提高胰腺导管腺癌和肿块型慢性胰腺炎的术前诊断：关于常规磁共振成像参数标准化的研究
Enhancing preoperative diagnosis of pancreatic ductal adenocarcinoma and mass-forming chronic pancreatitis: a study on normalized conventional MR imaging parameters.
作者信息
Li Yuxiao, Zheng Chenxi, Zhang Yang, He Tianlin, Chen Wei, Zheng Kailian
机构信息
Department of Radiology, Changhai Hospital Affiliated to Navy Medical University, 168 Changhai Road, Shanghai, People's Republic of China.
Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital Affiliated to Navy Medical University, 168 Changhai Road, Shanghai, People's Republic of China.
出版信息
Abdom Radiol (NY). 2024 Nov 2. doi: 10.1007/s00261-024-04652-7.
PURPOSE
To assess the utility of signal intensity ratio (SIR) in distinguishing between mass-forming chronic pancreatitis (MFCP) and pancreatic ductal adenocarcinoma (PDAC), thereby reducing unnecessary pancreatectomies or delayed diagnosis brought by misdiagnosis.
MATERIALS AND METHODS
This retrospective study included 170 participants (34 with MFCP and 136 with PDAC) who underwent radical pancreatic surgery and were diagnosed via specimen pathology. The study group was carefully selected with a 1:4 ratio matching for sex, age, and operation time between two entities. T1 SIR, T2 SIR, arterial phase (AP) SIR, portal venous phase (VP) SIR, delay phase (DP) SIR, DWI SIR, and DWI SIR, were calculated by dividing the signal intensity of lesions by that of the paraspinal muscle, serving as a reference organ. Intraclass Correlation Coefficient (ICC) was estimated to evaluate the intraobserver and interobserver reliability. Wilcoxon tests were employed for univariate analysis, and receiver operating characteristic (ROC) curves were generated to determine optimal cutoff points and AUC values for selected predictors. A tenfold cross-validation method was applied to validate the robustness of the results.
RESULTS
The ICC demonstrated excellent correlation for both intraobserver and interobserver(ICCs > 0.8). T1 SIR, AP SIR, VP SIR, and DP SIR were significantly lower in the PDAC group compared to the MFCP group, and exhibited good independent predictive properties with the sensitivities of 61.8, 61.8, 70.6, and 73.5%, specificities of 66.2, 68.4, 59.6, and 55.9%, and AUCs of 0.620, 0.659, 0.670, and 0.668, respectively, hovering around 0.7. The tenfold cross-validation confirmed the reliability and robustness of our findings, with consistent AUC, sensitivity, specificity, and 95% confidence intervals over 1000 iterations.
CONCLUSION
T1 SIR, AP SIR, VP SIR, and DP SIR show promise as potential imaging biomarkers for distinguishing between MFCP and PDAC.
目的
评估信号强度比（SIR）在鉴别肿块型慢性胰腺炎（MFCP）和胰腺导管腺癌（PDAC）中的效用，从而减少因误诊导致的不必要的胰腺切除术或诊断延迟。
材料与方法
这项回顾性研究纳入了170名接受根治性胰腺手术并经标本病理诊断的参与者（34例MFCP和136例PDAC）。研究组经过精心挑选，两个实体在性别、年龄和手术时间上按1:4的比例匹配。通过将病变的信号强度除以作为参考器官的椎旁肌的信号强度来计算T1 SIR、T2 SIR、动脉期（AP）SIR、门静脉期（VP）SIR、延迟期（DP）SIR、DWI SIR和DWI SIR。估计组内相关系数（ICC）以评估观察者内和观察者间的可靠性。采用Wilcoxon检验进行单变量分析，并生成受试者工作特征（ROC）曲线以确定选定预测指标的最佳截断点和AUC值。应用十倍交叉验证方法验证结果的稳健性。
结果
ICC显示观察者内和观察者间均具有良好的相关性（ICC>0.8）。与MFCP组相比，PDAC组的T1 SIR、AP SIR、VP SIR和DP SIR显著更低，并且表现出良好的独立预测特性，敏感性分别为61.8%、61.8%、70.6%和73.5%，特异性分别为66.2%、68.4%、59.6%和55.9%，AUC分别为0.620、0.659、0.670和0.668，均在0.7左右。十倍交叉验证证实了我们研究结果的可靠性和稳健性，在1000次迭代中AUC、敏感性、特异性和95%置信区间一致。
结论
T1 SIR、AP SIR、VP SIR和DP SIR有望成为鉴别MFCP和PDAC的潜在影像学生物标志物。
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