背景抑制扩散加权成像与PET/CT在恶性肿瘤转移性病变中的临床应用

摘要

Background and purpose: Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) can be used for magnetic resonance imaging systemic examination, especially in examing the metastatic lesions, lymph node and bone diseases, and the imaging result is similar with PET. This study aimed to evaluate the application value of magnetic resonance DWIBS and positron emission tomography with computed tomography (PET/CT) on malignant metastatic diseases. Methods: Thirty-six patients confirmed with malignant tumors accompanying metastasis by the pathology of operation or biopsy underwent both DWIBS imaging and PET/CT, chi-square test and Kappa test were used for comparing the detection results of metastasis by these 2 imaging methods. Results:Among the 36 malignant tumor patients with 238 metastatic lesions, 218 (91.6%, 218/238) lesions in DWIBS and 209 (87.8%, 209/238) lesions in PET/CT were detected, with 200 lesions detected by the two methods simultaneously, and the concordance rate was 88.7%(211/238);but there was no statistical signiifcance between this two methods (χ2=1.843, P=0.157). Kappa test showed a fair concordance rate between DWIBS and PET/CT (P=0.000).There were different significance between DWIBS and PET/CT in detecting metastatic lesions of brain and bone (P=0.005 and 0.031);But there was no signiifcant differences (P=0.309 and 1.000) in detecting metastatic lesions of lymph nodes and liver. Conclusion:DWIBS could detect metastatic lesions effectively, and there is ifne consistency with PET/CT. DWIBS is more sensitive than PET/CT in detecting metastatic lesions of brain and bone, so DWIBS could be chosed for screening metastatic lesions according to the characteristics of different primary tumors.%背景与目的：抑制扩散加权成像(diffusion-weighted whole-body imaging with background body signal suppression，DWIBS)，是一种可用于全身检查的核磁共振成像技术，尤其可以较好的显示转移病灶、淋巴结及骨骼系统病变。该文旨在评价DWIBS与正电子发射计算机体层摄影(positron emission tomography with computed tomography，PET/CT)在恶性肿瘤转移性病变中的临床应用价值。方法：对36例手术或穿刺病理证实为恶性肿瘤且有转移的患者行DWIBS扫描，并与PET/CT结果相对照，统计学采用χ2检验、Kappa一致性检验比较分析。结果：36例恶性肿瘤患者共有238个转移性病灶，其中DWIBS检出218个(91.6%，218/238)，PET/CT检出209个(87.8%，209/238)，且DWIBS和PET/CT同时检出200个转移性病灶，两者的一致率为88.7%(211/238)，但两种检查在检出转移病灶数目方面差异无统计学意义(χ2=1.843，P=0.157)；Kappa检验两种检查的一致性程度尚可(P=0.000)。DWIBS和PET/CT在检出脑及骨转移方面差异均有统计学意义(P=0.005和0.031)，但在检出淋巴结及肝脏转移方面差异均无统计学意义(P=0.309和1.000)。结论：DWIBS扫描技术可有效检出恶性肿瘤转移性病灶。与PET/CT相比，差异无统计学意义(P>0.05)。DWIBS检出脑、骨转移较PET/CT敏感，临床工作中可根据原发肿瘤特点，有针对性的选择DWIBS作为筛查转移病灶的方法之一。