食管癌：体素内不相干运动扩散加权 MRI 参数与组织病理学相关性。
Esophageal carcinoma: Intravoxel incoherent motion diffusion-weighted MRI parameters and histopathological correlations.
机构信息
Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
出版信息
J Magn Reson Imaging. 2019 Jan;49(1):253-261. doi: 10.1002/jmri.26172. Epub 2018 May 7.
BACKGROUND
The pathological grade of esophageal carcinoma is highly determinant of patient prognosis, but it still cannot be adequately evaluated preoperatively. Compared with conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM) diffusion-weighted MRI can separate true molecular diffusion and perfusion in tissues and has been shown to be useful in characterizing malignant tumors. There is no report that compared IVIM and conventional DWI in grading esophageal carcinoma.
PURPOSE
To prospectively determine the diagnostic performance of conventional DWI and IVIM models in differentiating the pathological differentiated grade of esophageal carcinoma.
STUDY TYPE
Prospective.
POPULATION
A cohort comprising 81 patients with newly diagnosed esophageal squamous cell carcinoma (ESCC) between December 2015 and August 2017 were evaluated.
FIELD STRENGTH/SEQUENCE: 3.0T, axial echo-planer imaging, fast spin echo (FSE) sequence, IVIM sequence (b = 0, 20, 50, 80, 100, 150, 200, 400, 600, 800, 1000, 1200).
ASSESSMENT
Apparent diffusion coefficient (ADC), true ADC (ADC ), pseudo ADC (ADC ), and perfusion fraction (f) of each tumor were calculated by two independent radiologists. Histopathologic grade was used as the reference standard.
STATISTICAL TESTS
Games-Howell test; diagnostic accuracy; Spearman correlation; intraclass correlation coefficient; and Bland-Altman analysis. Receiver operating characteristics (ROC) curves.
RESULTS
ADC demonstrated the highest area under curve (AUC) with a value of 0.830 (95% confidence interval [CI]: 0.730-0.904) and 0.816 (95% CI: 0.714-0.893) by two radiologists, followed by ADC with a value of 0.754 (95% CI: 0.646-0.843) and 0.761 (95% CI: 0.653-0.848). Good correlation was obtained between the histologic grade and ADC (r = 0.748, r = 0.720) and ADC (r = 0.576, r = 0.571).
DATA CONCLUSION
ADC and ADC had a significantly higher performance than the ADC and f, and ADC had a significantly higher performance than the ADC.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:253-261.
背景
食管癌的病理分级高度决定了患者的预后，但术前仍不能充分评估。与传统的弥散加权成像（DWI）相比，体素内不相干运动（IVIM）弥散加权 MRI 可分离组织中的真实分子弥散和灌注，已被证明可用于恶性肿瘤的特征描述。目前尚无比较 IVIM 和常规 DWI 分级食管癌的报道。
目的
前瞻性评估常规 DWI 和 IVIM 模型在鉴别食管癌病理分化程度方面的诊断性能。
研究类型
前瞻性。
人群
纳入了 2015 年 12 月至 2017 年 8 月期间 81 例新诊断为食管鳞状细胞癌（ESCC）的患者。
磁场强度/序列：3.0T，轴位回波平面成像，快速自旋回波（FSE）序列，IVIM 序列（b=0、20、50、80、100、150、200、400、600、800、1000、1200）。
评估
两位独立的放射科医生计算每个肿瘤的表观弥散系数（ADC）、真实 ADC（ADC）、假性 ADC（ADC）和灌注分数（f）。组织病理学分级作为参考标准。
统计学检验
Games-Howell 检验；诊断准确性；Spearman 相关性；组内相关系数；Bland-Altman 分析。受试者工作特征（ROC）曲线。
结果
ADC 具有最高的曲线下面积（AUC），两位放射科医生的 AUC 值分别为 0.830（95%置信区间[CI]：0.730-0.904）和 0.816（95% CI：0.714-0.893），其次是 ADC，其 AUC 值分别为 0.754（95% CI：0.646-0.843）和 0.761（95% CI：0.653-0.848）。组织学分级与 ADC（r=0.748，r=0.720）和 ADC（r=0.576，r=0.571）均具有良好的相关性。
数据结论
ADC 和 ADC 的性能明显优于 ADC 和 f，而 ADC 的性能明显优于 ADC。
证据水平
1 技术功效：第 2 阶段 J. Magn. Reson. Imaging 2019；49：253-261.
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