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目的对肺孤立性病变(SPLs)进行常规扩散加权成像(DWI)、体素内不相干运动扩散加权成像(IVIMDWI),明确单指数及双指数模型DWI在良恶性SPLs的诊断效能。方法前瞻性搜集经病理证实的62例SPLs(恶性肿瘤51例;良性病变11例),术前均行MRI平扫、DWI及IVIM-DWI。DWI扫描b值=0、600 s/mm~2,IVIMDWI采取13个b值(0、5、10、15、20、25、50、80、150、300、500、800、1000 s/mm~2)。应用受试者操作特征(ROC)曲线分析ADC、D、D~*及f值诊断效能。结果 51例恶性肿瘤D值为(0.92±0.20)×10-3mm~2/s,11例良性病变D值为(1.39±0.36)×10~(-3)mm~2/s,两者差异有统计学意义(P=0.001);恶性肿瘤f值为(16.02±8.7)%,良性病变f值为(20.72±8.75)%,两者差异无统计学意义(P=0.315);恶性肿瘤D~*值为(11.04±5.75)×10~(-3)mm~2/s,良性病变D*值为(9.79±5.27)×10~(-3)mm~2/s,两者差异无统计学意义(P=0.467)。应用ROC曲线进行分析,得出D值的曲线下面积为0.858,ADC b=600 s/mm~2曲线下面积为0.802;D值鉴别良恶性病变的最佳阈值为1.25×10~(-3)mm~2/s,敏感性和特异性分别为98.11%和72.73%。结论对于SPLs的鉴别,双指数模型与单指数模型DWI均有价值,其中D值的诊断价值最大。
Objective To investigate the diagnostic efficacy of DWI and IVIMDWI in the treatment of solitary pulmonary lesions (SPLs), and to determine the diagnostic efficacy of single and exponential DWI in the diagnosis of benign and malignant SPLs. Methods Sixty-two SPLs (51 malignant tumors and 11 benign lesions) confirmed by pathology were collected prospectively. MRI scan, DWI and IVIM-DWI were performed preoperatively. DWI scan b = 0,600 s / mm ~ 2, IVIMDWI 13 b values (0,5,10,15,20,25,50,80,150,300,500,800,1000 s / mm ~ 2). The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of ADC, D, D *, and f values. Results The D value of 51 malignant tumors was (0.92 ± 0.20) × 10-3mm ~ 2 / s and that of 11 benign lesions was (1.39 ± 0.36) × 10 ~ (-3) mm ~ 2 / s (P = 0.001). The f value of malignant tumor was (16.02 ± 8.7)% and the value of benign lesion was (20.72 ± 8.75)%, the difference was not statistically significant (P = 0.315) ~ (11.04 ± 5.75) × 10 ~ (-3) mm ~ 2 / s in benign lesions and (9.79 ± 5.27) × 10 ~ (-3) mm ~ 2 / s in benign lesions Statistical significance (P = 0.467). The area under the curve of D value was 0.858 and the area under the curve of ADC b = 600 s / mm ~ 2 was 0.802 by using ROC curve. The best threshold value of D value in differentiating benign and malignant lesions was 1.25 × 10 -3 ) mm ~ 2 / s, the sensitivity and specificity were 98.11% and 72.73% respectively. Conclusion For the identification of SPLs, the double exponential model and the single exponential model DWI are valuable, of which the D value of the diagnosis of the greatest value.