摘要/Abstract
摘要： 目的·探讨3.0-T磁共振扩散加权成像（diffusion-weighted imaging，DWI）联合动态增强磁共振成像（dynamic contrast-enhanced MR imaging，DCE-MRI）对甲状腺良恶性结节的鉴别诊断价值。方法·回顾性分析2018年1月—2019年10月于上海交通大学医学院附属第九人民医院诊治并经手术病理证实为甲状腺结节的患者65例。术前患者均行3.0-T MRI扫描包括常规MRI、DWI（b值取0、1 000 s/mm2）和DCE-MRI检查，并测量其表观扩散系数（apparent diffusion coefficient，ADC）值和DCE-MRI参数。采用逐步Logistic回归模型分析结节良恶性的独立预测因子，并绘制受试者操作特征曲线分析联合模型的诊断效能。结果·与恶性结节相比，良性甲状腺结节的ADC值较高、达峰时间较早（均P<0.05）。逐步Logistic回归分析显示，ADC值和达峰时间是结节良恶性的独立预测因子。ADC值和达峰时间的联合模型鉴别甲状腺良恶性结节的曲线下面积为0.93，灵敏度为82.4%，特异度为100%。结 论·ADC值和达峰时间是鉴别良恶性甲状腺结节的重要参数，两者联合诊断或可辅助临床，为术前诊断提供参考依据。
关键词: 甲状腺结节, 磁共振成像, 扩散加权成像, 动态增强成像
Abstract:
Objective · To investigate the value of 3.0-T MR diffusion-weighted imaging (DWI) combined with dynamic contrast-enhanced MR imaging (DCE-MRI) in the differential diagnosis of benign and malignant thyroid nodules. Methods · A total of 65 patients with thyroid nodules confirmed by operation and pathology in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to October 2019 were retrospectively analyzed. All patients underwent 3.0-T MRI scan, including routine MRI, DWI (b value was 0, 1 000 s/mm2) and DCE-MRI examination before operation. The apparent diffusion coefficient (ADC) values and DCE-MRI parameters were measured. Stepwise Logistic regression model was used to analyze the independent predictors of benign and malignant nodules, and receiver operator characteristic curve was used to analyze the diagnostic efficacy of the combined model. Results · Compared with the malignant thyroid nodules, the ADC value of the benign thyroid nodules was higher and the time to peak was earlier (both P<0.05). Stepwise Logistic regression analysis showed that ADC value and time to peak were independent predictors of benign and malignant nodules. The area under the curve of combined model of ADC values and time to peak for differentiating benign and malignant thyroid nodules was 0.93, the sensitivity was 82.4%, and the specificity was 100%. Conclusion · ADC value and time to peak are important parameters to distinguish benign and malignant thyroid nodules, and their combined model may be helpful for clinical diagnosis and provide reference for preoperative diagnosis.
Key words: thyroid nodule, magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), dynamic contrast-enhanced imaging
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