多模态DWI在急性胰腺炎严重程度分级中的价值
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摘要
目的:探讨单指数模型、双指数模型和拉伸指数模型DWI在急性胰腺炎(AP)临床严重程度分级中的应用价值。方法:按纳入标准及排除标准收集53例经临床确诊的AP患者为研究组(AP组),同期收集健康志愿者20例作为对照组(NP组),两组均行上腹部常规MRI和14个b值(0～2000 s/mm~2)的3.0T DWI检查,根据磁共振严重指数(MRSI)评分标准将AP组分为轻度、中重度及重度组,测量所有对象的DWI单指数模型参数标准ADC(Standard ADC),双指数模型参数慢速扩散ADC(slow ADC mono)、快速扩散ADC(fast ADC mono)、快速扩散ADC分数(Ff ADC mono)、慢速扩散ADC值(slow ADC Bi)、快速扩散ADC值(fast ADC Bi)、快速扩散ADC值分数(Ff ADC Bi),以及拉伸指数模型参数扩散分布系数(DDC)、水分子扩散异质性指数(α),比较各参数在AP组与NP组间,轻度、中重度及重度AP组间的差异。结果:本组53例AP中,轻度21例,中重度26例,重度6例。standard ADC、Ff ADC mono、DDC、α值在AP组和NP组间具有统计学意义(P均<0.05);其余参数在两组间均无统计学差异(P均>0.05)。Ff ADC mono、α值在轻度与中重度AP间具有统计学差异(P均<0.05);standard ADC、Ff ADC mono、DDC在中重度与重度AP间具有统计学差异(P均<0.05);standard ADC、Ff ADC mono、DDC、α值在轻度与重度AP间差异均具有统计学意义(P均<0.05)。结论:多模态DWI参数standard ADC、Ff ADC mono、DDC和α有助于AP的临床严重程度分级。
Objective:To explore the value of mono-exponential,bi-exponential and stretched-exponential model of diffusion-weighted MR imaging for clinical severity grading of acute pancreatitis.Methods:53 patients with clinical confirmed acute pancreatitis and 20 healthy volunteers underwent conventional upper abdominal MRI including DWI with 14 b values ranged 0～2000 s/mm~2 at 3.0 T MRI.The patients were devided into mild,moderate and severe groups according to the MR severity index.The quantitative parameters were determined including standard ADC,slow ADC mono,fast ADC mono,Ff ADC mono,slow ADC Bi,fast ADC Bi,Ff ADC Bi,DDC and α derived from mono-exponential,bi-exponential,stretched-exponential models.Then,the parameters above were compared among three groups.Result:Among 53 cases,21 were mild,26 were moderate-severe,and 6 were severe.The DWI parameters of standard ADC、Ff ADC mono、DDC were significant different between mild and severe acute pancreatitis(P<0.01),and α could significantly distinguish mild and severe acute pancreatitis(P<0.05).Ff ADC mono and α were significant to distinguish between mild and moderate acute pancreatitis(P<0.05),but there was no significance in standard ADC and DDC.Ff ADC mono and α had significant difference between moderate acute pancreatitis and severe acute pancreatitis(P<0.05),standard ADC,DDC had significant difference between moderate and severe acute pancreatitis(P<0.05).Conclusion:DWI parameters of Ff ADC,standard ADC,DDC and α may be useful for severity grading of acute pancreatitis.
Objective:To explore the value of mono-exponential,bi-exponential and stretched-exponential model of diffusion-weighted MR imaging for clinical severity grading of acute pancreatitis.Methods:53 patients with clinical confirmed acute pancreatitis and 20 healthy volunteers underwent conventional upper abdominal MRI including DWI with 14 b values ranged 0～2000 s/mm~2 at 3.0 T MRI.The patients were devided into mild,moderate and severe groups according to the MR severity index.The quantitative parameters were determined including standard ADC,slow ADC mono,fast ADC mono,Ff ADC mono,slow ADC Bi,fast ADC Bi,Ff ADC Bi,DDC and α derived from mono-exponential,bi-exponential,stretched-exponential models.Then,the parameters above were compared among three groups.Result:Among 53 cases,21 were mild,26 were moderate-severe,and 6 were severe.The DWI parameters of standard ADC、Ff ADC mono、DDC were significant different between mild and severe acute pancreatitis(P<0.01),and α could significantly distinguish mild and severe acute pancreatitis(P<0.05).Ff ADC mono and α were significant to distinguish between mild and moderate acute pancreatitis(P<0.05),but there was no significance in standard ADC and DDC.Ff ADC mono and α had significant difference between moderate acute pancreatitis and severe acute pancreatitis(P<0.05),standard ADC,DDC had significant difference between moderate and severe acute pancreatitis(P<0.05).Conclusion:DWI parameters of Ff ADC,standard ADC,DDC and α may be useful for severity grading of acute pancreatitis.
引文
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[10] 刘志成,胡玉川,颜林枫,等.拉伸指数与单指数模型DWI术前预测脑胶质瘤病理分级的对照[J].放射学实践,2016,31(6):478-481.
[2] 石林,黄小华,郑小华,等.多模态DWI在胰腺疾病诊断中的研究进展[J].放射学实践,2017,32(8):880-884.
[3] 肖波.新亚特兰大标准下急性胰腺炎局部并发症的MRI评价[J].放射学实践,2017,32(9):918-922.
[4] Thomas S,Kayhan A,Lakadamyali H,et al.Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values[J].Emerg Radiol,2012,19(1):5-9.
[5] Le Bihan D,Breton E,Lallemand D,et al.MR imaging of intravoxel incoherent motions:application to diffusion and perfusion in neurologic disorders[J].Radiology,1986,161(2):401-407.
[6] Bennett KM,Schmainda KM,Bennett RT,et al.Characterization of continuously distributed cortical water diffusion rates with a stretched-exponential model[J].Magn Reson Med,2003,50(4):727-734.
[7] Agre P,Sasaki S,Chrispeels MJ.Aquaporins: a family of water channel proteins[J].Am J Physiol,1994,19(10):421-425.
[8] Yencilek E,Telli S,Tekesin K,et al.The efficacy of diffusion weighted imaging for detection of acute pancreatitis and comparison of subgroups according to Balthazar classification[J].Turk J Gastroenterol,2014,25(5):553-557.
[9] Kim H,Lee JM,Yoon JH,et al.Reduced field-of-view diffusion-weighted magnetic resonance imaging of the pancreas:comparison with conventional single-shot echo-planar imaging[J].Korean J Radiol,2015,16(6):1216-1225.
[10] 刘志成,胡玉川,颜林枫,等.拉伸指数与单指数模型DWI术前预测脑胶质瘤病理分级的对照[J].放射学实践,2016,31(6):478-481.