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目的:探讨磁共振背景信号抑制弥散加权成像技术在胸部肿瘤性病变诊断中的应用价值。材料与方法:选择2009年1月～2010年12月在北京煤炭总医院就诊的临床怀疑胸部肿瘤患者102例,共计158处病灶,包括肺癌病灶33例,肺部良性肿瘤性病变18例,恶性淋巴瘤病灶24例,纵隔及腋下淋巴结转移病灶24例,乳腺癌病灶22例,乳腺良性病灶17例,20处正常乳腺组织。全部病例均行磁共振背景信号抑制弥散加权STIR-EPI序列成像,其中33例病灶同时行SE-EPI(SPIR)序列扫描,另有4例行全身大范围采集,包括胸部、腹部及盆腔;DWIBS图像后处理后可获得ADC图,利用ADC图各病变的ADC值,对其进行评价;利用3D MIP重建及黑白翻转技术立体观察病灶。结果:①STIR-EPI的背景抑制效果优于SE-EPI(SPIR)(P<0.05),经过3D MIP重建及黑白翻转技术可以得到类PET图像,从而更加清晰地观察病变。②胸部转移淋巴结ADC值为(1.37±0.41)mm2/s×10-3,而胸部淋巴瘤ADC值约为(0.91±0.12)mm2/s×10-3,差异有统计学意义(P<0.05);肺癌ADC值为(1.61±0.18)mm2/s×10-3,肺部良性肿瘤性病变ADC值为(2.06±0.21)mm2/s×10-3,差异有统计学意义;乳腺癌病灶、乳腺良性病灶和乳腺正常组织ADC值分别为(1.01±0.13)mm2/s×10-3、(1.81±0.18)mm2/s×10-3、(1.91±0.26)mm2/s×10-3,两两比较差异均有统计学意义。③不同类型胸部肿瘤性病变ADC值比较,除正常乳腺组织与乳腺良性病变、恶性淋巴瘤和乳腺癌之间差异无统计学意义外,其余各组之间差异均有统计学意义。④4例患者行大范围扫描(胸部、腹部及盆腔),3例发现远处转移。结论:①磁共振背景信号抑制弥散加权成像是一种安全有效的影像学检查方法;②胸部肿瘤性病变中,恶性病变ADC值低于良性病变,可以帮助判断病变良恶性;③不同类型恶性肿瘤ADC值不同,可用于鉴别诊断;④可用于肿瘤的筛查及疗效评估。
Objective: To investigate the value of magnetic resonance background signal suppression diffusion-weighted imaging in the diagnosis of thoracic neoplasia. MATERIALS AND METHODS: A total of 102 clinical cases of suspected thoracic tumors from January 2009 to December 2010 in Beijing Coal General Hospital were selected. A total of 158 lesions including 33 lung cancer lesions, 18 benign lung lesions and malignant 24 cases of lymphoma, 24 cases of mediastinal and axillary lymph node metastases, 22 cases of breast cancer, 17 cases of breast benign lesions, 20 normal breast tissues. In all cases, diffusion-weighted STIR-EPI imaging was performed on MRI background signals. Among them, 33 cases were simultaneously scanned by SE-EPI (SPIR) sequence, and 4 cases were extensively collected in the whole body including chest, abdomen and pelvis. DWIBS After the image is processed, an ADC map can be obtained. The ADC value of each lesion in the ADC map is used to evaluate the ADC value. The 3D MIP reconstruction and black-and-white flip technique are used to observe the lesion. RESULTS: ① The background suppression effect of STIR-EPI was better than that of SE-EPI (SPIR) (P <0.05). PET-like images could be obtained through 3D MIP reconstruction and black-and-white reversal technique to observe the lesions more clearly. The ADC value of metastatic lymph nodes in chest was (1.37 ± 0.41) mm2 / s × 10-3, while the ADC value of chest lymphoma was (0.91 ± 0.12) mm2 / s × 10-3, with statistical significance (P <0.05 ). The ADC value of lung cancer was (1.61 ± 0.18) mm2 / s × 10-3. The ADC value of benign tumor in lung was (2.06 ± 0.21) mm2 / s × 10-3, with significant difference , Benign breast lesions and normal breast tissues were (1.01 ± 0.13) mm2 / s × 10-3, (1.81 ± 0.18) mm2 / s × 10-3, (1.91 ± 0.26) mm2 / s × 10-3 The differences between the two groups were statistically significant. ③The ADC values of different types of thoracic neoplasms were not statistically different except normal breast tissue, benign breast lesions, malignant lymphoma and breast cancer. The differences among the other groups were statistically significant. ④ Four patients underwent extensive scan (chest, abdomen and pelvis) and distant metastasis in 3 cases. Conclusion: ① MRI background signal suppression diffusion-weighted imaging is a safe and effective imaging examination; ② thoracic neoplasms, malignant lesions ADC value lower than benign lesions, can help determine the benign and malignant lesions; ③ different types of malignant tumors ADC value is different, can be used for differential diagnosis; ④ can be used for cancer screening and efficacy evaluation.