对比不同方法MR弥散加权成像术前预测胃癌病理分化

Comparison on MR diffusion weighted imaging with different methods for preoperative predicting pathological differentiation of gastric cancer

目的对比观察常规视野弥散加权成像(fFOV-DWI)、小视野弥散加权成像(ZOOMit-DWI)与单层动态匀场弥散加权成像(iShim-DWI)术前预测胃癌病理分化的效能。方法收集188例接受不同方法MR DWI并经手术病理证实的胃癌患者,观察其fFOV-DWI、ZOOMit-DWI及iShim-DWI,测量相应表观弥散系数(ADC)值。以病理结果为标准,采用受试者工作特征(ROC)曲线评价其预测胃中分化腺癌的效能。结果共81例患者纳入研究,包括中分化腺癌25例(中分化组)、低分化腺癌37例(低分化组)及低黏附性癌19例(低黏附组);其fFOV-ADC(F=4.41,P=0.02)、ZOOMit-ADC(F=8.37,P<0.01)、iShim-ADC(H=22.82,P<0.01)差异均有统计学意义。ROC曲线显示,iShim-ADC预测胃中分化腺癌的AUC(0.83)高于fFOV-ADC(0.66,Z=3.44,P<0.01),而与ZOOMit-ADC(0.75)差异无统计学意义(Z=1.67,P=0.10);ZOOMit-ADC的AUC与fFOV-ADC差异无统计学意义(Z=1.80,P=0.07)。结论相比fFOV-DWI及ZOOMit-DWI,iShim-DWI术前预测胃中分化腺癌的效能较好。

Objective To analyze the diagnostic performances of conventional full field of view diffusion weighted imaging(fFOV-DWI),ZOOMit-DWI and individual shimming DWI(iShim-DWI)for preoperative predicting pathological differentiation of gastric cancer.Methods A total of 188 patients with gastric cancer confirmed by surgery and pathology who underwent fFOV-DWI,ZOOMit-DWI and iShim-DWI were collected,and tumor apparent diffusion coefficient(ADC)values were obtained.Taking pathological results as standard,receiver operating characteristic(ROC)curves were drawn to analyze the diagnostic efficacy of three DWI for preoperative predicting moderately differentiated gastric adenocarcinoma.Results Totally 81 patients were enrolled,including 25 cases of moderately differentiated adenocarcinoma(moderately differentiated group),37 of low differentiated adenocarcinoma(low differentiated group)and 19 cases of low adhesion carcinoma(low adhesion group).Statistical differences of fFOV-ADC(F=4.41,P=0.02),ZOOMit-ADC(F=8.37,P<0.01)and iShim-ADC(H=22.82,P<0.01)were found among 3 groups.ROC curve showed that the area under the curve(AUC)of iShim-DWI(0.83)for preoperative predicting moderately differentiated gastric adenocarcinoma was higher than that of fFOV-ADC(0.66,Z=3.44,P<0.01),but not significantly different with that of ZOOMit-ADC(0.75,Z=1.67,P=0.10).There was no significant difference of AUC between fFOV-ADC and ZOOMit-ADC(Z=1.80,P=0.07).Conclusion Compared with fFOV-DWI and ZOOMit-DWI,iShim-DWI had better diagnostic efficacy for preoperative predicting moderately differentiated gastric adenocarcinoma.