磁共振DWI表观扩散系数与胰腺导管腺癌分化关系的研究  

Evaluation of Pancreatic Adenocarcinoma using Diffusion Weighted Magnetic Resonance Imaging: Correlation with Tumor Differentiation

作　　者：李晶[1] 马超[1] 刘莉[1] 王莉[1] 李延军[1] 潘春树[1] 陈士跃[1] 陆建平[1] 

机构地区：[1]第二军医大学附属长海医院放射科,上海200433

出　　处：《中国CT和MRI杂志》2015年第7期57-59,68,F0002,共5页Chinese Journal of CT and MRI

基　　金：长海医院"1255"学科建设计划(CH125520800;CH1255 101102);长海医院青年科研启动基金(2013002);上海市自然科学基金(14ZR14 08300);国家自然科学基金(81070371)

摘　　要：目的探究磁共振扩散加权成像(DWI)表观扩散系数(ADC)与胰腺导管腺癌分化程度之间的关系。方法回顾性分析术后病理证实的75名胰腺导管腺癌患者(男性39名,女性36名,年龄36-76岁;中分化55名,低分化20名)及胰腺正常志愿者49名(男性29名,女性20名,年龄21-62岁)DWI(b值为0,600s/mm2),计算及测量正常胰腺头、体及尾部ADC和胰腺癌实性组织ADC。采用独立样本非参数Mann-Whitney U检验比较胰腺癌组与正常胰腺组ADC、胰腺癌中分化与低分化组ADC差异。ROC分析ADC诊断胰腺癌效能。结果胰腺癌平均ADC(1.36±0.14)×10-3m m2/s,与正常胰腺头、体及尾部ADC(分别为1.66±0.34、1.77±0.36、1.62±0.38×10-3mm2/s)差异皆具有统计学意义(P值皆=0.000)。胰腺癌中分化组与低分化组ADC(分别为1.36±0.14和1.35±0.13×10-3mm2/s)差异不具有统计学意义(P=0.657)。以正常胰腺平均ADC为参考,ROC分析胰腺癌ADC曲线下面积为0.863,95%可信区间为79.5%-93.1%,ADC≤1.492×10-3mm2/s作为诊断胰腺癌的临界值,敏感度和特异度分别为75.5%和85.3%。结论 DWI对胰腺导管腺癌有较好的诊断价值;ADC值不能用于预测胰腺导管腺癌分化程度。Objective To evaluate the clinical usefulness of diffusion-weighted magnetic resonance imaging（DWI） in patients with pancreatic cancer by comparing the apparent diffusion coefficient（ADC） value with tumor differentiation. Methods 75 patients（39 Males, 26 Females; age range 36-76 years） with histologically confirmed pancreatic ductal adenocarcinoma（55 with moderately differentiated tumors and 20 with poorly differentiated tumors） and 49 healthy volunteers（29 Males, 20 Females; age range 21-62 years） underwent respiratory triggered DWI at 3.0 T before surgery. Apparent diffusion coefficient（ADC） values of normal pancreas head, body and tail as well as ADC values of the pancreatic adenocarcinomas were calculated and measured. The ADC values of normal pancreas and tumors were statistically analyzed and compared using Mann-Whitney U test. Comparison of two data sets of the tumor differentiation was also performed using Mann-Whitney U test. ROC curve was used to analyze the diagnostic power of ADC value. Results Mann-Whitney U tests showed ADC values differed significantly between pancreatic adenocarcinoma group [（1.36±0.14）×10-3mm2/s] and normal pancreas head, body or tail groups[（1.66±0.34）,（1.77±0.36）,（1.62±0.38）×10-3mm2/s, respectively]（all of the P=0.000）. However, no association between ADC values of pancreatic adenocarcinoma and tumor differentiation was observed. With the global ADC values of normal pancreas as a reference, the area under the curve and the 95% confidence interval of ROC analysis were 0.863 and 79.5%-93.1%, respectively. The sensitivity and specificity were 75.5% and 85.3%, when ADC≤1.815×10-3mm2/s was used as the cutoff value for the differential diagnosis of pancreatic adenocarcinoma from normal pancreas. Conclusion Conclusion DWI had a better diagnostic accuracy in the diagnosis of pancreatic ductal adenocarcinoma. Although ADC values are significantly different between benign pancreas and pancreatic adenocarcinoma, no associations between

关 键 词：胰腺癌 扩散加权成像 表观扩散系数 分化 病理 

分 类 号：R735.9[医药卫生—肿瘤]