摘要目的 探讨儿童及青少年纵隔T淋巴母细胞淋巴瘤(T-LBL)的磁共振成像(MRI)特征,评估其对早期治疗反应的预测价值.方法 回顾性多中心病例系列研究.收集2020年9月至2024年5月郑州大学第五附属医院、北京高博博仁医院、河南省肿瘤医院诊断为儿童及青少年纵隔T-LBL的49例患儿资料.患儿均接受胸部MRI检查,影像包括常规MRI扫描和扩散加权成像,评估肿瘤MRI影像特征,并测量最小表观扩散系数(ADCmin)、最大ADC值(ADCmax)、平均ADC值(ADCmean)等定量参数.治疗后15 d评估患儿疗效,将患儿分为响应组(完全缓解或部分缓解,26例)和无响应组(疾病进展或轻微反应,23例).分析MRI特征与治疗反应的关系,采用组内相关系数评估影像医师判读一致性;采用独立样本t检验及x2检验比较组间差异.采用受试者工作特征(ROC)曲线分析各影像参数的预测性能.结果 响应组与无响应组在ADC值[ADCmin(0.80±0.41)×10-3 mm2/s 比(1.23±0.70)× 10-3 mm2/s、ADCmax(1.14±0.48)×10-3 mm2/s 比(1.92±0.77)×10-3 mm2/s、ADCmean(0.98±0.42)× 10-3 mm2/s 比(1.56±0.74)× 10-3 mm2/s]和肿瘤长径[(11.92±3.61)cm比(8.17±2.46)cm]等MRI特征比较,差异均有统计学意义(均P＜0.05).ROC曲线分析显示,ADCmax对治疗反应的预测效能最佳,其曲线下面积(AUC)值为0.853(95％CI:0.790～0.910),敏感度为92.3％,特异度为65.2％.肿瘤长径的AUC值为0.814,有较高的预测价值.结论 MRI影像特征,特别是ADC值和肿瘤长径,能够较好地预测儿童及青少年纵隔T-LBL的治疗反应.

abstractsObjective To investigate the magnetic resonance imaging(MRI)features of pediatric and adolescent mediastinal T-lymphoblastic lymphoma(T-LBL)and to evaluate their predictive value for early treatment response.Methods A retrospective,multicenter case series study was conducted on 49 pediatric and adolescent patients diagnosed with mediastinal T-LBL between September 2020 and May 2024 at the Fifth Affiliated Hospital of Zhengzhou University,Beijing Gaobo Boren Hospital,and Henan Cancer Hospital.All patients underwent chest MRI,including conventional MRI sequences and diffusion-weighted imaging.Tumor imaging characteristics were analyzed,and quantitative parameters such as minimum apparent diffusion coefficient(ADCmin),maximum ADC(ADCmax),and mean ADC(ADCmean)were measured.Treatment response was evaluated 15 days post-treatment.The patients were divided into a response group(complete or partial response,26 cases)and a non-response group(progressive disease or minor response,23 cases).The relationship between MRI features and treatment response was analyzed.The intraclass correlation coefficient was used to assess inter-reader agreement,and independent sample t-tests and chi-square tests were employed to compare differences between groups.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive performance of imaging parameters.Results Significant differences were observed between the response and non-response groups in ADC values[ADCmin(0.80±0.41)× 10-3 mm2/s vs.(1.23±0.70)× 10-3 mm2/s,ADCmax(1.14±0.48)× 10-3 mm2/s vs.(1.92±0.77)× 10-3 mm2/s,ADCmean(0.98±0.42)× 10-3 mm2/s vs.(1.56±0.74)× 10-3 mm2/s]and the maximum tumor diameter was[(11.92±3.61)cm vs.(8.17±2.46)cm](all P＜0.05).ROC curve analysis showed that ADCmax had the highest predictive efficiency for treatment response,with an area under the curve(AUC)of 0.853(95％CI:0.790-0.910),sensitivity of 92.3％,and specificity of 65.2％.The AUC for the maximum tumor diameter was 0.814,demonstrating itsexcellent predictive performance.Conclusions MRI features,particularly ADC values and the maximum tumor diameter,can effectively predict treatment response in pediatric and adolescent mediastinal T-LBL.