表观弥散系数术前评估胰腺神经内分泌肿瘤病理分级的价值  

Evaluating value of apparent diffusion coefficient for pathological grade of pancreatic neuroendocrine neoplasms before surgery

作　　者：费莹 王明亮 温虹 纪元 曾蒙苏 FEI Ying;WANG Ming-liang;WEN Hong;JI Yuan;ZENG Meng-su(Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipla Hospital, Suzhou 215002, Jiangsu, China;Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai institute of imaging Medicine, Shanghai 200032, China;Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China)

机构地区：[1]南京医科大学附属苏州医院,苏州市立医院放射科,苏州215002 [2]复旦大学附属中山医院放射科,上海市影像医学研究所,上海200032 [3]复旦大学附属中山医院病理科,上海200032

出　　处：《中国临床医学》2021年第5期864-868,共5页Chinese Journal of Clinical Medicine

基　　金：上海市临床重点专科项目(shslczdzk03202).

摘　　要：目的:探讨术前采用弥散加权成像(diffusion weighted imaging,DWI)定量参数表观弥散系数(apparent diffusion coefficient,ADC)区分不同病理级别胰腺神经内分泌肿瘤(pancreatic neuroendocrine neoplasms,pNEN)的价值。方法:回顾性分析2015年3月至2019年6月复旦大学附属中山医院收治的72例经病理证实为pNEN患者的MRI表现和病理资料,测量瘤灶ADC。参照WHO 2017年消化系统肿瘤分类标准,依据pNEN病理级别将患者分为4组,即pNET G1组、pNET G2组、pNET G3组和pNEC G3组。采用Spearman法分析pNEN瘤灶ADC与Ki-67的相关性,采用LSD法对各组间瘤灶ADC进行两两比较,采用ROC曲线分析ADC区分不同病理分级pNEN的效能。结果:72例患者pNEN均为单发,其中pNET G1组18例、pNET G2组36例、pNET G3组13例、pNEC G3组5例。pNEN瘤灶ADC与Ki-67负相关(r=-0.845,P<0.001)。各组两两(除外pNET G3与pNEC G3组)间瘤灶ADC差异无统计学意义(P<0.001)。ADC以1.596×10^(-3)mm^(2)/s为界值,区分G1级与G2级pNEN的灵敏度为97.22%、特异度为83.33%,AUC为0.941(Z=13.340,P<0.001);ADC以1.103×10^(-3) mm^(2)/s为界值,区分G2级与G3级pNEN的灵敏度为83.33%、特异度为100%、AUC为0.968(Z=18.830,P<0.001)。结论:ADC有助于术前评估pNEN的病理分级。Objective:To explore the value of apparent diffusion coefficient(ADC)in diffusion weighted imaging(DWI)for pathological grade of pancreatic neuroendocrine neoplasms(pNEN)before surgery.Methods:The MRI and pathological data of 72 patients with pathologically confirmed pNEN of Zhongshan Hospital,Fudan University from March 2015 to June 2019 were analyzed retrospectively,and ADC values of the tumors were measured.pNEN was classified into pNET G1,pNET G2,pNET G3,and pNEC G3 according to WHO 2017 latest classification standards for digestive system tumors.Spearman method was used to analyze the correlation between ADC of pNEN lesions and Ki-67.LSD method was used to pair-wise compare the difference of ADC.And receiver operating characteristic curve(ROC)method was used to analyze the diagnostic efficacy of ADC for pathological grade of pNEN.Results:All the 72 cases of pNEN were single lesion,and the pathological grade was 18 cases of pNET G1,36 cases of pNET G2,13 cases of pNET G3,and 5 cases of pNEC G3.ADC of pNEN was negatively correlated with Ki-67(r=-0.845,P<0.001).There was no significant difference in the ADC values of tumor foci between every two groups(except for pNET G3 and pNEC G3 groups,P<0.001).As the cut-off value of ADC was 1.596×10^(-3)mm^(2)/s,the sensitivity and specificity for distinguishing grade G1 and G2 pNEN were 97.22%and 83.33%,and the area under the ROC was 0.941(Z=13.340,P<0.001).As the cut-off value of ADC was 1.103×10^(-3)mm^(2)/s,the sensitivity and specificity for distinguishing grade G2 and G3 pNEN were 83.33%and 100%,and the area under the ROC was 0.968(Z=18.830,P<0.001).Conclusions:ADC values of pNEN at different levels are different to some extent.ADC is helpful for the pathological diagnosis of pNEN before surgery.

关 键 词：胰腺肿瘤 神经内分泌肿瘤 弥散加权成像 表观弥散系数 

分 类 号：R735.9[医药卫生—肿瘤]