Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA.
Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA; Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, New York, USA.
Can Assoc Radiol J. 2019 Nov;70(4):416-423. doi: 10.1016/j.carj.2019.07.001. Epub 2019 Oct 8.
To evaluate whole-lesion 3D-histogram apparent diffusion coefficient (ADC) metrics for assessment of pancreatic malignancy.
Forty-two pancreatic malignancies (36 pancreatic adenocarcinoma [PDAC], 6 pancreatic neuroendocrine [PanNET]) underwent abdominal magnetic resonance imaging (MRI) with diffusion-weighted imaging before endoscopic ultrasound biopsy or surgical resection. Two radiologists independently placed 3D volumes of interest to derive whole-lesion histogram ADC metrics. Mann-Whitney tests and receiver operating characteristic analyses were used to assess metrics' diagnostic performance for lesion histology, T-stage, N-stage, and grade.
Whole-lesion ADC histogram metrics lower in PDACs than PanNETs for both readers (P ≤ .026) were mean ADC (area under the curve [AUC] = 0.787-0.792), mean of the bottom 10th percentile (mean) (AUC = 0.787-0.880), mean of the 10th-25th percentile (mean) (AUC = 0.884-0.917) and mean of the 25th-50th percentile (mean) (AUC = 0.829-0.829). For mean (metric with highest AUC for identifying PDAC), for reader 1 a threshold > 0.94 × 10 mm/s achieved sensitivity 94% and specificity 83%, and for reader 2 a threshold > 0.82 achieved sensitivity 97% and specificity 67%. Metrics lower in nodal status ≥ N than N for both readers (P ≤ .043) were mean (AUC = 0.789-0.822) and mean (AUC = 0.800-0.822). For mean (metric with highest AUC for identifying N), for reader 1 a threshold <1.17 achieved sensitivity 87% and specificity 67%, and for reader 2 a threshold <1.04 achieved sensitivity 87% and specificity 83%. No metric was associated with T-stage (P > .195) or grade (P > .215).
Volumetric ADC histogram metrics may serve as non-invasive biomarkers of pancreatic malignancy. Mean outperformed standard mean for lesion histology and nodal status, supporting the role of histogram analysis.
评估全病变 3D 直方图表观扩散系数（ADC）指标在评估胰腺恶性肿瘤中的作用。
42 例胰腺恶性肿瘤（36 例胰腺腺癌[PDAC]，6 例胰腺神经内分泌肿瘤[PanNET]）在接受内镜超声活检或手术切除前进行了腹部磁共振成像（MRI）扩散加权成像。两名放射科医生独立放置 3D 感兴趣区以得出全病变直方图 ADC 指标。使用 Mann-Whitney 检验和受试者工作特征分析评估指标对病变组织学、T 分期、N 分期和分级的诊断性能。
两名读者均发现 PDAC 的全病变 ADC 直方图指标低于 PanNET（P≤.026），包括平均 ADC（曲线下面积[AUC]=0.787-0.792）、bottom 10th percentile（mean）（AUC=0.787-0.880）、mean of the 10th-25th percentile（mean）（AUC=0.884-0.917）和 mean of the 25th-50th percentile（mean）（AUC=0.829-0.829）。对于平均 ADC（识别 PDAC 的 AUC 最高的指标），对于读者 1，阈值>0.94×10mm/s 时，敏感性为 94%，特异性为 83%，对于读者 2，阈值>0.82 时，敏感性为 97%，特异性为 67%。两名读者均发现淋巴结状态≥N 的病变 ADC 指标低于 N（P≤.043），包括平均 ADC（AUC=0.789-0.822）和平均 ADC（AUC=0.800-0.822）。对于平均 ADC（识别 N 的 AUC 最高的指标），对于读者 1，阈值<1.17 时，敏感性为 87%，特异性为 67%，对于读者 2，阈值<1.04 时，敏感性为 87%，特异性为 83%。没有指标与 T 分期（P>.195）或分级（P>.215）相关。
容积 ADC 直方图指标可能是胰腺恶性肿瘤的非侵入性生物标志物。平均 ADC 优于标准平均 ADC 用于评估病变组织学和淋巴结状态，支持直方图分析的作用。
