不同b值磁共振扩散加权成像在肝外胆管良恶性狭窄诊断中的应用  

Application of different b-value diffusion-weighted imaging in the diagnosis of benign and malignant biliary stricture

作　　者：阴祖栋 姜相森 田本祥 于磊 韩武师 王光彬[2] YIN Zudong;JIANG Xiangsen;TIAN Benxiang;YU Lei;HAN Wushi;WANG Guangbin(Imaging Center Shandong Provincial Third Hospital,Jinan 250031,P.R.China;Shandong Medical Imaging Research Institute Affiliated to Shandong University,Jinan 250021,P.R.China)

机构地区：[1]山东省立第三医院影像中心,山东济南250031 [2]山东大学附属山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2019年第10期1747-1750,共4页Journal of Medical Imaging

摘　　要：目的采用不同b值(DWI)评价肝外胆管的良恶性狭窄的鉴别能力,确定较佳b值。方法回顾性分析经病理活检或临床治疗随访的肝外胆管肿瘤患者34例(恶性狭窄组)和肝外胆管炎症患者15例(良性狭窄组)分别进行DWI(b=300、600、800、1000、1500s/mm 2)扫描的影像学资料。分别对不同b值的ADC值进行测量并进行t检验统计学分析,测量ADC图不同b值的信噪比,均数间两两比较。结果当b值为300、600、800、1000、1500s/mm^2时,肿瘤组ADC平均值分别(2.63±0.24)×10^-3 mm^2/s、(1.99±0.18)×10^-3 mm^2/s、(1.74±0.22)×10^-3 mm^2/s、(1.57±0.17)×10^-3 mm^2/s、(1.35±0.23)×10^-3 mm^2/s,炎症组ADC值分别为(2.77±0.23)×10^-3 mm^2/s、(2.06±0.24)×10^-3 mm^2/s、(1.95±0.21)×10^-3 mm^2/s、(1.71±0.15)×10^-3 mm^2/s、(1.61±0.19)×10^-3 mm^2/s。随b值增加,图像的SNR值(信噪比)降低,肿瘤组和炎症组ADC平均值降低,在相同b值下,肿瘤组ADC平均值较明显低于炎症组(P值均<0.01),不同b值ADC值对于肿瘤组及炎症组鉴别诊断的ROC检验结果显示,b值为1500s/mm^2时鉴别诊断价值要高于b值为300、600、800及1000s/mm^2(P值均<0.05),当b=1500s/mm 2时诊断界值为1.43×10^-3 mm^2/s,诊断的敏感度为91.2%,特异度为66.7%;b=1000与b=300、600、800s/mm^2之间差异无统计学意义(P值均>0.05)。结论通过多b值测量的ADC值对肝外胆管良恶性狭窄鉴别具有一定意义,b=1500s/mm 2是鉴别胆管肿瘤及非特异性炎症的较佳b值。Objective To evaluate the discriminative ability of benign and malignant stenosis of extrahepatic bile duct by different b-value magnetic resonance diffusion-weighted imaging(DWI),and to determine the best b value.Methods A retrospective analysis of 34 cases of patients with extrahepatic biliary tract tumors(malignant stenosis group)and 15 cases of extrahepatic biliary tract inflammation(benign stenosis group)by pathological biopsy or clinical treatment were performed on DWI(b=300,600,800,1000,1500 s/mm^2)scanned imaging data.The ADC values of different b values were measured and statistical analysis was performed by t test.The signal-to-noise ratios of different b values of the ADC map were measured,and the averages were compared in pairs.Results When b was 300,600,800,1000,1500 s/mm^2,the mean ADC values of the tumor group were(2.63±0.24)×10^-3 mm 2/s,(1.99±0.18)×10^-3 mm^2/s,(1.74±0.22)×^-3 mm^2/s,(1.57±0.17)×10^-3 mm^2/s,(1.35±0.23)×10^-3 mm^2/s,the ADC values of the inflammation group were(2.77±0.23)×10^-3 mm^2/s,(2.06±0.24)×10^-3 mm^2/s,(1.95±0.21)×10^-3 mm^2/s,(1.71±0.15)×10^-3 mm^2/s,(1.61±0.19)×10^-3 mm^2/s.With the increase of b value,the SNR value(signal-to-noise ratio)of the image decreased,and the mean value of ADC in the tumor group and the inflammation group decreased.Under the same b value,the mean ADC value of the tumor group was significantly lower than that of the inflammation group(P<0.01).The ROC test results of different b-value ADC values for differential diagnosis of tumor group and inflammation group showed that the value of differential diagnosis was higher than b value of 300,600,800 and 1000 s/mm^2 when b value was 1500 s/mm^2(P value<0.05),when b=1500 s/mm 2,the diagnostic boundary value is 1.43×10^-3 mm^2/s,the sensitivity of diagnosis wass 91.2%,the specificity was 66.7%;b=1000 and b=300,600,800.There was no significant difference between s/mm^2(P>0.05).Conclusion ADC values measured by multiple b values have a certain significance for the differential diagnosis

关 键 词：肝外胆管 良恶性狭窄 磁共振成像 

分 类 号：R735.8[医药卫生—肿瘤] R445.2[医药卫生—临床医学]