扩散峰度成像模型与单指数模型定量化分析在肝细胞癌术前病理分级中的应用  

Quantitative Analysis of Diffusion Kurtosis Imaging Model and Mono-Exponential Model in Preoperative Pathological Classification of Hepatocellular Carcinoma

作　　者：李宏伟 杜勇[2] 杨汉丰[2] 徐晓雪[2] 卓丽华[1] 龙拥军[1] 姚洪超[1] 李凌霄 杨平 胡培曦 欧阳心芹 唐子云 LI Hongwei;DU Yong;YANG Hanfeng;XU Xiaoxue;ZHUO Lihua;LONG Yongjun;YAO Hongchao;LI Lingxiao;YANG Ping;HU Peixi;OUYANG Xinqin;TANG Ziyun(Department of Radiology,the Third Hospital of Mianyang,Sichuan Mental Health Center,Mianyang 621000,China;不详)

机构地区：[1]绵阳市第三人民医院,四川省精神卫生中心放射科,四川绵阳621000 [2]川北医学院附属医院放射科,四川南充637000

出　　处：《中国医学影像学杂志》2020年第10期784-788,共5页Chinese Journal of Medical Imaging

基　　金：绵阳市级科研课题鼓励项目(201840)。

摘　　要：目的探讨扩散峰度成像(DKI)模型与传统扩散加权成像(DWI)模型定量化分析对肝细胞癌术前病理分级的应用价值。资料与方法搜集经手术或穿刺病理证实的肝细胞癌患者64例,术前行常规及动态MRI增强扫描、DKI、DWI扫描,通过相应模型获得平均峰度系数(MK)、平均扩散系数(MD)值及表观扩散系数(ADC)值。根据Edmondson-Steiner分级法行病理分级,分析不同病理分级间各参数的差异和各参数值与病理分级的相关性,并通过受试者工作特征(ROC)曲线判断其诊断效能。结果在高、中、低分化肝细胞癌中,肿瘤实性部分的MK值依次增高,MD值及ADC值依次降低,差异均有统计学意义(P<0.05)。肝细胞癌肿瘤实性部分的MK值与肿瘤分化程度呈负相关(r=-0.689,P<0.001),MD值、ADC值与肿瘤分化程度呈正相关(r=0.534、0.428,P<0.001)。当MK、MD、ADC值的阈值分别取0.68、1.65×10^-3 mm^2/s及1.25×10^-3 mm^2/s时,判断高分化肝细胞癌的敏感度分别为84.2%、94.7%、73.7%,特异度分别为86.7%、73.3%、80.0%,准确度分别为85.94%、79.69%、78.13%。MK、MD、ADC值在术前判断高分化肝细胞癌的ROC曲线下面积分别为0.92、0.83、0.77。结论与DWI模型ADC值相比,DKI模型MK值、MD值对肝细胞癌病理分级具有较高的鉴别诊断效能,有助于术前评估肝细胞癌的病理分级,且以MK值为优。Purpose To explore the application value of quantitative analysis of diffusion kurtosis imaging(DKI) model and traditional diffusion weighted imaging(DWI) model in preoperative pathological classification of hepatocellular carcinoma(HCC). Materials and Methods Sixty-four patients with pathologically confirmed lesions were enrolled. Before operation, routine and dynamic MRI enhanced scans, DKI, DWI scans were obtained, the mean diffusion kurtosis(MK) and mean diffusion coefficient(MD) of the lesion were obtained by DKI model and the apparent diffusion coefficient(ADC) was obtained by DWI model. Pathological grading was performed according to the Edmondson Steiner classification. The difference of these parameters in grading HCC was evaluated, the correlation between each parameter value and pathological grade was analyzed, and the diagnostic efficiency was compared by ROC curve. Results In high-, moderate-and poor-differentiated HCC, the MK value of the solid part of the tumor decreased gradually with the degree of differentiation of the tumor, while the MD value and ADC value increased gradually with the degree of differentiation, the overall comparison between groups were statistically significant(P<0.05). MK was negatively correlated with the degree of differentiation of tumor( r=-0.689, P<0.001), while MD and ADC value were positively correlated with the tumor pathological differentiation(r=0.534 and 0.428, P<0.001). The threshold values of MK, MD and ADC were 0.68, 1.65×10^-3 mm^2/s and 1.25×10^-3 mm^2/s, respectively. The corresponding sensitivity of these parameters to diagnose the high-differentiated HCC was 84.2%, 94.7% and 73.7%, respectively;the specificity was 86.7%, 73.3% and 80.0%, respectively;the accuracy was 85.94%,79.69% and 78.13%, respectively. The MK, MD and ADC of AUC were 0.92, 0.83 and 0.77, respectively. Conclusion Compared with the ADC value derived by DWI model, MK and MD value derived by DKI model have better diagnostic efficiency for detection of pathological grade of HCC, and can di

关 键 词：癌 肝细胞 磁共振成像 扩散加权成像 扩散峰度成像 病理学 外科 诊断 鉴别 

分 类 号：R730.42[医药卫生—肿瘤] R735.7[医药卫生—临床医学]