基于全病变 ADC 直方图分析评估胰腺导管内乳头状黏液性肿瘤（IPMN）恶性潜能的价值。

Utility of whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs).

机构信息

Department of Radiology, NYU School of Medicine, Center for Biomedical Imaging, NYU Langone Medical Center, 660 First Avenue, 3rd Floor, New York, NY, 10016, USA.

Department of Pathology, NYU Langone Medical Center, New York, NY, 10016, USA.

出版信息

Abdom Radiol (NY). 2017 Apr;42(4):1222-1228. doi: 10.1007/s00261-016-1001-7.

DOI:10.1007/s00261-016-1001-7

PMID:27900458

Abstract

PURPOSE

To evaluate whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs), including in comparison with conventional MRI features.

METHODS

Eighteen branch-duct IPMNs underwent MRI with DWI prior to resection (n = 16) or FNA (n = 2). A blinded radiologist placed 3D volumes-of-interest on the entire IPMN on the ADC map, from which whole-lesion histogram metrics were generated. The reader also assessed IPMN size, mural nodularity, and adjacent main-duct dilation. Benign (low-to-intermediate grade dysplasia; n = 10) and malignant (high-grade dysplasia or invasive adenocarcinoma; n = 8) IPMNs were compared.

RESULTS

Whole-lesion ADC histogram metrics demonstrating significant differences between benign and malignant IPMNs were: entropy (5.1 ± 0.2 vs. 5.4 ± 0.2; p = 0.01, AUC = 86%); mean of the bottom 10th percentile (2.2 ± 0.4 vs. 1.6 ± 0.7; p = 0.03; AUC = 81%); and mean of the 10-25th percentile (2.8 ± 0.4 vs. 2.3 ± 0.6; p = 0.04; AUC = 79%). The overall mean ADC, skewness, and kurtosis were not significantly different between groups (p ≥ 0.06; AUC = 50-78%). For entropy (highest performing histogram metric), an optimal threshold of >5.3 achieved a sensitivity of 100%, a specificity of 70%, and an accuracy of 83% for predicting malignancy. No significant difference (p = 0.18-0.64) was observed between benign and malignant IPMNs for cyst size ≥3 cm, adjacent main-duct dilatation, or mural nodule. At multivariable analysis of entropy in combination with all other ADC histogram and conventional MRI features, entropy was the only significant independent predictor of malignancy (p = 0.004).

CONCLUSION

Although requiring larger studies, ADC entropy obtained from 3D whole-lesion histogram analysis may serve as a biomarker for identifying the malignant potential of IPMNs, independent of conventional MRI features.

摘要

目的

评估全病变 ADC 直方图指标在评估胰腺导管内乳头状黏液性肿瘤（IPMN）恶性潜能中的作用，包括与常规 MRI 特征的比较。

方法

18 例分支胰管 IPMN 在切除前（n=16）或 FNA 后（n=2）进行 MRI 检查，包括 DWI。一名盲法放射科医生在 ADC 图上对整个 IPMN 进行 3D 体积感兴趣区定位，从而生成全病变直方图指标。读者还评估了 IPMN 大小、壁结节和相邻主胰管扩张。良性（低级别到中级别异型增生；n=10）和恶性（高级别异型增生或浸润性腺癌；n=8）的 IPMN 进行了比较。

结果

良性和恶性 IPMN 之间全病变 ADC 直方图指标有显著差异的是：熵（5.1±0.2 vs. 5.4±0.2；p=0.01，AUC=86%）；底部 10%百分位数的均值（2.2±0.4 vs. 1.6±0.7；p=0.03，AUC=81%）；以及 10-25%百分位数的均值（2.8±0.4 vs. 2.3±0.6；p=0.04，AUC=79%）。两组间总体平均 ADC、偏度和峰度无显著差异（p≥0.06；AUC=50-78%）。对于熵（表现最佳的直方图指标），最佳阈值＞5.3 时，预测恶性的敏感性为 100%，特异性为 70%，准确性为 83%。良性和恶性 IPMN 之间在囊腔大小≥3cm、相邻主胰管扩张或壁结节方面无显著差异（p=0.18-0.64）。在结合所有其他 ADC 直方图和常规 MRI 特征的熵的多变量分析中，熵是唯一有统计学意义的恶性预测因子（p=0.004）。