Department of Radiology, University of Minnesota Medical Center, Minneapolis, MN, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Medical Center, Minneapolis, MN, USA.
Clin Imaging. 2019 May-Jun;55:76-82. doi: 10.1016/j.clinimag.2019.02.004. Epub 2019 Feb 7.
To evaluate the potential contribution of quantitative DWI parameters including ADC and ADC values to help in distinguishing the histopathological types of sinonasal neoplasms.
This retrospective study included 83 patients (50 males, 33 females; mean age 61 years) with pathologically proven untreated sinonasal neoplasms who have undergone diffusion-weighted MRI imaging from February 2010 to August 2017. Diffusion-weighted MRI was performed on a 3 T unit with b factors of 0 and 1000 s/mm, and ADC maps were generated. Mean ADC values of sinonasal tumors and ADC ratios (ADC of the tumor to ADC of pterygoid muscles) were compared with the histopathological diagnosis by utilizing the Kruskal-Wallis non-parametric test.
Mean ADC and ADC were 0.8 (SD, ±0.4) × (10 mm/s) and 1.2 (SD, ±0.5), respectively, and each parameter was significantly different between histopathological types (p < 0.05). Mean ADC and ADC were higher in adenoid cystic carcinoma (ACC) than in SCC, lymphoma, neuroendocrine carcinoma and sinonasal undifferentiated carcinoma (SNUC) (p < 0.05). Optimized ADC thresholds of 0.79, 0.81, 0.74 and 0.78 (10 mm/s) achieved maximal discriminatory accuracies of 100%, 79%, 100% and 89% for ACC/SNUC, ACC/SCC, ACC/neuroendocrine carcinoma, and ACC/lymphoma, respectively.
The optimized ADC threshold of 0.80 (10 mm/s) could be used to differentiate ACC from non-ACC sinonasal neoplasms with maximal discriminatory accuracy (82%) and sensitivity of 100%. However, there is considerable overlapping of the ADC and ADC values among non-ACC sinonasal neoplasms hence surgical biopsy is still needed.
评估定量 DWI 参数（包括 ADC 值和 ADC 值）在帮助鉴别鼻窦肿瘤组织学类型方面的潜在作用。
本回顾性研究纳入了 2010 年 2 月至 2017 年 8 月期间在我院接受扩散加权 MRI 成像检查且经病理证实未治疗的鼻窦肿瘤患者 83 例（男 50 例，女 33 例；平均年龄 61 岁）。DWI 检查在 3T 磁共振仪上进行，b 值分别为 0 和 1000s/mm2，生成 ADC 图。利用 Kruskal-Wallis 非参数检验比较鼻窦肿瘤的平均 ADC 值和 ADC 比值（肿瘤的 ADC 值与翼内肌的 ADC 值之比）与组织病理学诊断之间的关系。
平均 ADC 值和 ADC 比值分别为 0.8（标准差±0.4）×（10mm/s）和 1.2（标准差±0.5），各参数在不同组织学类型之间差异均有统计学意义（p<0.05）。腺样囊性癌（ACC）的平均 ADC 值和 ADC 比值均高于鳞状细胞癌（SCC）、淋巴瘤、神经内分泌癌和未分化癌（SNUC）（p<0.05）。优化后的 ADC 阈值为 0.79、0.81、0.74 和 0.78（10mm/s），用于鉴别 ACC/SNUC、ACC/SCC、ACC/神经内分泌癌和 ACC/淋巴瘤的最大鉴别准确率分别为 100%、79%、100%和 89%。
优化后的 ADC 阈值为 0.80（10mm/s），可以用于鉴别 ACC 和非 ACC 鼻窦肿瘤，最大鉴别准确率（82%）和敏感性均为 100%。然而，非 ACC 鼻窦肿瘤的 ADC 值和 ADC 比值有较大重叠，因此仍需要进行手术活检。
