目的 探讨DWI联合动态对比增强磁共振成像(DCE-MRI)在腮腺良恶性肿瘤鉴别诊断中的价值.方法 收集90例腮腺肿瘤患者共94个病灶,其中良性75个、恶性19个.对所有患者术前均行DWI和DCE-MRI检查,分析各病灶的ADC值和时间-信号强度曲线(TIC)类型.绘制ROC曲线,比较ADC值、TIC及两者联合对腮腺良恶性肿瘤的鉴别诊断效能.结果 恶性肿瘤的ADC值[(1.02±0.25)×10 3 mm2/s]显著低于良性肿瘤的ADC值[(1.38±0.44)×10-3mm2/s;t=5.170,P＜0.001].将表现为A型(流入型)、B型(廓清型)和D型(平坦型)曲线判为良性肿瘤、C型(平台型)曲线判为恶性肿瘤时,诊断腮腺肿瘤良恶性的敏感度为0.62,特异度为0.92;C型曲线患者中,以ADC＜1.36×10 3 mm2/s诊断恶性肿瘤时,敏感度为0.92,特异度为0.95.结论 良恶性腮腺肿瘤间ADC值存在重叠,鉴别诊断时不应单纯依赖DWI;TIC表现为A、B、D型多提示良性肿瘤,C型常提示恶性肿瘤;TIC曲线为C型时,联合ADC值可明显提高对良恶性肿瘤的鉴别诊断效能.%Objective To explore the value of DWI combined with dynamic contrast-enhanced MR imaging (DCE MRI) in differential diagnosis of benign and malignant parotid gland tumors.Methods DWI and DCE-MRI was performed in 90 patients with parotid gland tumors (94 lesions),included 75 benign tumors and 19 malignant tumors.The ADCs were measured,and the type of time-intensity curve (TIC) was assessed.ROC curve was used to analyze the diagnostic efficacy of ADC values,TIC types and combination of the two methods in diagnosing benign and malignant tumors.Results The ADC values of malignant tumors ([1.02 ± 0.25] × 10a mm2/s) were significantly smaller than that of benign tumors ([1.38±0.44] × 10-3 mm2/s;t=5.170,P＜0.001).The sensitivity was 0.62 and specificity was 0.92,when type A (persistent),B (washout),and D (flat) tumors regarded as benign and type C (plateau) tumors regarded as malignant.Sensitivity and specificity were significantly improved in diagnosis of malignant tumors when combined type C and ADC＜1.36× 10-3mm2/s,which were 0.92 and 0.95,respectively.Conclusion Due to an overlap within benign and malignant parotid tumors,the diagnosis should not be addressed on the basis of ADC values alone.The TIC manifestations type A,B or D on DCE-MRI indicates benign parotid tumors,and type C indicates malignant diseases.When the TIC shows type C,combining ADC value can elevate the differential diagnostic efficacy of benign and malignant parotid tumors.
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