Çakır Çağlayan, Gençhellaç Hakan, Temizöz Osman, Polat Ahmet, Şengül Ersin, Duygulu Gökhan
Department of Radiology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
Department of Radiology, Trakya University Hospital, Edirne, Turkey.
Balkan Med J. 2015 Oct;32(4):403-9. doi: 10.5152/balkanmedj.2015.15663. Epub 2015 Oct 1.
We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging.
To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions.
Randomized prospective study.
This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm(2)). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups.
On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm(2). In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10(-3) mm(2)/s for malignant lesions, and 1.195×10(-3)±0.3 mm(2)/s for benign lesions). Setting the cut-off value at 1.5×10(-3), ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions.
DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Identifier: NCT02482181).
我们评估了磁共振成像对孤立性肺病变的鉴别诊断。
探讨扩散加权成像在孤立性肺病变鉴别诊断中的价值。
随机前瞻性研究。
这项前瞻性研究纳入了48个孤立性肺结节和肿块（18个良性，30个恶性）。采用单次激发回波平面自旋回波扩散加权成像（DWI），设置两个b值（0和1000 s/mm²）。计算表观扩散系数（ADC）。在扩散加权（DW）追踪图像上，使用5分制将病变的信号强度（SI）与胸段脊髓的SI进行视觉比较：1：低信号；2：中度低信号；3：等信号；4：中度高信号；5：显著高信号。对于定量评估，比较两组之间病变与胸段脊髓的信号强度比值以及病变的ADC。
在视觉评估中，以脊髓密度为参照，发现大多数良性病变在b值为1000 s/mm²的DWI上为低信号，而大多数恶性病变为高信号。相比之下，在T2加权图像上，恶性病变与良性病变的区分无统计学意义。恶性病变的ADC显著低于良性病变（恶性病变的平均ADC为2.02×10⁻³ mm²/s，良性病变为1.195×10⁻³±0.3 mm²/s）。将截断值设定为1.5×10⁻³时，ADC对鉴别良性病变与恶性病变的敏感性为86.7%，特异性为88.9%。
DWI可能有助于孤立性肺病变的鉴别诊断。（ClinicalTrials.gov标识符：NCT02482181）
