感兴趣区大小选择对多形性腺瘤和腺淋巴瘤ADC测量的影响

doi:10.19438/j.cjoms.2021.01.006

摘要/Abstract

摘要： 目的: 确定感兴趣区（ROI）大小是否对多形性腺瘤（PA）、腺淋巴瘤（WT）和正常腮腺实质分化的表观扩散系数（ADC）测量有显著影响。方法: 采用弥散加权成像（DWI）对37例PA（37侧病灶）和28例WT（37侧病灶）患者进行检查,腮腺对侧实质正常者为对照组（56例）。使用第三方自制软件设定12个同心圆ROI（面积：9、28、34、50、60、82、93、98、115、130、136和149 mm²）,分别测量肿瘤和正常组织的平均ADC值及标准差（SD）。同时计算均匀性指数(ADC_SD/ADC均值),对每组12个ROI的平均ADC、ADC_SD和均质性指标进行单向重复方差分析（ANOVA）。采用Medcalc软件中的Kruska-Wallis分析并比较PA、WT和正常腮腺实质中不同ROI下的3个参数。结果: 12个ROIs对PA [组内相关系数（ICC）,0.98]、WT（ICC,0.99）和正常腮腺实质（ICC,0.95）的ADC测量结果良好。PA、WT和正常腮腺实质3组ROI的平均ADC值无显著差异（P>0.05）。3组中,正常腮腺组平均ADC值[（0.94±0.003）×10^-3 mm²/s]显著低于PA[（1.72±0.01）×10^-3 mm²/s]和WT[（1.16±0.01）×10^-3 mm²/s]组,而PA组平均ADC值最高。PA与WT的平均ADC_SD无显著差异（P>0.05）。与WT和正常腮腺实质组相比,PA组具有较低的均质性指标（P<0.01）。结论: ROI大小对ADC测量值的影响可以从PA、WT和正常腮腺实质的分化中排除,均质性指标是区分3组的有用参数。

关键词: 扩散加权成像, 表观扩散系数, 感兴趣区, 多形性腺瘤, 腺淋巴瘤

Abstract: PURPOSE: Tumor apparent diffusion coefficient (ADC) measurements may be influenced by region of interest (ROI) sizes; however, this effect has not been systematically studied in parotid tumors. The purpose of this study was to determine the effects of ROI size on ADC measurements for differentiation of pleomorphic adenoma (PA), Warthin tumor (WT), and normal parotid parenchyma. METHODS: Sixty-five patients including 37 with PA (lesions, n=37) and 28 with WT (lesions, n=37) were examined with diffusion-weighted imaging (DWI). Participants with normal contralateral parenchyma of the parotid gland comprised the control group (n=56). The mean ADC values and standard deviations (SD) of the ADC (ADC_SD) of 12 concentric round ROIs (areas: 9, 28, 34, 50, 60, 82, 93, 98, 115, 130, 136, and 149 mm²) for tumors and normal tissue were measured by using custom-made software. Homogeneity index that was defined by the ADC_SD/mean ADC was also calculated. One-way repeated analyses of variance (ANOVA) was performed on the mean ADCs, ADC_SD and homogeneity indices of the 12 ROIs in each group. The three parameters at different ROIs among PA, WT and normal parotid parenchyma were compared using Kruska-Wallis tests with Medcalc software. RESULTS: Excellent agreement was achieved for ADC measurements with 12 ROIs for PA (ICC, 0.98), WT (ICC, 0.99) or normal parotid parenchyma (ICC, 0.95). No significant difference was observed in the mean ADCs of 12 ROIs for each of the three groups (P>0.05). Among the three groups, the mean ADC of normal parotid parenchyma[(0.94±0.003) ×10^-3 mm²/s] was significantly lower than that of both PA [(1.72±0.01)×10^-3 mm²/s] and WT [(1.16±0.01)×10^-3 mm²/s] in 12 ROIs, whereas PA group had the highest mean ADC values. No significant difference was found in the mean ADC_SD with each ROI between PA and WT (P>0.017). PAs had significantly lower homogeneity indices compared with WTs and normal parotid parenchyma(P<0.01). CONCLUSIONS: The effect of ROI size on ADC measurements could be excluded from the differentiation of PA, WT, and normal parotid parenchyma. Homogeneity index was a useful parameter in discriminating the three groups.

Key words: Diffusion weighted imaging, ADC, Region of interest, Pleomorphic adenoma, Warthin tumor

中图分类号:

R739.8

孙琦, 马超, 董敏俊, 陶晓峰. 感兴趣区大小选择对多形性腺瘤和腺淋巴瘤ADC测量的影响[J]. 中国口腔颌面外科杂志, 2021, 19(1): 29-35.

SUN Qi, MA Chao, DONG Min-jun, TAO Xiao-feng. Effects of region of interest sizes on apparent diffusion coefficient measurements of pleomorphic adenoma, Warthin tumor, and normal parotid parenchyma[J]. China J Oral Maxillofac Surg, 2021, 19(1): 29-35.

参考文献

[1] Przewozny T, Stankiewicz C.Neoplasms of the parotid gland in northern Poland, 1991-2000: an epidemiologic study[J]. Eur Arch Otorhinolaryngol, 2004,261(7): 369-375.
[2] Wang J, Takashima S, Takayama F, et al.Head and neck lesions: characterization with diffusion-weighted echo-planar MR imaging[J]. Radiology, 2001, 220(3): 621-630.
[3] Matsusue E, Fujihara Y, Matsuda E, et al.Differentiating parotid tumors by quantitative signal intensity evaluation on MR imaging[J]. Clin Imaging, 2017, 46: 37-43.
[4] Yerli H, Aydin E, Haberal N, et al.Diagnosing common parotid tumours with magnetic resonance imaging including diffusion-weighted imaging vs fine-needle aspiration cytology: a comparative study[J]. Dentomaxillofac Radiol, 2010, 39(6): 349-355.
[5] Habermann CR, Arndt C, Graessner J, et al.Diffusion-weighted echo-planar MR imaging of primary parotid gland tumors: is a prediction of different histologic subtypes possible?[J] AJNR Am J Neuroradiol, 2009, 30(3): 591-596.
[6] Yologlu Z, Aydin H, Alp NA, et al.Diffusion weighted magnetic resonance imaging in the diagnosis of parotid masses:Preliminary results[J]. Saudi Med J, 2016, 37(12): 1412-1416.
[7] Antony J, Gopalan V, Smith RA, et al.Carcinoma ex pleomorphic adenoma: a comprehensive review of clinical, pathological and molecular data[J]. Head Neck Pathol, 2012, 6(1): 1-9.
[8] Hisatomi M, Asaumi J, Yanagi Y, et al.Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors[J]. Oral Oncol, 2007,43(9): 940-947.
[9] Motoori K, Ueda T, Uchida Y, et al.Identification of Warthin tumor: magnetic resonance imaging versus salivary scintigraphy with technetium-99m pertechnetate[J]. J Comput Assist Tomogr, 2005, 29(4): 506-512.
[10] Yerli H, Agildere AM, Aydin E, et al.Value of apparent diffusion coefficient calculation in the differential diagnosis of parotid gland tumors[J]. Acta Radiol, 2007, 48(9): 980-987.
[11] Supsupin EP Jr, Demian NM.Magnetic resonance imaging (MRI) in the diagnosis of head and neck disease[J]. Oral Maxillofac Surg Clin North Am, 2014, 26(2): 253-269.
[12] Hamilton BE, Salzman KL, Wiggins RH, et al.Earring lesions of the parotid tail[J]. AJNR Am J Neuroradiol, 2003, 24(9): 1757-1764.
[13] Ikeda K, Katoh T, Ha-Kawa SK, et al.The usefulness of MR in establishing the diagnosis of parotid pleomorphic adenoma[J]. AJNR Am J Neuroradiol, 1996,17(3): 555-559.
[14] Vogl TJ, Dresel SH, Späth M, et al.Parotid gland: plain and gadolinium-enhanced MR imaging[J]. Radiology, 1990, 177(3): 667-674.
[15] Mikaszewski B, Markiet K, Smugala A, et al.Diffusion-weighted MRI in the differential diagnosis of parotid malignancies and pleomorphic adenomas: can the accuracy of dynamic MRI be enhanced?[J] Oral Surg Oral Med Oral Pathol Oral Radiol, 2017, 124(1): 95-103.
[16] Srinivasan A, Dvorak R, Perni K, et al.Differentiation of benign and malignant pathology in the head and neck using 3T apparent diffusion coefficient values: early experience[J]. AJNR Am J Neuroradiol, 2008, 29(1): 40-44.
[17] Sumi M, Van Cauteren M, Sumi T, et al.Salivary gland tumors: use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors[J]. Radiology, 2012, 263(3): 770-777.
[18] Ma G, Zhu LN, Su GY, et al.Histogram analysis of apparent diffusion coefficient maps for differentiating malignant from benign parotid gland tumors[J]. Eur Arch Otorhinolaryngol, 2018,275(8): 2151-2157.
[19] Eida S, Sumi M, Sakihama N, et al.Apparent diffusion coefficient mapping of salivary gland tumors: prediction of the benignancy and malignancy[J]. AJNR Am J Neuroradiol, 2007, 28(1): 116-121.
[20] Fruehwald-Pallamar J, Czerny C, Holzer-Fruehwald L, et al.Texture-based and diffusion-weighted discrimination of parotid gland lesions on MR images at 3.0 Tesla[J]. NMR Biomed, 2013,26(11): 1372-1379.
[21] Ma C, Liu L, Li J, Wang L, et al.Apparent diffusion coefficient (ADC) measurements in pancreatic adenocarcinoma: A preliminary study of the effect of region of interest on ADC values and interobserver variability[J]. J Magn Reson Imaging, 2016,43(2): 407-413.
[22] Lambregts DM, Beets GL, Maas M, et al.Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability[J]. Eur Radiol, 2011, 21(12): 2567-2574.
[23] Ma C, Guo X, Liu L, et al.Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma[J]. Cancer Imaging, 2017, 17(1): 13.
[24] Attyé A, Troprès I, Rouchy RC, et al.Diffusion MRI: literature review in salivary gland tumors[J]. Oral Dis, 2017, 23(5): 572-575.
[25] Thoeny HC, De Keyzer F, King AD.Diffusion-weighted MR imaging in the head and neck[J]. Radiology, 2012,263(1): 19-32.
[26] Wang CW, Chu YH, Chiu DY, et al.JOURNAL CLUB: The Warthin tumor score: a simple and reliable method to distinguish Warthin tumors from pleomorphic adenomas and carcinomas[J]. AJR Am J Roentgenol, 2018, 210(6): 1330-1337.
[27] Tsili AC, Ntorkou A, Astrakas L, et al.Diffusion-weighted magnetic resonance imaging in the characterization of testicular germ cell neoplasms: Effect of ROI methods on apparent diffusion coefficient values and interobserver variability[J]. Eur J Radiol, 2017, 89: 1-6.
[28] Mahmood F, Johannesen HH, Geertsen P1, et al. The effect of region of interest strategies on apparent diffusion coefficient assessment in patients treated with palliative radiation therapy to brain metastases[J]. Acta Oncol, 2015,54(9): 1529-1534.
[29] Mukuda N, Fujii S, Inoue C, et al.Apparent diffusion coefficient (ADC) measurement in ovarian tumor: Effect of region-of-interest methods on ADC values and diagnostic ability[J]. J Magn Reson Imaging, 2016,43(3): 720-725.
[30] Habermann CR, Gossrau P, Graessner J, et al.Diffusion-weighted echo-planar MRI: a valuable tool for differentiating primary parotid gland tumors?[J]. Rofo, 2005,177(7): 940-945.
[31] Matsushima N, Maeda M, Takamura M, et al.Apparent diffusion coefficients of benign and malignant salivary gland tumors. Comparison to histopathological findings[J]. J Neuroradiol, 2007, 34(3): 183-189.
[32] Thoeny HC, De Keyzer F, Boesch C, et al.Diffusion-weighted imaging of the parotid gland: Influence of the choice of b-values on the apparent diffusion coefficient value[J]. J Magn Reson Imaging, 2004,20(5): 786-790.
[33] Padhani AR, Liu G, Koh DM, et al.Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations[J]. Neoplasia, 2009,11(2): 102-125.
[34] Juan CJ, Chang HC, Hsueh CJ, et al.Salivary glands: echo-planar versus PROPELLER Diffusion-weighted MR imaging for assessment of ADCs[J]. Radiology, 2009,253(1): 144-152.
[35] Liu YJ, Lee YH, Chang HC, et al.A potential risk of overestimating apparent diffusion coefficient in parotid glands[J]. PLoS One, 2015,10(4): e0124118.