体素内不相干运动扩散加权成像评价胰腺癌的可切除性

Evaluating the Rsectability of Pancreatic Cancer by Incoherent Motion Diffusion Weighted Imaging

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)定量参数在评估术前胰腺癌可切除性的价值。方法回顾性分析2018年11月至2019年9月苏州大学附属第三医院39例病理诊断为胰腺癌的临床和影像学资料,利用IMAgenGINE软件测量病灶感兴趣区(ROI)的IVIM相关定量参数:真实扩散系数(D)值,假性扩散系数(D*)值,灌注分数(f)值。利用组内相关系数(ICC)分析各参数值的测量者内可重复性,t检验比较可切除组与不可切除组各参数的差异性,受试者工作特征(ROC)曲线评价各参数值的诊断效能,χ^(2)检验比较单一IVIM参数值与影像征象评估胰腺癌是否可切除的差异,比较IVIM参数值联合影像征象是否评估效能高于单一IVIM参数值。结果可切除组胰腺癌的D、D*、f值分别为(1.66±0.39)×10^(-3)mm^(2)/s、(1.91±2.29)×10^(-3)mm^(2)/s、37.8%±14.2%,不可切除组胰腺癌的D、D*、f值分别为(1.30±0.33)×10^(-3)mm^(2)/s、(1.14±1.82)×10^(-3)mm^(2)/s、23.9%±13.8%,其中D、f值的差异具有统计学意义(P值均<0.05)。各参数值的测量可重复性较好(ICC=0.799,P<0.001)。D、f值预测胰腺癌为可切除性的ROC曲线下面积(AUC)分别为0.714、0.728,D值>1.42×10^(-3)mm^(2)/s时预测胰腺癌可切除性的敏感度为79.3%,f值>17.2%时预测胰腺癌的可切除性的敏感度为96.6%,IVIM参数值联合常规影像征象较单一IVIM参数值评估胰腺癌是否可切除并无统计学差异。结论IVIM定量参数,尤其是D,f值能预测胰腺癌的术前可切除性。

Objective To investigate the value of assessing the resectability of pancreatic cancer before surgery by incoherent motion diffusion weighted imaging(IVIM-DWI).Methods The clinical and imaging data of 39 cases of pancreatic cancer diagnosed pathologically in the third affiliated Hospital of Soochow University from November 2018 to September2019 were analyzed retrospectively.The D*,D,f values of the ROIs of tumor and normal tissue were measured by IMAgenG INE.Interobserver reliability was assessed with intraclass correlation coefficient(ICC).T-test was used to compare the differences of parameters between the resectable and unresectable pancreatic cancer,and the predictive value.Diagnostic efficacy of each parameter value were evaluated by receiver operating characteristic(ROC)curve analysis of the subjects,comparing the difference between single IVIM parameter values and imaging signs to evaluate the resectability of pancreatic cancer,comparing whether IVIM parameter values combined with imaging signs were more effective than single IVIM parameter values byχ^(2)test.Significance threshold was set as P<0.05.Results The D,D*and f values of resectable pancreatic cancer were(1.66±0.39)×10^(-3)mm^(2)/s,(1.91±2.29)×10^(-3)mm^(2)/s,37.8±14.2%,respectively,and the D,D*and f values of unresectable pancreatic cancer were(1.30±0.33)×10^(-3)mm^(2)/s,(1.14±1.82)×10^(-3)mm^(2)/s,23.9±13.8%.D value and f values between resectable and unresectable pancreatic cancer were statistically significant(P<0.05).The measurement of each parameter value has good repeatability(ICC=0.799,P<0.001).The area under ROC curve with D,f value predicting resectability of pancreatic cancer was 0.714,0.728,respectively.The sensitivity of predicting resectability of pancreatic cancer was 79.3%when D value>1.42×10^(-3)mm^(2)/s,and 96.6%when f value>17.2%.There was no significant difference between IVIM parameter values combined with imaging signs and single IVIM parameter values evaluating pancreatic cancer resection.Conclusion IVIM quantitative parameters,especially D,f values,can predict preoperative resectability of pancreatic cancer.