肿瘤性和非肿瘤性胰腺：定量动态对比增强磁共振成像与组织病理学参数的相关性。
Tumoral and nontumoral pancreas: correlation between quantitative dynamic contrast-enhanced MR imaging and histopathologic parameters.
机构信息
Department of Radiology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.
出版信息
Radiology. 2011 Nov;261(2):456-66. doi: 10.1148/radiol.11103515. Epub 2011 Aug 18.
PURPOSE
To prospectively determine whether dynamic contrast material-enhanced (DCE) magnetic resonance (MR) quantitative parameters correlate with fibrosis and microvascular density (MVD) in malignant and benign solid pancreatic focal lesions and nontumoral pancreatic tissue.
MATERIALS AND METHODS
The institutional review board approved the study; written informed consent was obtained. DCE MR was performed in 28 patients with surgically resectable focal pancreatic lesions. DCE MR quantitative parameters derived from one-compartment (OC) (transfer rate constant [K(trans)] and distribution fraction [ƒ]) and two-compartment (TC) (K(trans), tissue volume fraction occupied by extravascular extracellular space [v(i)], and tissue volume fraction occupied by vascular space [v(p)]) pharmacokinetic models were correlated with fibrosis content and MVD counts in focal lesions and nontumoral tissue (Spearman correlation coefficient [SCC]). Pharmacokinetic parameters were compared (Mann-Whitney test) between tumoral and nontumoral tissue. Diagnostic performance of DCE MR fibrosis detection was assessed (receiver operator characteristic curve analysis).
RESULTS
K(trans) OC and K(trans) TC were significantly lower in primary malignant tumors compared with benign lesions (P = .023) and nontumoral pancreatic tissue downstream (P < .001) and upstream (P = .006); ƒ and v(i) were significantly higher in primary malignant tumors compared with nontumoral pancreatic tissue downstream (P = .012 and .018, respectively). Fibrosis was correlated negatively with K(trans) OC (SCC, -0.600) and K(trans) TC (SCC, -0.564) and positively with ƒ (SCC, 0.514) and v(i) (SCC, 0.464), with P < .001 (all comparisons). MVD was positively correlated with ƒ (SCC, 0.355; P = .019) and v(i) (SCC, 0.297; P = .038) but not with K(trans) OC (SCC, -0.140; P = .33) and K(trans) TC (SCC, -0.194; P = .181). Sensitivity and specificity for fibrosis detection were 65% (24 of 37) and 83% (10 of 12) for K(trans) OC (cutoff value, 0.35 min(-1)) and 76% (28 of 37) and 83% (10 of 12) for K(trans) TC (cutoff value, 0.29 min(-1)), respectively.
CONCLUSION
Quantitative DCE MR parameters, derived from pharmacokinetic models in malignant and benign pancreatic solid lesions and nontumoral pancreatic tissue, were significantly correlated with fibrosis and MVD.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11103515/-/DC1.
目的
前瞻性地确定动态对比增强（DCE）磁共振（MR）定量参数是否与恶性和良性胰腺实性局灶性病变及非肿瘤性胰腺组织中的纤维化和微血管密度（MVD）相关。
材料与方法
本研究经机构审查委员会批准，所有患者均签署书面知情同意书。对 28 例经手术切除的胰腺局灶性病变患者行 DCE-MR 检查。从单室（OC）（转移速率常数[K(trans)]和分布分数[ƒ]）和双室（TC）（K(trans)、血管外细胞外间隙的组织体积分数[v(i)]和血管空间的组织体积分数[v(p)])药代动力学模型中得出的 DCE-MR 定量参数与病灶和非肿瘤组织中的纤维化含量和 MVD 计数进行相关性分析（Spearman 相关系数[SCC]）。对肿瘤与非肿瘤组织间的药代动力学参数进行比较（Mann-Whitney 检验）。评估 DCE-MR 检测纤维化的诊断性能（受试者工作特征曲线分析）。
结果
与良性病变相比，原发性恶性肿瘤的 OC-K(trans)和 TC-K(trans)明显降低（P =.023），下游和上游的非肿瘤胰腺组织中的 K(trans)也明显降低（P <.001 和 P =.006）；ƒ和 v(i)在原发性恶性肿瘤中明显高于非肿瘤胰腺组织下游（P =.012 和 P =.018）。纤维化与 OC-K(trans)（SCC，-0.600）和 TC-K(trans)（SCC，-0.564）呈负相关，与 ƒ（SCC，0.514）和 v(i)（SCC，0.464）呈正相关，均具有统计学意义（所有比较 P <.001）。MVD 与 ƒ（SCC，0.355；P =.019）和 v(i)（SCC，0.297；P =.038）呈正相关，但与 OC-K(trans)（SCC，-0.140；P =.33）和 TC-K(trans)（SCC，-0.194；P =.181）无关。OC-K(trans)（截断值，0.35 min(-1)）检测纤维化的敏感性和特异性分别为 65%（24/37）和 83%（10/12），TC-K(trans)（截断值，0.29 min(-1)）分别为 76%（28/37）和 83%（10/12）。
结论
在恶性和良性胰腺实性病变及非肿瘤性胰腺组织中，定量 DCE-MR 参数与纤维化和 MVD 显著相关。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11103515/-/DC1.
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