IVIM成像在直肠腺瘤与腺癌鉴别诊断中的应用
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摘要
目的:探讨体素内不相干运动(IVIM)成像在直肠腺瘤与腺癌鉴别诊断中的应用价值。方法:回顾性分析本院经手术病理证实并行IVIM扫描的直肠肿瘤患者51例,其中直肠腺瘤21例,直肠腺癌30例。后处理采用AW4.5工作站,测量病灶的真性扩散系数(D)、灌注相关扩散系数(D~*)及灌注分数(f)值。直肠腺瘤组与直肠腺癌组间参数D、D~*及f值的比较采用独立样本t (或t')检验。绘制有显著差异参数的受试者操作特征曲线(ROC),计算ROC曲线下面积(AUC)、敏感度及特异度。结果:直肠腺癌组D、f值低于直肠腺瘤组,差异具有统计学意义(P<0.05),腺癌组值略与腺瘤组D~*,差异无统计学意义(P>0.05)。D、f值相应的AUC分别为0.885、0.746。D、f值分别以0.807×10~(-3)mm~2/s、0.297为诊断界值,相应的敏感度分别为86.67%、83.33%,特异度分别为80.95%、66.67%。结论:IVIM成像参数D、f值在一定程度上能鉴别直肠腺瘤与腺癌,且D值诊断效能优于f值。
Objective:To evaluate the value of 3.0 T intravoxel incoherent motion(IVIM) imaging in the differential diagnosis of rectal adenoma and adenocarcinoma. Methods:51 patients(21 adenoma,30 adenocarcinoma) with rectal neoplasm proved by surgical pathology underwent IVIM scan.The values of parameters of true diffusion coefficient(D),perfusion-related diffusion coefficient(D~*) and perfusion fraction(f) measured on an AW4.5 work station were analyzed.The differences of D,D~*and f values were compared by independent samples t-test between adenoma and adenocarcinoma groups.The ROC curve was plotted and then the area under the curve(AUC),sensitivity and specificity were analyzed to assess the diagnostic performance with statistical difference.Results:The D and f values in adenocarcinoma group were significantly lower than those in rectal adenoma group(P<0.05);the D~* values had no statistical difference between the two groups(P>0.05).The AUCs of D and f values were 0.885 and 0.746.At the cutoff of 0.807×10~(-3)mm~2/s,0.297 for D and f,the corresponding sensitivities were 86.67%,83.33% and the corresponding specificities were 80.95%,66.67%.Conclusion:The D and f values of the(IVIM) imaging could differentiate rectal adenoma and adenocarcinoma group to some extent.The D value has bigger diagnostic efficiency than f value.
Objective:To evaluate the value of 3.0 T intravoxel incoherent motion(IVIM) imaging in the differential diagnosis of rectal adenoma and adenocarcinoma. Methods:51 patients(21 adenoma,30 adenocarcinoma) with rectal neoplasm proved by surgical pathology underwent IVIM scan.The values of parameters of true diffusion coefficient(D),perfusion-related diffusion coefficient(D~*) and perfusion fraction(f) measured on an AW4.5 work station were analyzed.The differences of D,D~*and f values were compared by independent samples t-test between adenoma and adenocarcinoma groups.The ROC curve was plotted and then the area under the curve(AUC),sensitivity and specificity were analyzed to assess the diagnostic performance with statistical difference.Results:The D and f values in adenocarcinoma group were significantly lower than those in rectal adenoma group(P<0.05);the D~* values had no statistical difference between the two groups(P>0.05).The AUCs of D and f values were 0.885 and 0.746.At the cutoff of 0.807×10~(-3)mm~2/s,0.297 for D and f,the corresponding sensitivities were 86.67%,83.33% and the corresponding specificities were 80.95%,66.67%.Conclusion:The D and f values of the(IVIM) imaging could differentiate rectal adenoma and adenocarcinoma group to some extent.The D value has bigger diagnostic efficiency than f value.
引文
[1] Strum WB.Colorectal adenomas[J].N Engl J Med,2016,374(11):1065-1075.
[2] 王余,徐晋珩,马梦华,等.直肠管状绒毛状腺瘤的3.0T MRI特征[J].放射学实践,2017,32(3):279-282.
[3] 王强修,王新美,王启志,等.消化道肿瘤诊断病理学[M].上海:第二军医大学出版社,2013:110-111.
[4] Hollestein LM,van Herk-Sukel MP,Ruiter R,et al.Incident cancer risk after the start of aspirin use:results from a Dutch population-based cohort study of low dose aspirin users[J].Int J cancer,2014,135(1):157-165.
[5] 陈菲菲,梁文,李余发,等.直肠腺瘤性息肉癌变的MR多方位增强扫描表现[J].临床放射学杂志,2016,35(2):224-227.
[6] 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.
[7] 马晓璐,沈浮,王敏杰,等.直肠高分辨MRI 结合腔内对比剂的应用对直肠癌术前诊断的价值[J].临床放射学杂志,2016,35(9):1386-1389.
[8] 李爱银.IVIM不同测量方法和参数在直肠癌术前分期诊断效能的初步研究[D].山东:山东大学,2017.
[9] 王灵华,李勇刚.3.0T磁共振体素内不相干运动成像参数在直肠癌与直肠管状绒毛状腺瘤鉴别诊断中的应用[J].磁共振成像,2017,8(12):912-916.
[10] Cohen AD,Schieke MC,Hohenwalter MD,et al.The effect of low b-values on the intravoxel incoherent motion derived pseudodiffusion parameter in liver[J].Magn Reson Med,2015,73(1):306-311.
[11] 卢宝兰,肖晓娟,杨心悦,等.直肠癌体素内不相干运动MRI参数的一致性和可重复性[J].中国医学影像技术,2018,34(4):568-572.
[12] Lewin M,Fartoux L,Vignaud A,et al.The diffusion-weighted imaging perfusion fraction f is a potential marker of sorafenib treatment in advanced hepatocellular carcinoma:a pilot study[J].Eur Radiol,2011,21(2):281-290.
[13] 邱麟,蔡香然,刘斯润,等.3.0T磁共振体素内不相干运动扩散加权成像术前检查直肠癌[J].中国医学影像技术,2015,31(9):1349-1353.
[14] Lu B,Yang X,Xiao X,et al.Intravoxel incoherent motion diffusion-weighted imaging of primary rectal carcinoma:correlation with histopathology[J].Med Sci Moint,2018,24:2429-2436.
[15] Sumi M,Van Cauteren M,Sumi T,et al.Salivary gland tumors:use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors[J].Radiology,2012,263(3):770-777.
[2] 王余,徐晋珩,马梦华,等.直肠管状绒毛状腺瘤的3.0T MRI特征[J].放射学实践,2017,32(3):279-282.
[3] 王强修,王新美,王启志,等.消化道肿瘤诊断病理学[M].上海:第二军医大学出版社,2013:110-111.
[4] Hollestein LM,van Herk-Sukel MP,Ruiter R,et al.Incident cancer risk after the start of aspirin use:results from a Dutch population-based cohort study of low dose aspirin users[J].Int J cancer,2014,135(1):157-165.
[5] 陈菲菲,梁文,李余发,等.直肠腺瘤性息肉癌变的MR多方位增强扫描表现[J].临床放射学杂志,2016,35(2):224-227.
[6] 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.
[7] 马晓璐,沈浮,王敏杰,等.直肠高分辨MRI 结合腔内对比剂的应用对直肠癌术前诊断的价值[J].临床放射学杂志,2016,35(9):1386-1389.
[8] 李爱银.IVIM不同测量方法和参数在直肠癌术前分期诊断效能的初步研究[D].山东:山东大学,2017.
[9] 王灵华,李勇刚.3.0T磁共振体素内不相干运动成像参数在直肠癌与直肠管状绒毛状腺瘤鉴别诊断中的应用[J].磁共振成像,2017,8(12):912-916.
[10] Cohen AD,Schieke MC,Hohenwalter MD,et al.The effect of low b-values on the intravoxel incoherent motion derived pseudodiffusion parameter in liver[J].Magn Reson Med,2015,73(1):306-311.
[11] 卢宝兰,肖晓娟,杨心悦,等.直肠癌体素内不相干运动MRI参数的一致性和可重复性[J].中国医学影像技术,2018,34(4):568-572.
[12] Lewin M,Fartoux L,Vignaud A,et al.The diffusion-weighted imaging perfusion fraction f is a potential marker of sorafenib treatment in advanced hepatocellular carcinoma:a pilot study[J].Eur Radiol,2011,21(2):281-290.
[13] 邱麟,蔡香然,刘斯润,等.3.0T磁共振体素内不相干运动扩散加权成像术前检查直肠癌[J].中国医学影像技术,2015,31(9):1349-1353.
[14] Lu B,Yang X,Xiao X,et al.Intravoxel incoherent motion diffusion-weighted imaging of primary rectal carcinoma:correlation with histopathology[J].Med Sci Moint,2018,24:2429-2436.
[15] Sumi M,Van Cauteren M,Sumi T,et al.Salivary gland tumors:use of intravoxel incoherent motion MR imaging for assessment of diffusion and perfusion for the differentiation of benign from malignant tumors[J].Radiology,2012,263(3):770-777.