Ma Chao, Li Yanjun, Wang Li, Wang Yang, Zhang Yong, Wang He, Chen Shiyue, Lu Jianping
Department of Radiology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, 200433, China.
Department of Pathology, Changhai Hospital of Shanghai, The Second Military Medical University, No.168 Changhai Road, Shanghai, China.
Cancer Imaging. 2017 Apr 28;17(1):12. doi: 10.1186/s40644-017-0114-8.
To investigate the associations between the diffusion parameters obtained from multiple-b-values diffusion weighted imaging (DWI) of pancreatic ductal adenocarcinoma (PDAC) and the aggressiveness and local stage prediction, and assess the values of the quantitative parameters for the discrimination of tumors from healthy pancreas.
Fifty-one patients with surgical pathology-proven PDAC (size, 35 ± 12 mm) and fifty-seven healthy volunteers were enrolled. Diffusion parameters including monoexponential apparent diffusion coefficient (ADC and ADC) and biexponential intravoxel incoherent motion (IVIM) parameters (ADC, ADC and f) based on 9 b-values (0 to 1000s/mm) DWI were calculated for the lesions and the healthy pancreas. These parameters were compared by grades of differentiation, lymph node status, tumor stage and location. The diagnostic performances were calculated and compared by using the receiver operating characteristic curves (ROC) analyses.
There was no statistically significant difference in ADC, ADC, ADC, ADC or f between PDAC stage T1/T2 and stage T3/T4 or moderately differentiated versus poorly differentiated PDAC (p = 0.060-0.941). In addition, no significant differences were observed for the quantitative parameters between tumors located in the pancreatic head versus other pancreatic regions (p = 0.203-0.954) or between tumors with and without metastatic peri-pancreatic lymph nodes (p = 0.313-0.917). ADC, ADC, ADC and ADC were significantly lower for PDAC compared the healthy pancreas (all p < 0.05). ROC analyses showed the area under curve for ADC was the largest (0.911) to distinguish PDAC from normal pancreas (cut-off value, 5.58 × 10mm/s) and had the highest combined sensitivity (89.5%) and specificity (82.4%).
Multiple-b-values DWI derived monoexponential and biexponential parameters of PDAC do not exhibit significance dependence on tumor grade or tumor characteristics. ADC provided the best accuracy for differentiating PDAC from healthy pancreas in the study.
探讨胰腺导管腺癌（PDAC）多b值扩散加权成像（DWI）获得的扩散参数与侵袭性及局部分期预测之间的相关性，并评估定量参数在区分肿瘤与健康胰腺方面的价值。
纳入51例经手术病理证实的PDAC患者（肿瘤大小为35±12mm）和57名健康志愿者。基于9个b值（0至1000s/mm²）的DWI计算病变及健康胰腺的扩散参数，包括单指数表观扩散系数（ADC和ADC*）和双指数体素内不相干运动（IVIM）参数（ADC、ADC*和f）。将这些参数按分化程度、淋巴结状态、肿瘤分期和位置进行比较。采用受试者操作特征曲线（ROC）分析计算并比较诊断性能。
PDAC的T1/T2期与T3/T4期之间，或中度分化与低分化PDAC之间，ADC、ADC*、ADC、ADC或f无统计学显著差异（p = 0.060 - 0.941）。此外，位于胰头的肿瘤与胰腺其他区域的肿瘤之间，或有与无胰腺周围转移性淋巴结的肿瘤之间，定量参数也无显著差异（p = 0.203 - 0.954）。与健康胰腺相比，PDAC的ADC、ADC、ADC和ADC*显著更低（所有p < 0.05）。ROC分析显示，ADC区分PDAC与正常胰腺的曲线下面积最大（0.911）（截断值为5.58×10⁻⁴mm²/s），且联合灵敏度最高（89.5%），特异性最高（82.4%）。
多b值DWI得出的PDAC单指数和双指数参数对肿瘤分级或肿瘤特征无显著依赖性。在本研究中，ADC在区分PDAC与健康胰腺方面准确性最高。
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