T_(3)期胆囊癌癌旁及背景肝组织的扩散加权成像术前对比研究  

Preoperative comparative study on diffusion weighted imaging of liver tissue adjacent to T_(3 )stage gallbladder carcinoma and background liver tissue

作　　者：唐钊 谭邦国 陈天武[1] 张小明[1] TANG Zhao;TAN Bangguo;CHEN Tianwu;ZHANG Xiaoming(Medical Imaging Key Laboratory of Sichuan Province and Department of Radiology,Affiliated Hospital of North SichuanMedical College,Nanchong 637000,China;Department of Radiology,Meishan Hospital of Traditional Chinese Medicine;Department of Radiology,Panzhihua Central Hospital.)

机构地区：[1]医学影像四川省重点实验室,川北医学院附属医院放射科,南充637000 [2]眉山市中医医院放射科 [3]攀枝花市中心医院放射科

出　　处：《国际医学放射学杂志》2023年第5期530-536,561,共8页International Journal of Medical Radiology

基　　金：南充市市校科技战略合作项目(NSMC20170206)。

摘　　要：目的探讨表观扩散系数(ADC)及其标准差(ADCsd)对T_(3)期胆囊癌(GBC)近癌旁、远癌旁及背景肝组织的术前区分可行性。方法回顾性收集经手术病理证实的T_(3)期GBC病人45例,以手术病理结果为金标准,将其分为肝脏受侵组(31例)和肝脏未受侵组(14例)。所有病人均在术前于3.0 TMRI行多b值(b值包括0、20、50、80、100、200、400、600、800及1000 s/mm^(2))DWI扫描,并在各b值DWI影像上分别测量近癌旁、远癌旁及背景肝组织的ADC及其ADCsd。采用单因素方差分析或Kruskal-Wallis H检验比较3种肝组织ADC及ADCsd的差异。采用受试者操作特征(ROC)曲线评估ADC和ADCsd区分3种肝组织的效能,并计算ROC曲线下面积(AUC)。结果肝脏受侵组中,b值为600、800及1000 s/mm^(2)时,近癌旁肝组织的ADC和ADCsd均低于远癌旁及背景肝组织(均P<0.05),而ADC和ADCsd在远癌旁与背景肝组织间差异无统计学意义(均P>0.05)。当b值≤400 s/mm^(2),ADC和ADCsd值在近癌旁、远癌旁及背景肝组织间的差异无统计学意义(均P>0.05)。肝脏未受侵组中,所有b值对应的ADC和ADCsd在近癌旁、远癌旁及背景肝组织三者间的差异均无统计学意义(均P>0.05)。b值为800 s/mm^(2)时,ADC区分近癌旁与远癌旁肝组织的AUC值最高(0.696)。b值为1000 s/mm^(2)时,ADCsd区分近癌旁与远癌旁肝组织的AUC值最高(0.696)。b值为800及1000 s/mm^(2)时,ADC区分近癌旁与背景肝组织的AUC值相近(分别为0.713及0.714)。b值为1000 s/mm^(2)时,ADCsd区分近癌旁与背景肝组织的AUC值最高(0.710)。结论当GBC侵犯肝脏,选取b值为600、800及1000 s/mm^(2)时,其ADC和ADCsd有助于近癌旁与远癌旁、背景肝组织的区分,但不能区分远癌旁与背景肝组织。Objective To investigate the feasibility of apparent diffusion coefficient(ADC)and its standard deviation(ADCsd)in differentiating tumor-adjacent,tumor-distant,and background liver tissues in T_(3) staged gallbladder carcinoma(GBC)preoperativety.Methods A total of 45 patients with T_(3) staged GBC confirmed by postoperative pathology were included in this retrospective study and divided into two sets with(n=31)and without(n=14)liver invasion.All patients underwent DWI at b-values of 0,20,50,80,100,200,400,600,800 and 1000 s/mm^(2)with a 3.0 T magnetic resonance scanner before surgery.ADC and ADCsd of tumor-adjacent,tumor-distant and background liver tissues were measured on DWI at previous b-values.One way ANOVA or Kruskal Wallis H test were used to compare the ADC and ADCsd among the three liver tissues.The diagnostic efficacy of ADC and ADCsd to differentiate the three liver tissues was evaluated using the receiver operating characteristic curve(ROC),and the area under the curve(AUC)was calculated.Results In the set with liver invasion:ADC and ADCsd at b-values of 600,800,and 1000 s/mm^(2)of tumor-adjacent liver tissues were lower than those of tumor-distant and background liver tissues(all P<0.05),but there were no statistical differences in ADC and ADCsd between tumor-distant and background liver tissues(all P>0.05).When the b-values were not more than 400 s/mm^(2),the ADC and ADCsd values showed no differences among the tumor-adjacent,tumor-distant,and background liver tissues(all P>0.05).In the set without liver invasion:ADC and ADCsd at all b-values had no statistical differences among tumor-adjacent,tumor-distant,and background liver tissues(all P>0.05).When the b value was 800 s/mm^(2),ADC had the highest diagnostic performance for distinguishing between tumor-adjacent and tumor-distant liver tissues,with an AUC of 0.696.When the b-value was 1000 s/mm^(2),ADCsd obtained the highest diagnostic performance for distinguishing between tumor-adjacent and tumor-distant liver tissues,with an AUC of 0.696.When t

关 键 词：胆囊癌 扩散加权成像 近癌旁肝组织 远癌旁肝组织 背景肝组织 

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