Zhang Rongli, King Ann D, Wong Lun M, Bhatia Kunwar S, Qamar Sahrish, Mo Frankie K F, Vlantis Alexander C, Ai Qi Yong H
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Diagn Interv Imaging. 2023 Feb;104(2):67-75. doi: 10.1016/j.diii.2022.08.003. Epub 2022 Sep 10.
The purpose of this study was to retrospectively evaluate the diagnostic performances of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) for discriminating between benign and malignant salivary gland tumors (SGTs).
Sixty-seven patients with 71 SGTs who underwent MRI examination at 3 Tesla were included. There were 34 men and 37 women with a mean age of 57 ± 17 (SD) years (age range: 20-90 years). SGTs included 21 malignant tumors (MTs) and 50 benign SGTs (33 pleomorphic adenomas [PAs] and 17 Warthin's tumors [WTs]). For each SGT, DWI and IVIM parameters, mean, skewness, and kurtosis of apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion volume fraction (f) were calculated and further compared between SGTs using univariable analysis. Areas under the curves (AUC) of receiver operating characteristic of significant parameters were compared using the Delong test.
Significant differences in ADC, D and D* were found between SGTs (P < 0.001). The highest AUC values were obtained for ADC (0.949) for identifying PAs and D* (0.985) for identifying WTs and skewness and kurtosis did not outperform mean. To discriminate benign from malignant SGTs with thresholds set to maximize Youden index, IVIM and DWI produced accuracies of 85.9% (61/71; 95% CI: 75.6-93.0) and 77.5% (55/71; 95% CI: 66.0-86.5) but misdiagnosed MTs as benign in 28.6% (6/21) and 61.9% (13/21) of SGTs, respectively. After maximizing specificity to 100% for benign SGTs, the accuracies of IVIM and DWI decreased to 76.1% (54/71; 95% CI: 64.5-85.4) and 64.8% (46/71; 95% CI: 52.5-75.8) but no MTs were misdiagnosed as benign. IVIM and DWI correctly diagnosed 66.0% (33/50) and 50.0% (25/50) of benign SGTs and 46.5% (33/71) and 35.2% (25/71) of all SGTs, respectively.
IVIM is more accurate than DWI for discriminating between benign and malignant SGTs because of its advantage in detecting WTs. Thresholds set by maximizing specificity for benign SGTs may be advantageous in a clinical setting.
本研究旨在回顾性评估扩散加权成像（DWI）和体素内不相干运动（IVIM）在鉴别涎腺良恶性肿瘤（SGTs）中的诊断性能。
纳入67例患者，共71个SGTs，均接受3特斯拉的MRI检查。其中男性34例，女性37例，平均年龄57±17（标准差）岁（年龄范围：20 - 90岁）。SGTs包括21例恶性肿瘤（MTs）和50例良性SGTs（33例多形性腺瘤[PAs]和17例沃辛瘤[WTs]）。对于每个SGT，计算DWI和IVIM参数，即表观扩散系数（ADC）、纯扩散系数（D）、伪扩散系数（D*）和灌注分数（f）的均值、偏度和峰度，并通过单变量分析在SGTs之间进行进一步比较。使用德龙检验比较显著参数的受试者操作特征曲线下面积（AUC）。
SGTs之间在ADC、D和D方面存在显著差异（P < 0.001）。识别PAs时ADC的AUC值最高（0.949），识别WTs时D的AUC值最高（0.985），偏度和峰度的表现不如均值。为将良恶性SGTs区分开，将阈值设定为最大化约登指数时，IVIM和DWI的准确率分别为85.9%（61/71；95%可信区间：75.6 - 93.0）和77.5%（55/71；95%可信区间：66.0 - 86.5），但分别有28.6%（6/21）和61.9%（13/21）的MTs被误诊为良性。在将良性SGTs的特异性最大化至100%后，IVIM和DWI的准确率分别降至76.1%（54/71；95%可信区间：64.5 - 85.4）和64.8%（46/71；95%可信区间：5
