitative DWI and contrast-enhanced MR imaging are useful in further improving the accuracy of MR imaging for differentiation of orbital lymphoma from benign orbital lymphoproliferative disorders.
背景与目的
准确区分眼眶淋巴瘤与良性眼眶淋巴增生性疾病对于治疗方案的制定至关重要。我们评估了包括扩散加权成像（DWI）和对比增强磁共振成像（MR成像）在内的磁共振成像技术，以鉴别眼眶淋巴瘤与良性眼眶淋巴增生性疾病。
材料与方法
对47例经组织病理学证实的眼眶淋巴增生性疾病（29例眼眶淋巴瘤和18例良性眼眶淋巴增生性疾病）进行评估。两名获得委员会认证的放射科医生回顾了T1加权、脂肪抑制T2加权、扩散加权和对比增强MR图像上的视觉特征。为进行定量评估，测量了所有病变的表观扩散系数（ADC）和对比增强率，并使用受试者操作特征分析确定区分眼眶淋巴瘤与良性眼眶淋巴增生性疾病的最佳截断阈值和曲线下面积；计算相应的敏感性和特异性。
结果
多因素逻辑回归分析显示，肿瘤边界不清（P = 0.003）与眼眶淋巴瘤显著相关，而“流空征”（P = 0.005）和鼻窦炎的影像学证据（P = 0.0002）与良性眼眶淋巴增生性疾病相关。眼眶淋巴瘤的平均ADC和对比增强率显著低于良性眼眶淋巴增生性疾病（P < 0.01）。ADC小于0.612×10⁻³ mm²/s和对比增强率小于1.88时，预测眼眶淋巴瘤时曲线下面积分别为0.980和0.770，敏感性分别为94.1%和95.5%，特异性分别为93.3%和80.0%。
结论
一些特征性的MR成像表现以及定量DWI和对比增强MR成像有助于进一步提高MR成像鉴别眼眶淋巴瘤与良性眼眶淋巴增生性疾病的准确性。
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