基于RESOLVE DWI结合常规MRI鉴别鼻腔自然杀伤T细胞淋巴瘤和弥漫性大B细胞淋巴瘤 ... ...

OBJECTIVE:

To explore the feasibility of using RESOLVE DWI combined with conventional magnetic resonance imaging (MRI) to discriminate between sinonasal NKTLs and DLBCLs and to investigate the correlation between ADC value and Ki-67 expression in the two subtypes of NHLs.

探讨使用RESOLVE DWI结合常规磁共振成像（MRI）鉴别鼻腔NK细胞和DLBCL的可行性，并研究两种NHLs亚型中ADC值与Ki-67表达的相关性。

MATERIALS AND METHODS:

Sixty patients with NKTLs and twenty-six patients with DLBCLs in the sinonasal region who were confirmed by histopathology underwent high-resolution DWI and conventional MRI. The apparent diffusion coefficients (ADCs) and conventional MRI features associated with NKTLs and DLBCLs were compared using multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis was performed, and the area under the curve (AUC) values for conventional MRI and MRI in combination with DWI were compared to determine the diagnostic performances of the approaches in the differentiation of NKTLs and DLBCLs. Spearman's rank correlations were used to analyze the correlation between ADC value with the higher AUC and Ki-67 expression.

通过组织病理学证实的60例NKTL患者和26例鼻腔鼻窦DLBCL患者接受了高分辨率DWI和常规MRI检查。使用多变量逻辑回归比较表观扩散系数（ADC）和与NKTL和DLBCL相关的常规MRI特征。使用受试者操作特征（ROC）曲线分析，比较常规MRI和联合MRI与DWI的曲线下面积（AUC）值，以确定这些方法在鉴别NKTL和DLBCL中的诊断性能。Spearman秩相关用于分析ADC值与较高AUC和Ki-67表达之间的相关性。

RESULTS:

For conventional MRI, localization in the nasal cavity and poor or moderate enhancement indicated an NKTL, whereas localization in the paranasal sinus and intense enhancement indicated a DLBCL, with sensitivity, specificity and area under the curve(AUC)value of 88.5%, 85.0% and 0.883, respectively. A combination with a cut-off ADC value of 0.646 × 10-3 mm2/s yielded sensitivity, specificity and AUC values of 100.0%, 80.0% and 0.951, respectively. A significant difference between the AUCs for conventional MRI and MRI in combination with DWI (p = 0.02) was identified. Ki-67 expression of NKTLs was significantly lower than that of DLBCLs (p < 0.001). Besides, there was an inversely poor correlation between them in the overall sample (r = -0.395, p < 0.001). However, the ADC value was not significantly correlated with Ki-67 LI in neither NKTLs nor DLBCLs (both p > 0.05).

对于常规MRI，病变位于鼻腔、呈轻中度强化提示为NKTL，而病变位于鼻旁窦和显著强化提示为DLBCL，鉴别诊断的敏感性、特异性和曲线下面积（AUC）值分别为88.5％、85.0％ 和0.883。 联合诊断的ADC截断值为0.646×10-3mm2/s时，其敏感性、特异性和AUC值分别为100.0％、80.0％和0.951。 常规MRI和MRI联合DWI的鉴别诊断AUC间存在显著差别（P = 0.02）。 NKTL的Ki-67表达显著低于DLBCL的表达（P<0.001）。 此外，总体样本中它们之间存在弱的负相关（r = -0.395，P<0.001）。 然而，在NKTL和DLBCL中，ADC值与Ki-67 LI均无显著相关性（P值> 0.05）。

CONCLUSIONS:

Location and enhancement degree were the most valuable conventional MRI features for differentiating between NKTLs and DLBCLs. A combination of DWI and MRI could significantly improve the differential performance. ADC values may be used to noninvasively evaluate the proliferation level of sinonasal NHLs.

肿瘤位置和增强程度是鉴别NKTL和DLBCL的最有价值的常规MRI特征。联合DWI和MRI可显著提高鉴别诊断效能。ADC值可用于无创性地评估鼻腔鼻窦（鼻腔）NHL的增殖水平。

KEYWORDS:

Diffuse large B-cell lymphoma; Diffusion-weighted imaging; Magnetic resonance imaging; Natural killer/T-cell lymphoma; Sinonasal neoplasm

弥漫性大B细胞淋巴瘤; 扩散加权成像; 磁共振成像; 自然杀伤/T细胞淋巴瘤; 鼻腔肿瘤

ROC curves of the diagnostic efficacy of ADC values using polygonal ROI and small-round ROI to differentiate between NKTLs and DLBCLs. The AUC of polygonal ROI is significantly larger than that of small-round ROI (p < 0.001).