IVIM-DWI多模型参数在鉴别单发转移瘤和肝癌中的联合应用  

A combined application of IVIM-DWI with multi-model parameters in identifying of single metastatic tumor and hepatocellular carcinoma

作　　者：王海霞 邰兆琴 许亚春 李宏 刘向东 杨孺牛 WANG Hai-xia;TAI Zhao-qin;XU Ya-chun(Department of Image,The Affiliated Haian Hospital of Nantong University,Haian 226600,China)

机构地区：[1]南通大学附属海安医院影像科,江苏海安226600

出　　处：《中国医学装备》2020年第3期67-71,共5页China Medical Equipment

摘　　要：目的:探讨磁共振成像(MRI)体素内不相干运动(IVIM)弥散加权成像(DWI)单、双指数模型多个参数在鉴别单发转移瘤和肝癌中的联合应用价值。方法:选取医院经术后病理或穿刺活检确诊的45例单发肝细胞癌(HCC)和单发转移瘤(MT)患者,分别将其纳入HCC组(27例)和MT组(18例),分析两组患者的MRI图像和IVIM-DWI参数图。选取肿瘤病灶及背景肝实质为感兴趣区域(ROI),测量表观弥散系数(ADC)值、真实弥散系数(D)值、灌注相关弥散系数(D*)值和灌注分数(f)值,计算各参数相对值(rADC值、rD值、rD*值和rf值)。比较病灶ADC值、D值、D*值和f值与rADC值、rD值、rD*值和rf值之间的差异。使用受试者工作特征(ROC)曲线和ROC曲线下面积(AUC),分析ADC、D、rADC、rD值及两者联合(ADC+D值、rADC+rD值)组间的诊断效能差异。结果:HCC组病灶ADC值、D值、rADC值及rD值均低于MT组(t=-2.903,t=-2.957,t=-3.447,t=-4.717;P<0.05)。鉴别HCC和MT的ADC值、D值、rADC值和rD值的最佳阈值分别为1.305×10^-3mm^2/s、1.080×10^-3mm^2/s、0.635和0.735,约登指数最高的是rADC联合rD(rADC+rD)和rD值,AUC最大的是rADC+rD。两组AUCrD、AUCrADC+rD分别大于AUCD和AUCADC+D(Z=2.776,Z=3.712;P<0.05);AUCADC与AUCrADC比较差异无统计学意义。两组AUCrADC明显小于AUCrD和AUCrADC+rD,差异有统计学意义(Z=2.561,Z=2.992;P<0.05),AUCrD和AUCrADC+rD两者比较差异无统计学。结论:IVIM-DWI可用于临床单发MT和HCC的鉴别诊断,病灶rADC值联合rD值鉴别诊断效能最高。rD值可代替rADC值与rD值的联合诊断,有效鉴别两组病灶,从而简化临床工作。Objective:To explore the value of combined application of intra voxel incoherent motion-diffusion weighted imaging(IVIM-DWI)with multi-model(single or double exponential)parameters of magnetic resonance imaging(MRI)in identifying of single metastatic tumor and hepatocellular carcinoma.Methods:A total of 45 patients with single hepatocellular carcinoma(HCC)or single metastatic tumor(MT)who were diagnosed by postoperative pathology or puncture biopsy in hospital were selected,and they were included into HCC group(27 cases)and MT group(18 cases),respectively.And MRI images and IVIM-DWI parameters images of two groups were analyzed.Tumor lesions and background liver parenchyma were selected as region of interest(ROI).The values of apparent diffusion coefficient(ADC),true diffusion coefficient(D),perfusion related diffusion coefficient(D*)and perfusion fraction(f)were measured,and then the relative values of each parameter(rADC,rD,rD*,rf)were calculated.The differences of ADC,D,D*,f values,rADC,rD,rD*and rf values of lesions were compared.The differences of diagnostic efficacy of ADC,D,rADC,rD and their combination(ADC+D and rADC+rD)between two groups were analyzed by using receiver operating characteristic(ROC)curve and area under the curve(AUC)of ROC.Results:The values of ADC,D,rADC and rD of lesions in HCC group were significantly lower than those in MT group(t=-2.903,t=-2.957,t=-3.447,t=-4.717,P<0.05),respectively.For identifying HCC and MT,the optimal thresholds of ADC,D,rADC and rD were 1.305×10^-3mm^2/s,1.080×10^-3mm^2/s,0.635 and 0.735,respectively.The value that rADC combined rD(rADC+rD),and rD value had the highest Youden index.And rADC+rD had the largest AUC.And AUCrD and AUCrADC+rD were significantly larger than AUCD and AUCADC+D in each group(Z=2.776,Z=3.712,P<0.05)respectively.And there were no statistical differences between AUCADC and AUCrADC in each group.AUCrADC were significantly smaller than AUCrD and AUCrADC+rD in each group(Z=2.561,Z=2.992,P<0.05),respectively.And there were no statistical diff

关 键 词：磁共振成像(MRI) 体素内不相干运动(IVIM) 弥散加权成像(DWI) 肝癌 转移瘤 弥散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]