Wang Annie, Shanbhogue Alampady K, Dunst Diane, Hajdu Cristina H, Rosenkrantz Andrew B
Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
J Magn Reson Imaging. 2016 Jul;44(1):89-97. doi: 10.1002/jmri.25128. Epub 2015 Dec 22.
To assess the use of diffusion-weighted imaging (DWI) for differentiating acute from chronic cholecystitis, in comparison with conventional magnetic resonance imaging (MRI) features.
Liver MRI including DWI (b-values 0/500/1000s/mm(2) ) was performed at 1.5T ≤30 days before cholecystectomy in 83 patients with abdominal pain. Two radiologists assessed cases for conventional (gallstones, wall thickening, pericholecystic fluid, pericholecystic fat changes, gallbladder distension, pericholecystic liver enhancement, mural T2 -hyperintensity, mural hyperenhancement, mural striations, abscess, intraluminal membranes, and mural defect) and DWI (increased mural signal on high b-value images, visually low apparent diffusion coefficient [ADC], and ADC values) features.
Acute cholecystitis was present in 43%; chronic cholecystitis was present in 57%. Nine of 12 conventional features were more frequent in acute cholecystitis for both readers (P ≤ 0.003). Increased mural signal on high b-value images was more frequent (P < 0.001) in acute than chronic cholecystitis for R1 (92% vs. 32%) and R2 (83% vs. 30%). Sensitivity and specificity of increased signal on high b-value images were: R1, 92%/68%; R2, 83%/70%. Visually low ADC was more frequent in acute cholecystitis for R2 (P < 0.001) but not R1 (P = 0.406); ADC values were not different between groups for either reader (P = 0.104-0.139). Among conventional and DWI features, only increased signal on high b-value DWI was independently associated with acute cholecystitis for both readers (P = 0.006-0.012).
Visually increased mural signal on high b-value DWI was highly sensitive and moderately specific for acute cholecystitis, being an independent predictor relative to conventional features for both readers. Although requiring larger studies, DWI (particularly the high b-value images) may have additive value relative to conventional MRI-suspected acute cholecystitis. J. Magn. Reson. Imaging 2016;44:89-97.
与传统磁共振成像（MRI）特征相比较，评估扩散加权成像（DWI）在鉴别急性胆囊炎与慢性胆囊炎中的应用。
对83例腹痛患者在胆囊切除术前≤30天进行肝脏MRI检查，包括DWI（b值为0/500/1000s/mm²）。两名放射科医生对病例的传统特征（胆结石、胆囊壁增厚、胆囊周围积液、胆囊周围脂肪改变、胆囊扩张、胆囊周围肝脏强化、胆囊壁T2高信号、胆囊壁强化、胆囊壁条纹、脓肿、腔内隔膜和胆囊壁缺损）和DWI特征（高b值图像上胆囊壁信号增加、表观扩散系数[ADC]视觉上降低以及ADC值）进行评估。
急性胆囊炎患者占43%；慢性胆囊炎患者占57%。对于两位读者，12项传统特征中的9项在急性胆囊炎中更为常见（P≤0.003）。对于读者R1（92%对32%）和R2（83%对30%），高b值图像上胆囊壁信号增加在急性胆囊炎中比慢性胆囊炎更为常见（P<0.001）。高b值图像上信号增加的敏感度和特异度分别为：R1，92%/68%；R2，83%/70%。对于读者R2，视觉上低ADC在急性胆囊炎中更为常见（P<0.001），但对于读者R1并非如此（P = 0.406）；对于两位读者中的任何一位，两组之间的ADC值均无差异（P = 0.104 - 0.139）。在传统特征和DWI特征中，只有高b值DWI上信号增加与两位读者的急性胆囊炎均独立相关（P = 0.006 - 0.012）。
高b值DWI上视觉上胆囊壁信号增加对急性胆囊炎具有高敏感度和中度特异度，相对于传统特征而言，是两位读者的独立预测指标。尽管需要更大规模的研究，但相对于传统MRI怀疑的急性胆囊炎，DWI（尤其是高b值图像）可能具有附加价值。《磁共振成像杂志》2016年；44：89 - 97。
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