3.0 T MR扩散加权成像及表观扩散系数诊断胃癌不同分化程度的临床价值
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摘要
目的分析3.0 T MR扩散加权成像(Diffusion Weighted Imaging,DWI)及表观扩散系数(Apparent Diffusion Coefficient,ADC)诊断胃癌不同分化程度的临床价值。方法选取2015年10月至2017年3月在我院科室诊治54例胃癌患者,根据患者胃癌分化程度分为低、中、高分化3组,采用3.0 T MR获得3组胃癌患者DWI及ADC参数,对3组胃癌患者的ADC值采用单因素方差分析法用t检验,而3组胃癌患者的LAVA强化特点用n (%)表示用χ2检验,分化程度的等级资料组间比较采用秩和检验分析的临床价值。结果 54例胃癌患者病灶处DWI图像均显示高信号影,全部病灶的T2WI图像显示呈高或稍高信号影,T1WI图像显示为低或等信号,LAVA示病灶均有强化;其中,高、中、低分化腺癌强化特点比较,差异有统计学意义(Z=-5.2800,P=0.000);正常胃壁ADC值(3.034±0.211)×10-3 mm2/s明显高于胃癌患者胃壁ADC值(1.121±0.186)×10-3 mm2/s,差异有统计学意义(t=49.978,P=0.000);DWI与LAVA+DWI图像均显示低分化腺癌ADC值明显低于中、高分化腺癌ADC值,比较差异有统计学意义(P<0.05)。结论 DWI及ADC可有效鉴别与诊断不同分化程度胃癌,而辅助LAVA可进一步获得更全面的参数信息,评价其生物学行为,具有较高的临床诊断价值。
Objective To analyze the clinical value of 3.0 T MR diffusion-weighted imaging(DWI) and apparent diffusion coefficient(ADC) in the diagnosis of different degrees of differentiation of gastric cancer. Methods Fifty-four patients with gastric cancer who were diagnosed and treated in our hospital from October 2015 to March 2017 were selected in this study. According to the degree of differentiation of gastric cancer, the patients were divided into three groups: low, medium and high differentiation. Then DWI and ADC parameters of three groups of gastric cancer patients were obtained by using 3.0 T MR. The ADC values of three groups of gastric cancer patients were evaluated by one-way anova with t test, and the LAVA reinforcement characteristics of three groups of gastric cancer patients were evaluated by n(%) and χ2 test. The grade data of differentiation degree were compared between groups and the clinical value was analyzed by rank sum test. Results All the 54 patients with gastric cancer showed high signal shadow on DWI, high or slightly high signal shadow on T2 WI, low or equal signal on T1 WI, and LAVA showed enhanced lesions. Among them, there were statistically significant differences in the enhancement characteristics of high, moderate and poorly differentiated adenocarcinomas(Z=-5.2800, P=0.000). The ADC value of normal gastric wall(3.034±0.211)×10-3 mm2/s was significantly higher than that of gastric cancer patients(1.121±0.186)×10-3 mm2/s. The difference was statistically significant(t=49.978, P=0.000). Both DWI and LAVA+DWI images showed that the ADC value of poorly differentiated adenocarcinoma was significantly lower than that of moderately and well differentiated adenocarcinoma, and the difference was statistically significant(P<0.05). Conclusion DWI and ADC can effectively identify and diagnose different degree of differentiation of gastric cancer, while auxiliary LAVA can further obtain more comprehensive parameter information, evaluate its biological behavior, which has high clinical diagnostic value.
Objective To analyze the clinical value of 3.0 T MR diffusion-weighted imaging(DWI) and apparent diffusion coefficient(ADC) in the diagnosis of different degrees of differentiation of gastric cancer. Methods Fifty-four patients with gastric cancer who were diagnosed and treated in our hospital from October 2015 to March 2017 were selected in this study. According to the degree of differentiation of gastric cancer, the patients were divided into three groups: low, medium and high differentiation. Then DWI and ADC parameters of three groups of gastric cancer patients were obtained by using 3.0 T MR. The ADC values of three groups of gastric cancer patients were evaluated by one-way anova with t test, and the LAVA reinforcement characteristics of three groups of gastric cancer patients were evaluated by n(%) and χ2 test. The grade data of differentiation degree were compared between groups and the clinical value was analyzed by rank sum test. Results All the 54 patients with gastric cancer showed high signal shadow on DWI, high or slightly high signal shadow on T2 WI, low or equal signal on T1 WI, and LAVA showed enhanced lesions. Among them, there were statistically significant differences in the enhancement characteristics of high, moderate and poorly differentiated adenocarcinomas(Z=-5.2800, P=0.000). The ADC value of normal gastric wall(3.034±0.211)×10-3 mm2/s was significantly higher than that of gastric cancer patients(1.121±0.186)×10-3 mm2/s. The difference was statistically significant(t=49.978, P=0.000). Both DWI and LAVA+DWI images showed that the ADC value of poorly differentiated adenocarcinoma was significantly lower than that of moderately and well differentiated adenocarcinoma, and the difference was statistically significant(P<0.05). Conclusion DWI and ADC can effectively identify and diagnose different degree of differentiation of gastric cancer, while auxiliary LAVA can further obtain more comprehensive parameter information, evaluate its biological behavior, which has high clinical diagnostic value.
引文
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[14]Belli G,Busoni S,Ciccarone A,et al.Quality assurance multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging[J].J Magn Reson Imaging,2016,43(1):213-219.
[15]郑国淀,程向东,汪丽菁,等.胃腺癌磁共振扩散加权成像表观弥散系数与分子标记物Ki-67的相关性分析[J].中华胃肠外科杂志,2017,20(7):803-808.
[16]Priola AM,Priola SM,Parlatano D,et al.Apparent diffusion coefficient measurements in diffusion-weighted magnetic resonance imaging of the anterior mediastinum:inter-observer reproducibility of five different methods of region-of-interest positioning[J].Eur radiol,2016,27(4):1-9.
[17]杨虹,李雪霜,陆通,等.DWI及ADC值对胃癌转移淋巴结的诊断价值[J].临床放射学杂志,2017,36(9):1271-1275.
[18]Ho JC,Allen PK,Bhosale PR,et al.Diffusion-weighted magnetic resonance imaging as a predictor of outcome in cervical cancer after chemoradiation[J].Int J Radiat Oncol Biol Phys,2017,97(3):546-553.
[19]Liu S,Zheng H,Zhang Y,et al.Whole-volume apparent diffusion coefficient-based entropy parameters for assessment of gastric cancer aggressiveness[J].J Magn Reson Imaging,2017,47(1):168-175.
[20]Zhao YH,Cao YY,Zhang Q,et al.Role of diffusion-weighted and contrast-enhanced magnetic resonance imaging in differentiating activity of ankylosing spondylitis[J].Chin Med J,2017,130(11):1303-1308.
[2]Zhang Y,Chen J,Liu S,et al.Assessment of histological differentiation in gastric cancers using whole-volume histogram analysis of apparent diffusion coefficient maps[J].J Magn Reson Imaging,2017,45(2):440-449.
[3]屈昭慧,高雪梅,程敬亮,等.扩散加权成像评价胃癌血管内皮生长因子表达及病理分化程度的研究[J].中国医学影像学杂志,2016,24(9):666-668.
[4]Ma W,Li N,Zhao W,et al.Apparent diffusion coefficient and dynamic contrast-enhanced magnetic resonance imaging in pancreatic cancer:characteristics and correlation with histopathologic parameters[J].J Comput Assist Tomogr,2016,40(5):709-716.
[5]李华兵,赵瑞峰,晋记龙,等.3.0 T与1.5 T磁共振扩散加权成像对胃癌淋巴结转移诊断价值的比较[J].肿瘤研究与临床,2017,29(3):176-179.
[6]吕茜婷,陈勇,李珊玫,等.基于磁共振扩散加权成像直肠癌ADC值与其分化程度及神经脉管侵犯相关性研究[J].磁共振成像,2016,7(12):915-920.
[7]Faure A,Panait N,Panuel M,et al.Predicting postnatal renal function of prenatally detected posterior urethral valves using fetal diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient determination[J].Prenat Diagn,2017,37(7):666-672.
[8]Yu X P,Hou J,Li FP,et al.Intravoxel incoherent motion diffusion weighted magnetic resonance imaging for differentiation between nasopharyngeal carcinoma and lymphoma at the primary site[J].J Comput Assist Tomogr,2016,40(3):413-418.
[9]Rabasco P,Caivano R,Simeon V,et al.Can diffusion-weighted imaging and related apparent diffusion coefficient be a prognostic value in women with breast cancer?[J].Cancer Invest,2017,35(2):92-99.
[10]许传军,刘林祥,李晓东,等.胃肿瘤MR扩散加权成像中扩散敏感因子选择的初步研究[J].中国临床医学影像杂志,2010,21(9):625-628.
[11]Shen G,Jia Z,Deng H.Apparent diffusion coefficient values of diffusion-weighted imaging for distinguishing focal pulmonary lesions and characterizing the subtype of lung cancer:a metaanalysis[J].Eur Radiol,2016,26(2):556-566.
[12]王铮,苏丹柯,赖少侣,等.直肠癌扩散加权成像ADC值与病理分级的相关性研究[J].临床放射学杂志,2017,36(6):828-832.
[13]Priola AM,Andrea Veltri MD,Priola SM.Importance of different region-of-interest protocols for the apparent diffusion coefficient measurement of tumors in diffusionweighted magnetic resonance imaging[J].J Magn Reson Imaging,2016,44(4):1056-1062.
[14]Belli G,Busoni S,Ciccarone A,et al.Quality assurance multicenter comparison of different MR scanners for quantitative diffusion-weighted imaging[J].J Magn Reson Imaging,2016,43(1):213-219.
[15]郑国淀,程向东,汪丽菁,等.胃腺癌磁共振扩散加权成像表观弥散系数与分子标记物Ki-67的相关性分析[J].中华胃肠外科杂志,2017,20(7):803-808.
[16]Priola AM,Priola SM,Parlatano D,et al.Apparent diffusion coefficient measurements in diffusion-weighted magnetic resonance imaging of the anterior mediastinum:inter-observer reproducibility of five different methods of region-of-interest positioning[J].Eur radiol,2016,27(4):1-9.
[17]杨虹,李雪霜,陆通,等.DWI及ADC值对胃癌转移淋巴结的诊断价值[J].临床放射学杂志,2017,36(9):1271-1275.
[18]Ho JC,Allen PK,Bhosale PR,et al.Diffusion-weighted magnetic resonance imaging as a predictor of outcome in cervical cancer after chemoradiation[J].Int J Radiat Oncol Biol Phys,2017,97(3):546-553.
[19]Liu S,Zheng H,Zhang Y,et al.Whole-volume apparent diffusion coefficient-based entropy parameters for assessment of gastric cancer aggressiveness[J].J Magn Reson Imaging,2017,47(1):168-175.
[20]Zhao YH,Cao YY,Zhang Q,et al.Role of diffusion-weighted and contrast-enhanced magnetic resonance imaging in differentiating activity of ankylosing spondylitis[J].Chin Med J,2017,130(11):1303-1308.