扩散加权磁共振成像在外周型胆管细胞癌诊断中的作用。
Role of diffusion-weighted magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma.
机构信息
Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi 214023, Jiangsu Province, China.
出版信息
World J Gastroenterol. 2010 Jul 7;16(25):3196-201. doi: 10.3748/wjg.v16.i25.3196.
AIM
To determine the clinical value of diffusion-weighted imaging (DWI) for the diagnosis of extrahepatic cholangiocarcinoma (EHCC) by comparing the diagnostic sensitivity of DWI and magnetic resonance cholangiopancreatography (MRCP).
METHODS
Magnetic resonance imaging examination was performed in 56 patients with suspected EHCC. T1-weighted imaging, T2-weighted imaging, MRCP and DWI sequence, DWI using single-shot spin-echo echo-planar imaging sequence with different b values (100, 300, 500, 800 and 1000 s/mm(2)), were performed. All cases were further confirmed by surgery or histopathological diagnosis. Two radiologists jointly performed the analysis of the DWI and MRCP images. Apparent diffusion coefficient (ADC) value and signal-noise ratio were calculated for EHCC. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were tested using DWI with a b value of 500 s/mm(2) and MRCP images, respectively.
RESULTS
Histopathological diagnosis confirmed that among the 56 cases, 35 were EHCC (20 hilar and 15 distal extrahepatic), 16 were cholangitis, and 5 were calculus of bile duct. Thirty-three out of the 35 EHCC cases were detected by DWI. EHCC exhibited differential levels of high signal intensity in DWI and low signal intensity in the ADC map. The mean value for ADC was (1.31 +/- 0.29) x 10(-3) mm(2)/s. The detection rate of EHCC was significantly higher by DWI (94.3%) than by MRCP (74.3%) (P < 0.05). There was a significant difference in sensitivity (94.3% vs 74.3%), specificity (100% vs 71.4%), accuracy (96.4% vs 73.2%), positive predictive value (100% vs 81.3%), and negative predictive value (91.3% vs 62.5%) between DWI and MRCP in diagnosing EHCC.
CONCLUSION
DWI has a high sensitivity for the detection of EHCC as it shows the EHCC lesion more unambiguously than MRCP does. DWI can also provide additional clinically important information in EHCC patients when added to routine bile duct MR imaging protocols.
目的
通过比较扩散加权成像（DWI）与磁共振胆胰管成像（MRCP）对诊断肝外胆管癌（EHCC）的诊断灵敏度，来确定 DWI 在 EHCC 诊断中的临床价值。
方法
对 56 例疑似 EHCC 患者进行磁共振成像检查。采用 T1 加权成像、T2 加权成像、MRCP 和 DWI 序列，DWI 采用单次激发自旋回波平面回波成像序列，b 值分别为 100、300、500、800 和 1000 s/mm²。所有病例均经手术或组织病理学诊断进一步证实。由两位放射科医生共同分析 DWI 和 MRCP 图像。计算 EHCC 的表观扩散系数（ADC）值和信噪比。分别用 DWI（b 值为 500 s/mm²）和 MRCP 图像测试诊断 EHCC 的灵敏度、特异度、准确率、阳性预测值和阴性预测值。
结果
组织病理学诊断证实，56 例中 35 例为 EHCC（20 例肝门部和 15 例肝外远端），16 例为胆管炎，5 例为胆管结石。35 例 EHCC 中有 33 例在 DWI 上被检测到。EHCC 在 DWI 上呈不同程度的高信号强度，在 ADC 图上呈低信号强度。ADC 的平均值为（1.31±0.29）×10⁻³mm²/s。DWI 对 EHCC 的检出率明显高于 MRCP（94.3% vs 74.3%）（P＜0.05）。DWI 诊断 EHCC 的灵敏度（94.3% vs 74.3%）、特异度（100% vs 71.4%）、准确率（96.4% vs 73.2%）、阳性预测值（100% vs 81.3%）和阴性预测值（91.3% vs 62.5%）均明显高于 MRCP。
结论
DWI 对 EHCC 的检出率较高，比 MRCP 更能明确显示 EHCC 病变。在常规胆管 MR 成像方案中加入 DWI 还可为 EHCC 患者提供额外的有临床意义的信息。
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