分析扩散峰度指数和表观扩散系数直方图评估 ALPPS 后肝脏再生，并与门静脉结扎进行比较研究。
Histogram analyses of diffusion kurtosis indices and apparent diffusion coefficient in assessing liver regeneration after ALPPS and a comparative study with portal vein ligation.
机构信息
Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, P.R. China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
出版信息
J Magn Reson Imaging. 2018 Mar;47(3):729-736. doi: 10.1002/jmri.25793. Epub 2017 Jun 22.
PURPOSE
To investigate the value of diffusion kurtosis imaging (DKI) histogram analysis in assessing liver regeneration and the microstructure basis after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), in comparison with portal vein ligation (PVL).
MATERIALS AND METHODS
Thirty rats were divided into the ALPPS, PVL, and control groups. Histograms of DKI using a 3T magnetic resonance imaging (MRI) scanner were performed for corrected apparent diffusion (D), kurtosis (K), and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis, and the percentiles (5 , 25 , 50 , 75 , and 95 ) were generated and compared, and radiologic-pathologic correlations were evaluated.
RESULTS
There were more significant volume increases of the right median lobe after ALPPS than PVL (P = 0.0304/0.0017). The ALPPS group had larger hepatocyte size (P = 0.009/0.000), higher Ki-67 and hepatocyte growth factor expression (P = 0.001-0.036) compared with both PVL and control groups. Mean, median, 5 , 25 , 50 , 75 percentiles of D map in ALPPS were lower than the control group (P = 0.001-0.022). Skewness and 75 , 95 percentiles of K map in ALPPS were higher than the PVL group (P = 0.011-0.042). No differences existed in the ADC map between groups (P = 0.073-0.291). Mean, median, 5 , 25 , 50 percentiles of D map, and 5 percentile of K map showed significant correlations with hepatocyte size (r = -0.582 to -0.426); no significant correlations were found in ADC parameters (P = 0.460-0.934).
CONCLUSION
ALPPS induced true accelerated liver hypertrophy, superior to that seen with PVL. Histogram analysis of diffusion kurtosis indices may provide added values in evaluating liver regeneration and the intrinsic microstructure basis after ALPPS in comparison with the standard monoexponential ADC.
LEVEL OF EVIDENCE
3 Technical Efficacy Stage: Stage 2 J. Magn. Reson. Imaging 2018;47:729-736.
目的
探讨磁共振扩散峰度成像（DKI）直方图分析在评估联合肝脏离断和门静脉结扎的二步肝切除术（ALPPS）后肝再生和微观结构基础中的价值，并与门静脉结扎（PVL）进行比较。
材料与方法
将 30 只大鼠分为 ALPPS、PVL 和对照组。使用 3T 磁共振成像（MRI）扫描仪对 DKI 直方图进行校正表观扩散（D）、峰度（K）和表观扩散系数（ADC）分析。生成平均值、中位数、偏度、峰度和百分位数（5%、25%、50%、75%和 95%）并进行比较，并评估影像学-病理学相关性。
结果
ALPPS 组右中叶的体积增加明显大于 PVL 组（P=0.0304/0.0017）。与 PVL 和对照组相比，ALPPS 组的肝细胞体积更大（P=0.009/0.000），Ki-67 和肝细胞生长因子表达更高（P=0.001-0.036）。ALPPS 组的 D 图平均值、中位数、5%、25%、50%、75%百分位数均低于对照组（P=0.001-0.022）。ALPPS 组的 K 图偏度和 75%、95%百分位数高于 PVL 组（P=0.011-0.042）。各组间 ADC 图无差异（P=0.073-0.291）。D 图的平均值、中位数、5%、25%、50%百分位数和 K 图的 5%百分位数与肝细胞大小呈显著负相关（r=-0.582 至-0.426）；ADC 参数无显著相关性（P=0.460-0.934）。
结论
ALPPS 诱导真正的加速肝肥大，优于 PVL。与标准单指数 ADC 相比，DKI 扩散峰度指数的直方图分析可为评估 ALPPS 后肝再生和内在微观结构基础提供附加价值。
证据水平
3 技术功效阶段：2 级。J. Magn. Reson. Imaging 2018;47:729-736.
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