动脉自旋标记灌注成像能否用于鉴别鼻咽癌和鼻咽淋巴瘤？
Can Arterial Spin Labeling Perfusion Imaging be Used to Differentiate Nasopharyngeal Carcinoma From Nasopharyngeal Lymphoma?
机构信息
Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi City, China.
Department of Pathology, Affiliated Hospital of Jiangnan University, Wuxi City, China.
出版信息
J Magn Reson Imaging. 2021 Apr;53(4):1140-1148. doi: 10.1002/jmri.27451. Epub 2020 Nov 23.
BACKGROUND
Differentiating nasopharyngeal carcinoma (NPC) from nasopharyngeal lymphoma (NPL) is useful for deciding the appropriate treatment. However, the diagnostic accuracy of current imaging methods is low.
PURPOSE
To explore the feasibility of arterial spin labeling (ASL) perfusion imaging in the qualitative and quantitative differentiation between NPC and NPL to improve the diagnosis of malignancies in the nasopharynx.
STUDY TYPE
Retrospective.
POPULATION
Ninety seven patients: NPC (65 cases) and NPL (32 cases), histologically confirmed.
FIELD STRENGTH/SEQUENCE: 3T/3D fast spin echo pseudo-continuous ASL imaging with spiral readout scheme, 3D inverse recovery fast spoiled gradient recalled echo brain volume (BRAVO) imaging.
ASSESSMENT
Cerebral blood flow (CBF) images from ASL perfusion imaging were assessed by three radiologists. Each tumor was visually scored based on CBF images. Intratumoral CBF and intramuscular CBF values were obtained from intratumoral and lateral pterygoid muscle areas, respectively. Through dividing intratumoral CBF by intramuscular CBF, normalized CBF (nCBF) was further calculated.
STATISTICAL TESTS
Fleiss's kappa and intraclass correlation coefficients (ICCs) were used to assess interobserver agreement among the three readers. The Mann-Whitney U-test was used to compare visual scoring, and an unpaired t-test was performed to compare CBF value between the NPC and NPL groups. The area under the curve (AUC) value was used to quantify the diagnostic ability of each parameter.
RESULTS
Good interobserver agreements were validated by high Fleiss's kappa and ICC values (all >0.80). NPCs showed significantly higher visual scores than NPLs (P < 0.05). Both intratumoral CBF and nCBF in NPC were significantly higher than those in NPL (both P < 0.05). Intratumoral CBF showed the highest AUC of 0.861 (P < 0.05) in differentiating NPC (n = 65) from NPL (n = 32), while the AUCs of nCBF and visual scoring were 0.847 and 0.753, respectively.
DATA CONCLUSION
For the diagnosis of distinguishing NPC from NPL, ASL perfusion imaging demonstrated high diagnostic efficiency.
LEVEL OF EVIDENCE
3 TECHNICAL EFFICACY STAGE: 2.
背景
鉴别鼻咽癌（NPC）和鼻咽部淋巴瘤（NPL）有助于确定适当的治疗方案。然而，目前影像学方法的诊断准确性较低。
目的
探讨动脉自旋标记（ASL）灌注成像在定性和定量鉴别 NPC 和 NPL 中的可行性，以提高对鼻咽部恶性肿瘤的诊断能力。
研究类型
回顾性。
研究人群
97 例患者：NPC（65 例）和 NPL（32 例），经组织学证实。
磁场强度/序列：3T/3D 快速自旋回波伪连续 ASL 灌注成像，采用螺旋读取方案，3D 反转恢复快速扰相梯度回波脑容积（BRAVO）成像。
评估
由三位放射科医生评估 ASL 灌注成像的脑血流（CBF）图像。根据 CBF 图像对每个肿瘤进行视觉评分。从肿瘤内区域和翼外肌外侧区域分别获得肿瘤内 CBF 和肌肉内 CBF 值。通过将肿瘤内 CBF 除以肌肉内 CBF，进一步计算出归一化 CBF（nCBF）。
统计学检验
采用 Fleiss'kappa 和组内相关系数（ICC）评估三位观察者之间的组间一致性。采用 Mann-Whitney U 检验比较视觉评分，采用独立样本 t 检验比较 NPC 组和 NPL 组之间的 CBF 值。采用曲线下面积（AUC）值来量化各参数的诊断能力。
结果
通过高 Fleiss'kappa 和 ICC 值（均>0.80）验证了良好的观察者间一致性。NPC 的视觉评分明显高于 NPL（P<0.05）。NPC 的肿瘤内 CBF 和 nCBF 均明显高于 NPL（均 P<0.05）。肿瘤内 CBF 在鉴别 NPC（n=65）与 NPL（n=32）时具有最高的 AUC（0.861，P<0.05），而 nCBF 和视觉评分的 AUC 分别为 0.847 和 0.753。
数据结论
对于 NPC 和 NPL 的鉴别诊断，ASL 灌注成像显示出较高的诊断效率。
证据水平
3 级技术功效。
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