磁共振弥散加权成像鉴别胆囊良恶性病变。
Diffusion-weighted MRI for differentiation of benign from malignant lesions in the gallbladder.
机构信息
Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea.
出版信息
Clin Radiol. 2014 Feb;69(2):e78-85. doi: 10.1016/j.crad.2013.09.017. Epub 2013 Nov 26.
AIM
To investigate the value of diffusion-weighted imaging (DWI) for differentiating benign from malignant gallbladder lesions.
MATERIALS AND METHODS
One hundred and twenty-six patients who had undergone magnetic resonance imaging (MRI) with DWI, in whom the histopathological diagnosis of their gallbladder lesions was confirmed by biopsy or surgery were retrospectively analysed. Thirty-six malignant and 90 benign lesions were included. Two radiologists categorized gallbladder lesions into seven types on two imaging sets [T2-weighted imaging (WI) alone and combined T2WI and DWI (b = 800 s/mm(2))] according to the presence of wall thickening, layered patterns, morphology of the mass, and diffusion restriction. Disagreements were resolved in consensus. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each imaging set for diagnosing gallbladder carcinoma were calculated. The diagnostic performance of each imaging set was calculated using receiver operating characteristic (ROC) curve analysis. Additionally, ADC values of malignant and benign gallbladder lesions were compared separately for 1.5 and 3 T MRI.
RESULTS
The sensitivity, specificity, PPV, and NPV of diagnosis at T2WI were 97.2%, 86.7%, 74.5%, and 98.7%, respectively. The sensitivity, specificity, PPV, and NPV using combined T2WI and DWI were 97.2%, 92.2%, 83.3%, and 98.8%, respectively. Diagnostic accuracy for gallbladder carcinoma slightly improved after adding DWI, from 0.92 to 0.95 (p < 0.05). ADC values for gallbladder carcinoma were significantly lower than those for benign lesions. Mean ADC values of malignant and benign lesions were 0.97 ± 0.25 × 10(-3) and 1.72 ± 0.56 × 10(-3) mm(2)/s, respectively, at 1.5 T (p < 0.001), and 1.04 ± 0.38 × 10(-3) and 2.2 ± 0.72 × 10(-3) mm(2)/s, respectively, at 3 T (p < 0.001).
CONCLUSION
DWI can improve diagnostic accuracy for differentiating benign from malignant gallbladder lesions.
目的
探讨磁共振扩散加权成像（DWI）在鉴别胆囊良恶性病变中的价值。
材料与方法
回顾性分析 126 例经磁共振成像（MRI）DWI 检查，且经活检或手术病理证实的胆囊病变患者。其中 36 例为恶性病变，90 例为良性病变。两名放射科医生根据胆囊壁增厚、分层模式、肿块形态和弥散受限，将胆囊病变分为 T2WI 单独和 T2WI 联合 DWI（b = 800 s/mm²）两种成像方式下的 7 种类型[。（b = 800 s/mm²）]。存在分歧时通过协商解决。计算每种成像方式诊断胆囊癌的敏感度、特异度、阳性预测值（PPV）和阴性预测值（NPV）。采用受试者工作特征（ROC）曲线分析评估每种成像方式的诊断效能。另外，分别在 1.5T 和 3T MRI 上比较良恶性胆囊病变的 ADC 值。
结果
T2WI 诊断的敏感度、特异度、PPV 和 NPV 分别为 97.2%、86.7%、74.5%和 98.7%。T2WI 联合 DWI 的敏感度、特异度、PPV 和 NPV 分别为 97.2%、92.2%、83.3%和 98.8%。添加 DWI 后，胆囊癌的诊断准确性略有提高，从 0.92 提高到 0.95（p < 0.05）。胆囊癌的 ADC 值明显低于良性病变。在 1.5T 时，恶性和良性病变的平均 ADC 值分别为 0.97 ± 0.25×10（-3）和 1.72 ± 0.56×10（-3）mm²/s（p < 0.001），在 3T 时分别为 1.04 ± 0.38×10（-3）和 2.2 ± 0.72×10（-3）mm²/s（p < 0.001）。
结论
DWI 可提高鉴别胆囊良恶性病变的诊断准确性。
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