IVIM-DWI在肝外胆管癌分级中的临床应用  

Value of Intravoxel Incoherent Motion MR Imaging in Assessment of Differentiation of Extrahepatic Cholangiocarcinoma

作　　者：崔兴宇[1] 蔡崧[2] 汤群锋[1] 方向明[1] 邢春华[1] 陈宏伟[1] 

机构地区：[1]南京医科大学附属无锡人民医院影像科,江苏214023 [2]江苏省无锡市中医医院,214023

出　　处：《临床放射学杂志》2016年第9期1380-1384,共5页Journal of Clinical Radiology

基　　金：江苏省自然科学基金资助项目(编号:BK2012541)

摘　　要：目的探讨体素内不相干运动磁共振扩散加权成像(IVIM-DWI)对肝外胆管癌(EHCC)病理分级的临床应用价值。方法搜集经手术病理证实为EHCC,并于术前行3.0 T MRI常规序列及IVIM-DWI序列扫描的患者33例。测量计算以下参数:肿瘤DWI单指数成像ADC值;IVIM-DWI成像参数,包括真性扩散系数(D)值、灌注分数(f)值和假性扩散系数(D*)值。不同病理级别EHCC组间参数的比较采用单因素ANOVA检验(正态分布)或Kruskal-Wallis H检验(非正态分布),采用Spearman相关分析研究各参数和病理分级的相关性,通过受试者工作特征曲线(ROC)曲线下面积(AUC)来比较参数的诊断效能。结果 33例EHCC患者按照病理分级分为高分化(Ⅰ级)9例、中分化(Ⅱ级)13例和低分化(Ⅲ级)11例,ADC值分别为(1.34±0.23)×10^(-3)mm^2/s、(1.22±0.19)×10^(-3)mm^2/s、(0.97±0.13)×10^(-3)mm^2/s,D值分别为(1.31±0.15)×10^(-3)mm^2/s、(1.17±0.14)×10^(-3)mm^2/s、(0.86±0.12)×10^(-3)mm^2/s,D*值分别为(5.84±0.73)×10^(-3)mm^2/s、(6.39±1.67)×10^(-3)mm^2/s、(5.56±2.01)×10^(-3)mm^2/s,f值分别为37.35±9.01、30.91±8.55、22.78±7.47。不同病理分级组间D*值的差异无统计学意义(P>0.05)外,其余参数的差异均有统计学意义(P<0.05)。ADC值、D值和f值均与病理分级呈负相关(r值分别为-0.677、-0.821、-0.582,P均<0.05),ROC AUC分别为0.743、0.876、0.691,且差异存在统计学意义(P=0.000)。结论 IVIM-DWI技术可以在一定程度上反映EHCC的组织分化程度和血供,对术前预测肿瘤病理分级具有一定价值。Objective To investigate the value of intravoxel incoherent motion（ IVIM） MR diffusion-weighted imaging（ DWI） in assessing grades of extrahepatic cholangiocarcinoma（ EHCC）. Methods Thirty-three patients with EHCC confirmed pathologically underwent preoperative conventional MRI and IVIM sequence scan. The parameters such as the average value of ADC,pure molecular diffusion（ D）,perfusion fraction（ f） and perfusion-based molecular diffusion（ D＊）were calculated. One-way ANOVA analysis of variance was used to analyze normally distributed continuous data. The Kruskal-Wallis H test was used to analyze abnormally distributed continuous data. The MRI parameters were compared as well as correlated with pathological grading by Spearman correlation analysis. The diagnostic potential of parameters was evaluated by using ROC analysis. Results 33 cases of EHCC were divided into well differentiated group（ 9 cases）,moderately differentiated group（ 13 cases）,and poorly differentiated group（ 11 cases）. ADC values of the three groups were（ 1. 34 ± 0. 23） × 10^-3mm^2/ s、（ 1. 22 ± 0. 19） × 10^-3mm^2/ s、（ 0. 97 ± 0. 13） × 10^-3mm^2/ s,respectively. D values were（ 1. 31 ± 0. 15） × 10^-3mm^2/ s、（ 1. 17 ± 0. 14） × 10^-3mm^2/ s、（ 0. 86 ± 0. 12） × 10^-3mm^2/ s,respectively. D＊values were（ 5. 84 ± 0. 73） × 10^-3mm^2/ s 、（ 6. 39 ± 1. 67） × 10^-3mm^2/ s、（ 5. 56 ± 2. 01） × 10^-3mm^2/ s,respectively. f values were37. 35 ± 9. 01、30. 91 ± 8. 55、22. 78 ± 7. 47,respectively. The differences of ADC,D,and f values were statistically significant（ P〈0. 05）. D＊values were of no significant difference（ P〈0. 05）. ADC,D,and f values correlated negatively with tumor grading（ r =- 0. 677,- 0. 821 and- 0. 582,P〈0. 05,respectively）. Areas under ROC curves（ AUC）were 0. 743,0. 876 and 0. 691,respectively; the differences were statistically significant（ P = 0. 000）. Conclusion IVIM-DWI may provide information in the assessmen

关 键 词：肝外胆管癌 扩散加权成像 病理分级 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.8[医药卫生—诊断学]