多模态功能磁共振成像（ fMRI ）联合灌注、弥散加权 MRI 和磁共振波谱（ H-MRS ）在腮腺淋巴相关良恶性病变诊断中的应用。
Multimodality fMRI with perfusion, diffusion-weighted MRI and H-MRS in the diagnosis of lympho-associated benign and malignant lesions of the parotid gland.
机构信息
Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Department of Radiology, Shanghai, P.R. China.
出版信息
J Magn Reson Imaging. 2019 Feb;49(2):423-432. doi: 10.1002/jmri.26260. Epub 2018 Nov 26.
BACKGROUND
Differential diagnosis of the mucosa-associated lymphoid tissue lymphoma (MALToma) and tumor-like benign lymphoepithelial lesion (BLEL) in the parotid gland is difficult.
PURPOSE
To distinguish MALToma and BLEL with multimodality MRI including hydrogenproton magnetic resonance spectroscopy ( H-MRS), diffusion-weighted imaging (DWI-MR), and dynamic contrast-enhanced (DCE-MR), and evaluate each sequence.
STUDY TYPE
Retrospective.
POPULATION
Twenty-five patients with parotid tumor-like BLEL and 20 with parotid MALToma.
FIELD STRENGTH/SEQUENCE: 1.5-T/T WI, T WI, single-voxel H-MRS, DWI-MR, and DCE-MR.
ASSESSMENT
All MR images were interpreted and agreed upon by two radiologists who were blinded to clinical information and histopathologic results. The imaging diagnoses were then compared to the histopathologic results.
STATISTICAL TESTS
Youden index was used to determine the optimized threshold value. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of different functional (f)MRI methods.
RESULTS
Fisher's exact test indicated a significant difference between the H-MRS images of the two lesions (P < 0.001). The sensitivity, specificity, and accuracy of positive choline (Cho) peak in H-MRS of parotid MALToma were 80%, 76%, and 77.7%, respectively. The mean apparent diffusion coefficient (ADC) was 0.992 × 10 mm /s in patients with parotid tumor-like BLEL and 0.634 × 10 mm /s in patients with parotid MALToma, and the difference was statistically significant (t-test, P < 0.001). Choosing the Youden index as 0.669 × 10 mm /s, the sensitivity, specificity, and accuracy of the assay were 78.9%, 95.8%, and 88.4%, respectively. Assuming that time-intensity curve (TIC) type I indicated parotid MALToma (positive), and type II and type III indicated parotid tumor-like BLEL (negative), the sensitivity, specificity, and accuracy of time-to-peak (TTP) and initial slope of increase (ISI) in diagnosing MALToma were 94.1%, 95.2%, and 94.7%, respectively. Combining methods of TTP, ADC, and Cho peak reached the highest AUC (1.000).
DATA CONCLUSION
Combined use H-MRS, DWI-MR, and DCE-MR increased the accuracy of the differential diagnosis between these lesions to 100%. Cho peak in H-MRS, ADC less than 0.669 × 10 mm /s, TIC type I together indicated parotid MALToma.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:423-432.
背景
腮腺黏膜相关淋巴组织淋巴瘤（MALToma）和肿瘤样良性淋巴上皮病变（BLEL）的鉴别诊断具有一定难度。
目的
利用多模态 MRI（包括氢质子磁共振波谱成像（H-MRS）、扩散加权成像（DWI-MR）和动态对比增强（DCE-MR））对腮腺 MALToma 和 BLEL 进行鉴别诊断，并评估每种序列的诊断效能。
研究类型
回顾性研究。
研究对象
25 例腮腺肿瘤样 BLEL 患者和 20 例腮腺 MALToma 患者。
磁场强度/序列：1.5T/T1WI、T2WI、单体素 H-MRS、DWI-MR 和 DCE-MR。
评估
两位放射科医生对所有 MR 图像进行解读并达成一致意见，他们对临床信息和组织病理学结果均不知情。然后将影像学诊断与组织病理学结果进行比较。
统计学方法
采用约登指数确定最佳阈值。受试者工作特征（ROC）曲线用于评估不同功能 MRI 方法的诊断效能。
结果
Fisher 确切概率法提示两种病变的 H-MRS 图像存在显著差异（P<0.001）。腮腺 MALToma 中 Cho 峰阳性的 H-MRS 诊断的灵敏度、特异度和准确率分别为 80%、76%和 77.7%。腮腺肿瘤样 BLEL 患者的平均表观扩散系数（ADC）值为 0.992×10 mm/s，腮腺 MALToma 患者的 ADC 值为 0.634×10 mm/s，差异具有统计学意义（t 检验，P<0.001）。选择约登指数为 0.669×10 mm/s 时，该检测的灵敏度、特异度和准确率分别为 78.9%、95.8%和 88.4%。假设 TIC 类型 I 提示腮腺 MALToma（阳性），类型 II 和类型 III 提示腮腺肿瘤样 BLEL（阴性），则 TTP 和初始斜率（ISI）诊断 MALToma 的灵敏度、特异度和准确率分别为 94.1%、95.2%和 94.7%。TTP、ADC 和 Cho 峰联合方法的 AUC 值最高（1.000）。
数据结论
联合使用 H-MRS、DWI-MR 和 DCE-MR 可将这些病变的鉴别诊断准确性提高到 100%。H-MRS 中的 Cho 峰、ADC 值小于 0.669×10 mm/s、TIC 类型 I 共同提示腮腺 MALToma。
证据水平
3 级 技术效果：2 级 J. 磁共振成像 2019；49：423-432.
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