3特斯拉扩散加权成像在头颈部鳞状细胞癌患者良性与恶性颈部淋巴结鉴别诊断中的作用

The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma.

作者信息

Barchetti Flavio, Pranno Nicola, Giraldi Guglielmo, Sartori Alessandro, Gigli Silvia, Barchetti Giovanni, Lo Mele Luigi, Marsella Luigi Tonino

机构信息

Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00186 Rome, Italy.

Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, 00186 Rome, Italy.

出版信息

Biomed Res Int. 2014;2014:532095. doi: 10.1155/2014/532095. Epub 2014 Jun 9.

OBJECTIVE

The aim of this study was to validate the role of diffusion-weighted imaging (DWI) at 3 Tesla in the differential diagnosis between benign and malignant laterocervical lymph nodes in patients with head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

Before undergoing surgery, 80 patients, with biopsy proven HNSCC, underwent a magnetic resonance exam. Sensitivity (Se) and specificity (Spe) of conventional criteria and DWI in detecting laterocervical lymph node metastases were calculated. Histological results from neck dissection were used as standard of reference.

RESULTS

In the 239 histologically proven metastatic lymphadenopathies, the mean apparent diffusion coefficient (ADC) value was 0.903 × 10(-3) mm(2)/sec. In the 412 pathologically confirmed benign lymph nodes, an average ADC value of 1.650 × 10(-3) mm(2)/sec was found. For differentiating between benign versus metastatic lymph nodes, DWI showed Se of 97% and Spe of 93%, whereas morphological criteria displayed Se of 61% and Spe of 98%. DWI showed an area under the ROC curve (AUC) of 0.964, while morphological criteria displayed an AUC of 0.715.

CONCLUSIONS

In a DWI negative neck for malignant lymph nodes, the planned dissection could be converted to a wait-and-scan policy, whereas DWI positive neck would support the decision to perform a neck dissection.

目的

本研究旨在验证3特斯拉磁共振扩散加权成像（DWI）在头颈部鳞状细胞癌（HNSCC）患者颈外侧淋巴结良恶性鉴别诊断中的作用。

材料与方法

80例经活检证实为HNSCC的患者在手术前行磁共振检查。计算常规标准及DWI检测颈外侧淋巴结转移的敏感性（Se）和特异性（Spe）。颈部清扫的组织学结果作为参考标准。

结果

在239例经组织学证实的转移性淋巴结病中，平均表观扩散系数（ADC）值为0.903×10⁻³mm²/秒。在412例经病理证实的良性淋巴结中，平均ADC值为1.650×10⁻³mm²/秒。对于鉴别良性与转移性淋巴结，DWI的Se为97%，Spe为93%，而形态学标准的Se为61%，Spe为98%。DWI的ROC曲线下面积（AUC）为0.964，而形态学标准的AUC为0.715。