应用体素内不相干运动 MRI 和 CT 灌注评估胰腺癌组织灌注作为潜在的影像学生物标志物：与组织学微血管密度的相关性作为金标准。
Assessment of tissue perfusion of pancreatic cancer as potential imaging biomarker by means of Intravoxel incoherent motion MRI and CT perfusion: correlation with histological microvessel density as ground truth.
机构信息
Clinic for Diagnostic and Interventional Radiology (DIR), Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Institute of Pathology, Heidelberg University Hospital, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
出版信息
Cancer Imaging. 2021 Jan 19;21(1):13. doi: 10.1186/s40644-021-00382-x.
BACKGROUND/OBJECTIVES: The aim of this study was to compare intravoxel incoherent motion (IVIM) diffusion weighted (DW) MRI and CT perfusion to assess tumor perfusion of pancreatic ductal adenocarcinoma (PDAC).
METHODS
In this prospective study, DW-MRI and CT perfusion were conducted in nineteen patients with PDAC on the day before surgery. IVIM analysis of DW-MRI was performed and the parameters perfusion fraction f, pseudodiffusion coefficient D*, and diffusion coefficient D were extracted for tumors, upstream, and downstream parenchyma. With a deconvolution-based analysis, the CT perfusion parameters blood flow (BF) and blood volume (BV) were estimated for tumors, upstream, and downstream parenchyma. In ten patients, intratumoral microvessel density (MVD) and microvessel area (MVA) were analyzed microscopically in resection specimens. Correlation coefficients between IVIM parameters, CT perfusion parameters, and histological microvessel parameters in tumors were calculated. Receiver operating characteristic (ROC) analysis was performed for differentiation of tumors and upstream parenchyma.
RESULTS
f significantly positively correlated with BF (r = 0.668, p = 0.002) and BV (r = 0.672, p = 0.002). There were significant positive correlations between f and MVD/ MVA (r ≥ 0.770, p ≤ 0.009) as well as between BF and MVD/ MVA (r ≥ 0.697, p ≤ 0.025). Correlation coefficients between f and MVD/ MVA were not significantly different from correlation coefficients between BF and MVD/ MVA (p ≥ 0.400). Moreover, f, BF, BV, and permeability values (PEM) showed excellent performance in distinguishing tumors from upstream parenchyma (area under the ROC curve ≥0.874).
CONCLUSIONS
The study shows that IVIM derived f and CT perfusion derived BF similarly reflect vascularity of PDAC and seem to be comparably applicable for the evaluation of tumor perfusion for tumor characterization and as potential quantitative imaging biomarker.
TRIAL REGISTRATION
DRKS, DRKS00022227, Registered 26 June 2020, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00022227.
背景/目的：本研究旨在比较体素内不相干运动（IVIM）扩散加权（DW）MRI 和 CT 灌注成像以评估胰腺导管腺癌（PDAC）的肿瘤灌注。
方法
在这项前瞻性研究中，19 例 PDAC 患者在手术前一天进行 DW-MRI 和 CT 灌注检查。对 DW-MRI 进行 IVIM 分析，并提取肿瘤、上游和下游实质的灌注分数 f、假性扩散系数 D*和扩散系数 D 等参数。通过基于解卷积的分析，估算肿瘤、上游和下游实质的 CT 灌注参数血流量（BF）和血容量（BV）。在 10 例患者中，在切除标本中分析肿瘤内微血管密度（MVD）和微血管面积（MVA）。计算肿瘤内 IVIM 参数、CT 灌注参数和组织学微血管参数之间的相关系数。对肿瘤和上游实质的区分进行接收者操作特征（ROC）分析。
结果
f 与 BF（r=0.668，p=0.002）和 BV（r=0.672，p=0.002）呈显著正相关。f 与 MVD/MVA（r≥0.770，p≤0.009）以及 BF 与 MVD/MVA（r≥0.697，p≤0.025）之间均存在显著正相关。f 与 MVD/MVA 之间的相关系数与 BF 与 MVD/MVA 之间的相关系数无显著差异（p≥0.400）。此外，f、BF、BV 和通透性值（PEM）在区分肿瘤和上游实质方面表现出优异的性能（ROC 曲线下面积≥0.874）。
结论
本研究表明，IVIM 衍生的 f 和 CT 灌注衍生的 BF 相似地反映了 PDAC 的血管生成情况，并且似乎可同样适用于肿瘤灌注的评估，以用于肿瘤特征描述和作为潜在的定量成像生物标志物。
试验注册
DRKS，DRKS00022227，2020 年 6 月 26 日注册，回顾性注册。https://www.drks.de/drks_web/navigate.do?navigationId=trial&TRIAL_ID=DRKS00022227.
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