Liu Dingxia, Chen Jiejun, Zhang Yunfei, Dai Yongming, Yao Xiuzhong
Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
Department of Radiology, Zhongshan Hospital of Fudan University, Shanghai, China.
Abdom Radiol (NY). 2023 Aug;48(8):2604-2614. doi: 10.1007/s00261-023-03956-4. Epub 2023 May 26.
This study sought to determine the diagnostic performance of magnetic resonance elastography (MRE) for pancreatic solid masses, compared with diffusion-weighted imaging (DWI) and serum CA19-9, to establish a threshold for differentiating between pancreatic ductal adenocarcinoma (PDAC) and benign tumors in pancreas.
Between July 2021 to January 2023, 75 adult patients confirmed with pancreatic solid tumors were enrolled in this prospective and consecutive study. All patients underwent MRE and DWI examinations that were both performed with a spin echo-EPI sequence. Stiffness maps and apparent diffusion coefficient (ADC) maps were generated, with MRE-derived mass stiffness and stiffness ratio (computing as the ratio of mass stiffness to the parenchyma stiffness) and DWI-derived ADC values obtained by placing regions of interest over the focal tumors on stiffness and ADC maps. Further analysis of comparing diagnostic performances was assessed by calculating the area under ROC curves.
PDAC had significantly higher tumor stiffness [3.795 (2.879-4.438) kPa vs. 2.359 (2.01-3.507) kPa, P = 0.0003], stiffness ratio [1.939 (1.562-2.511) vs. 1.187 (1.031-1.453), P < 0.0001] and serum CA19-9 level [276 (31.73-1055) vs. 10.45 (7.825-14.15), P < 0.0001] than other pancreatic masses. Mass stiffness, stiffness ratio and serum CA19-9 showed good diagnostic performance for differentiation with AUC of 0.7895, 0.8392 and 0.9136 respectively. The sensitivity/specificity/positive predictive value/negative predictive value for differentiating malignant from benign pancreatic tumors with mass stiffness (cutoff, > 2.8211 kPa) and stiffness ratio (cutoff, > 1.5117) were 78.4/66.7/82.9/60% and 77.8/83.3/90.3/65.2% respectively. The combined performance of Mass stiffness, stiffness ratio and serum CA19-9 got an AUC of 0.9758.
MRE holds excellent clinical potential in discriminating pancreatic ductal adenocarcinoma from other pancreatic solid masses according to their mechanical properties.
本研究旨在确定磁共振弹性成像（MRE）对胰腺实性肿块的诊断性能，并与扩散加权成像（DWI）和血清CA19-9进行比较，以建立区分胰腺导管腺癌（PDAC）和胰腺良性肿瘤的阈值。
2021年7月至2023年1月期间，75例确诊为胰腺实性肿瘤的成年患者纳入了这项前瞻性连续研究。所有患者均接受了MRE和DWI检查，两者均采用自旋回波-EPI序列进行。生成了硬度图和表观扩散系数（ADC）图，通过在硬度图和ADC图上的局灶性肿瘤上放置感兴趣区域，获得MRE衍生的肿块硬度和硬度比（计算为肿块硬度与实质硬度之比）以及DWI衍生的ADC值。通过计算ROC曲线下面积来评估比较诊断性能的进一步分析。
与其他胰腺肿块相比，PDAC的肿瘤硬度[3.795（2.879-4.438）kPa对2.359（2.01-3.507）kPa，P = 0.0003]、硬度比[1.939（1.562-2.511）对1.187（1.031-1.453），P < 0.0001]和血清CA19-9水平[276（31.73-1055）对10.45（7.825-14.15），P < 0.0001]显著更高。肿块硬度、硬度比和血清CA19-9在鉴别诊断方面表现出良好的性能，AUC分别为0.7895、0.8392和0.9136。使用肿块硬度（截断值，> 2.8211 kPa）和硬度比（截断值，> 1.5117）区分胰腺恶性肿瘤和良性肿瘤的敏感性/特异性/阳性预测值/阴性预测值分别为78.4/66.7/82.9/60%和77.8/83.3/90.3/65.2%。肿块硬度、硬度比和血清CA19-9的联合性能AUC为0.9758。
MRE在根据胰腺实性肿块的力学特性鉴别胰腺导管腺癌与其他胰腺实性肿块方面具有出色的临床潜力。
