IVIM-DWI对可切除性胃腺癌脉管侵犯的预测价值  

Predictive value of intravoxel incoherent motion imaging for lymphovascular invasion in resectable gastric adenocarcinomas

作　　者：杨慧远 曲金荣 王艺 黎海亮 吴越 赵卫杰 李靖 YANG Hui-yuan;QU Jing-rong;WANG Yi(Department of Radiology,The Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China;不详)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)医学影像科,河南郑州450008 [2]郑州大学附属肿瘤医院(河南省肿瘤医院)病理科,河南郑州450008 [3]郑州大学附属肿瘤医院(河南省肿瘤医院)普外科,河南郑州450008

出　　处：《放射学实践》2024年第4期503-508,共6页Radiologic Practice

基　　金：河南省中青年卫生健康科技创新优秀青年人才培养项目(YXKC2021054);国家自然科学基金(82202146)。

摘　　要：目的:探讨体素内不相干运动磁共振成像(IVIM-DWI)术前预测胃腺癌脉管侵犯的价值。方法:2021年1月-2022年5月,前瞻性搜集行根治性胃切除的胃腺癌患者的术前MRI资料,包括IVIM和DWI。根据术后病理结果,将患者分为有、无脉管侵犯组。测量胃癌病灶的厚度、ADC和IVIM-DWI参数(D、D^(*)、f)值,采用student t检验或Mann-Whitney U检验比较两组间连续变量的差异,采用逻辑回归分析筛选脉管侵犯的独立危险因素,采用ROC曲线评估各参数鉴别脉管侵犯状态的效能,采用Delong检验比较各参数预测效能的差异。结果:共纳入73例胃癌手术患者,其中49例有脉管侵犯(67.12%)。有脉管侵犯组的肿瘤处胃壁厚度大于无脉管侵犯组,而ADC、D和f值均低于无脉管侵犯组,差异均有统计学意义(P<0.05);两组间D^(*)值的差异无统计学意义(P>0.05)。ROC曲线分析显示肿瘤处胃壁厚度及ADC、D和f值均能有效预测脉管侵犯状态,AUC分别为0.821、0.686、0.792和0.727(P均<0.05)。肿瘤处胃壁厚度[OR:1.302(1.098~1.543)]和f[OR:686.801(6.126~77004.267)]是预测脉管侵犯的独立危险因素;联合两者进行诊断时,AUC、敏感度和特异度分别为0.897、81.63%和91.67%,其AUC显著高于ADC和f(Delong检验,P均<0.05),但与D和肿瘤处胃壁厚度的差异均无统计学意义(P=0.055、0.052)。结论:IVIM-DWI定量参数及肿瘤处胃壁厚度均能在术前有效预测胃癌脉管侵犯情况,尤其是肿瘤处胃壁厚度和f是胃癌患者脉管侵犯的独立危险因素,两者联合诊断可提高预测效能。Objective:To investigate the value of intravoxel incoherent motion(IVIM)DWI in predicting lymphovascular invasion(LVI)in resectable gastric adenocarcinomas(GAC).Methods:Between Jan 2021 and May 2022,MRI data(including IVIM and DWI)of patients with gastric adenocarcinomas treated with radical gastrectomy were prospectively collected.The patients were divided into two groups:lymphovascular invasion(LVI+)group and no LVI(LVI-)group according to pathologic reports.Tumor thickness,ADC,and IVIM-DWI parameters(D,D^(*),f)of gastric cancer lesion were measured and compared by student t-test or Mann-Whitney U-test between the two groups.Multivariable logistic analysis was performed to screen the independent risk factors of LVI.ROC analysis was used to evaluate the diagnostic efficacy of the parameters.Delong test was plotted to compare the differences of AUCs of the parameters.Results:A total of 73 patients were recruited,of which LVI was found by pathology in 49 cases(67.12%).Tumor thickness in LVI+group was higher than that in LVI-group,the values of ADC,D and f in LVI+group were lower than those in LVI-group(all P<0.05).There was no significant difference of D^(*)values between the two groups(P>0.05).ROC analysis revealed that tumor thickness,ADC,D and f could effectively predict LVI in GAC patients,with AUCs of 0.821,0.686,0.792 and 0.727,respectively(all P<0.05).Tumor thickness[OR:1.302(1.099~1.543)]and f-value[OR:686.801(6.126~77004.267)]were independent risk factors of LVI.Their combination for predicting LVI yielded AUC,sensitivity and specificity were 0.897,81.63%,and 91.67%,respectively,and its AUC was significantly higher than that of ADC and f(Delong test,both P<0.05),but there were no significant differences when compared with that of D and thickness(P=0.055,0.052).Conclusion:IVIM-DWI quantitative parameters and tumor thickness can effectively assess the lymphovascular invasion status in GAC patients preoperatively.The tumor thickness and f were independent risk factors,their combination can increase the diagn

关 键 词：胃肿瘤 脉管侵犯 扩散加权成像 体素内不相干运动 预测模型 

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