扩散峰度成像在直肠癌特征描述中的应用：在 3T 扫描仪上利用最可重复的感兴趣区策略获取扩散参数。
Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner.
机构信息
Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Eur Radiol. 2018 Dec;28(12):5211-5220. doi: 10.1007/s00330-018-5495-y. Epub 2018 May 24.
OBJECTIVES
Our goal was to investigate the correlation between histopathology and diffusion parameters by utilising the most repeatable region-of-interest (ROI) strategy for diffusion parameters in rectal cancer on a 3T scanner.
METHODS
113 patients underwent DKI-MR and 66 of these patients received surgery without neoadjuvant chemoradiotherapy. Two readers independently measured the parameters using three slice protocols including single slice, three slices and whole-tumour slice (WTS), combined with one of two ROIs, including outline and round ROI. ANOVA, Kruskal-Wallis, a paired sample t-test, interclass correlation coefficient (ICC), Bland-Altman, Student's t-tests, receiver operating characteristic curves and z statistic were used for statistical analysis.
RESULTS
There were no significant differences among the three slice protocols in ADC values (p = 0.822, 0.987), K values (p = 0.842, 0.859) and D values (p = 0.917, 0.988) using round and outline ROI, respectively. The ADC and D values derived from outline ROIs were higher than those from round ROIs (all p < 0.001 for ADC, all p < 0.001 for D), while K values derived from outline ROIs were lower than those from round ROIs (p < 0.001, p = 0.001, p < 0.001) using three slice protocols, respectively. The WTS-outline ROI resulted in the best intra- and inter-observer ICC. Utilising the WTS-outline ROI method, the AUC for assessment of well-differentiated tumours was 0.871 by K and 0.809 by ADC; and the AUC for T2 was 0.768 by K.
CONCLUSIONS
The most repeatable strategy was the WTS-outline ROI method. In addition to DWI, DKI also have diagnostic value for rectal cancer histopathological characteristics utilising the WTS-outline ROI on a 3T scanner.
KEY POINTS
• DKI using a 3T scanner is feasible for assessing rectal cancer. • ROI and slice protocol show considerable influence on DKI parameters. • DKI parameters exhibit excellent repeatability using whole-tumour slice-outline ROI on 3T scanner. • DKI has considerable diagnostic value for the estimation of rectal cancer characteristics.
目的
本研究旨在利用在 3T 扫描仪上获取的直肠癌最可重复的感兴趣区（ROI）策略，通过扩散参数来探究组织病理学与扩散参数之间的相关性。
方法
113 名患者接受了 DKI-MR 检查，其中 66 名患者在未接受新辅助放化疗的情况下接受了手术。两位读者分别使用包括单层面、三层面和全肿瘤层面（WTS）的三种层面协议，并结合两种 ROI 之一（轮廓 ROI 和圆形 ROI）来独立测量参数。采用方差分析、Kruskal-Wallis 检验、配对样本 t 检验、组内相关系数（ICC）、Bland-Altman 分析、Student's t 检验、受试者工作特征曲线和 z 检验进行统计学分析。
结果
在使用圆形 ROI 和轮廓 ROI 时，三种层面协议之间的 ADC 值（p=0.822，0.987）、K 值（p=0.842，0.859）和 D 值（p=0.917，0.988）均无显著差异。使用轮廓 ROI 获得的 ADC 值和 D 值均高于使用圆形 ROI 获得的值（ADC 所有 p<0.001，D 所有 p<0.001），而使用三种层面协议时，轮廓 ROI 获得的 K 值均低于圆形 ROI 获得的值（p<0.001，p=0.001，p<0.001）。使用 WTS-轮廓 ROI 可获得最佳的组内和组间 ICC。利用 WTS-轮廓 ROI 方法，K 值和 ADC 值对评估高分化肿瘤的 AUC 分别为 0.871 和 0.809，K 值对 T2 的 AUC 为 0.768。
结论
最可重复的策略是 WTS-轮廓 ROI 方法。在 3T 扫描仪上使用 WTS-轮廓 ROI，除 DWI 外，DKI 还具有评估直肠癌组织病理学特征的诊断价值。
关键点
使用 3T 扫描仪进行 DKI 是可行的，可用于评估直肠癌。
ROI 和层面协议对 DKI 参数有显著影响。
使用 3T 扫描仪上的全肿瘤层面-轮廓 ROI，DKI 参数具有极好的重复性。
DKI 对估计直肠癌特征具有重要的诊断价值。
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