Feng L L, Xian J F, Yan F, Fu L, Zhou H Y
Department of Radiology, Beijing Tongren Hospital, Capital Medical University , Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2017 Feb 21;97(7):487-491. doi: 10.3760/cma.j.issn.0376-2491.2017.07.003.
To evaluate the value of dynamic contrast-enhanced MR (DCE-MRI) and diffusion weighted MR (DWI) in differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland. In this retrospective study, a total of 24 cases of inflammatory pseudotumor and 22 cases of lymphoma in the lacrimal gland at Beijing Tongren Hospital confirmed by histological results were enrolled from January 2010 to January 2015.DCE-MRI and DWI were performed in these cases, and the type of time-signal intensity curve (time-intensity curve, TIC), the peak contrast index (CIpeak), maximum enhancement ratio (ERmax), washout ratio (WR) and ADC value were analyzed.Differences of these parameters between inflammatory pseudotumor and lymphoma in the lacrimal gland was evaluated by independent samples test or - test.The receiver operating characteristic analysis was used to evaluate the utility of these parameters in discriminating the two diseases. Type of TIC, CIpeak, WR, ERmax and ADC values were statistically different (all <0.05) between the inflammatory pseudotumor and lymphoma in the lacrimal gland.ERmax, CIpeak and ADC values of inflammatory pseudotumor were greater than those of lymphoma, but the WR values of inflammatory pseudotumor was less than those of lymphoma.The area under the ROC of the CIpeak, WR, ERmax and ADC values was 0.68±0.08, 0.70±0.08, 0.70±0.08, 0.84±0.81 respectively.Using an ADC(b=0, 1000) value of 1.005×10(-3) mm(2)/s as the diagnostic threshold, the sensitivity, specificity and accuracy to differentiate benign lesions from malignant lesions were 84.2%, 65.0% and 75.0% respectively.The diagnostic ability of DWI combined with DCE-MRI was superior to that of DCE-MRI(=0.000) or DWI alone(=0.008) with overall sensitivity, specificity and accuracy of 86.3%, 87.5% and 86.9%. DCE-MRI and DWI may improve the diagnostic accuracy in differentiation of the inflammatory pseudotumors and lymphomas in the lacrimal gland, and play an important role in differentiation among them.
评估动态对比增强磁共振成像（DCE-MRI）和扩散加权磁共振成像（DWI）在泪腺炎性假瘤和淋巴瘤鉴别诊断中的价值。在这项回顾性研究中，选取了2010年1月至2015年1月在北京同仁医院经组织学结果确诊的24例泪腺炎性假瘤和22例泪腺淋巴瘤患者。对这些患者进行了DCE-MRI和DWI检查，并分析了时间-信号强度曲线（time-intensity curve，TIC）类型、峰值对比指数（CIpeak）、最大强化率（ERmax）、廓清率（WR）和表观扩散系数（ADC）值。采用独立样本t检验或秩和检验评估泪腺炎性假瘤和淋巴瘤之间这些参数的差异。采用受试者工作特征分析评估这些参数在鉴别这两种疾病中的效用。泪腺炎性假瘤和淋巴瘤之间的TIC类型、CIpeak、WR、ERmax和ADC值差异有统计学意义（均P<0.05）。炎性假瘤的ERmax、CIpeak和ADC值大于淋巴瘤，但炎性假瘤的WR值小于淋巴瘤。CIpeak、WR、ERmax和ADC值的ROC曲线下面积分别为0.68±0.08、0.70±0.08、0.70±0.08、0.84±0.01。以ADC（b=0，1000）值1.005×10⁻³mm²/s作为诊断阈值，鉴别良性病变与恶性病变的敏感度、特异度和准确度分别为84.2%、65.0%和75.0%。DWI联合DCE-MRI的诊断能力优于单独的DCE-MRI（P=0.000）或DWI（P=0.008），总体敏感度、特异度和准确度分别为86.3%、87.5%和86.9%。DCE-MRI和DWI可提高泪腺炎性假瘤和淋巴瘤鉴别诊断的准确性，并在两者的鉴别中发挥重要作用。
