胰腺扩散加权磁共振成像的定量分析：在实性胰腺肿块特征性诊断中的应用价值
Quantitative analysis of diffusion-weighted magnetic resonance imaging of the pancreas: usefulness in characterizing solid pancreatic masses.
作者信息
Lee Seung Soo, Byun Jae Ho, Park Beom Jin, Park Seong Ho, Kim Namkug, Park Bumwoo, Kim Jeong Kon, Lee Moon-Gyu
机构信息
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
出版信息
J Magn Reson Imaging. 2008 Oct;28(4):928-36. doi: 10.1002/jmri.21508.
PURPOSE
To evaluate whether measurement of apparent diffusion coefficient (ADC) and pure diffusion coefficient (D) can help to characterize solid pancreatic masses.
MATERIALS AND METHODS
Diffusion-weighted MR imaging was performed in both a patient group (n = 71; pancreatic cancer [n = 47], mass-forming pancreatitis [n = 13], solid pseudopapillary neoplasm [n = 6], and neuroendocrine tumor [n = 5]) and a normal control group (n = 11) by applying three b-factors of 0, 500, and 1000 sec/mm(2). ADC(500), ADC(1000), D (ADC using b = 500 and 1000 sec/mm(2)), and perfusion fraction (f, 1- exp [-500 sec/mm(2) x (ADC(500) - D)]) of normal pancreas, pancreatic cancer, and mass-forming pancreatitis were compared using the Kruskal-Wallis test. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance and optimal cutoff value of these parameters in differentiating pancreatic cancer from mass-forming pancreatitis.
RESULTS
Normal pancreas had significantly higher mean ADC(500), ADC(1000), and f than either pancreatic cancer (P < 0.001, < 0.001, and 0.004, respectively) or mass-forming pancreatitis (P < 0.001, < 0.001, and 0.002, respectively). ADC(500), ADC(1000), and D of mass-forming pancreatitis were significantly lower than those of pancreatic cancer (P = 0.002, 0.004, and 0.014, respectively). Sensitivities and specificities in the diagnosis of pancreatic cancer were 72.3% and 76.9% for ADC(500), 87.2% and 69.2% for ADC(1000), 87.2% and 61.5% for D, and 42.6% and 92.3% for f, respectively.
CONCLUSION
Measurement of ADC and D may be helpful in differentiating pancreatic cancers from mass-forming pancreatitis.
目的
评估表观扩散系数（ADC）和纯扩散系数（D）的测量是否有助于对实性胰腺肿块进行特征性描述。
材料与方法
对一组患者（n = 71；胰腺癌[n = 47]、肿块型胰腺炎[n = 13]、实性假乳头状肿瘤[n = 6]和神经内分泌肿瘤[n = 5]）以及一个正常对照组（n = 11）施加0、500和1000 sec/mm²这三个b值进行扩散加权磁共振成像。使用Kruskal-Wallis检验比较正常胰腺、胰腺癌和肿块型胰腺炎的ADC(500)、ADC(1000)、D（使用b = 500和1000 sec/mm²时的ADC）以及灌注分数（f，1 - exp[-500 sec/mm²×(ADC(500) - D)]）。进行受试者操作特征（ROC）分析以评估这些参数在鉴别胰腺癌与肿块型胰腺炎时的诊断性能及最佳截断值。
结果
正常胰腺的平均ADC(500)、ADC(1000)和f显著高于胰腺癌（分别为P < 0.001、< 0.001和0.004）及肿块型胰腺炎（分别为P < 0.001、< 0.001和0.002）。肿块型胰腺炎的ADC(500)、ADC(1000)和D显著低于胰腺癌（分别为P = 0.002、0.004和0.014）。ADC(500)、ADC(1000)、D和f诊断胰腺癌的敏感性和特异性分别为72.3%和76.9%、87.2%和69.2%、87.2%和61.5%、42.6%和92.3%。
结论
ADC和D的测量可能有助于鉴别胰腺癌与肿块型胰腺炎。
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