IVIM-DWI在胰腺癌与慢性胰腺炎鉴别诊断中的应用与研究

发布时间：2018-04-29 06:20

本文选题：体素内不相干运动 + 磁共振成像　；参考：《昆明医科大学》2017年硕士论文

【摘要】：研究目的:通过多个b值体素内不相干运动(intravoxel incoherent motion,IVIM)磁共振扩散加权成像(diffusion-weighted imaging,DWI)双指数模型分析比较胰腺癌、慢性胰腺炎以及癌周相对正常胰腺组织的常规DWI表观扩散系数(Apparent diffusion coefficient,ADC)与多个b值IVIM-DWI的衍生参数纯扩散系数(pure diffusion coefficient,D)、假性扩散系数(pseudo-diffusion coefficient,D*)和灌注分数(perfusion fraction,f)之间是否存在差异,探讨上述4个参数对区分胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的最佳诊断临界值及其诊断效能。研究方法:入选2015年12月至2017年1月在我院经病理活检确诊和(或)临床确诊并经随访1-6个月证实为胰腺癌及慢性胰腺炎的患者共55例,分为胰腺癌组、慢性胰腺炎组,将癌周相对正常胰腺组织设为对照。所有MRI检查均在Philips Achieva 3.0TTX磁共振扫描仪上进行,扫描的序列包括T2WI、T1WI、动态增强成像(Dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)及常规横轴位DWI(b值为0和700s/mm2)。对所有病例再加行IVIM扫描(b值设置为0、20、40、70、100、200、400、700、1000s/mm2)。通过 Philips 的后处理工作站处理常规ADC图并设置感兴趣区(Region of interest,ROI,包括病变及癌周相对正常胰腺组织)获得ADC值;利用Philips公司开发的软件(IVIM v1.0,For Philips Data Only)对IVIM-DWI图像行后处理分析,得出病变及癌周相对正常胰腺组织的D值、D*值及f值,以及生成相应的参数伪彩图。结果采用单因素方差分析和t检验比较胰腺癌组、慢性胰腺炎组及癌周相对正常胰腺组织组间的ADC值、D值、D*值及f值的差异;利用受试者工作特征(receiver operating characteristic,ROC)曲线来计算曲线下面积(area under curve,AUC),分析ADC值、D值、D*值和f值4个参数区分胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的敏感度、特异度及诊断价值。结果:1、本研究对象中胰腺癌35例,手术病理证实23例,经临床确诊并随访1-6月证实12例;慢性胰腺炎20例,手术病理证实11例,经临床确诊并随访1-6月证实9例。2、单因素方差分析结果显示,胰腺癌组、慢性胰腺炎组及癌周相对正常胰腺组织组的D值(F=0.045,p=0.956)比较无统计学意义,ADC值(F=3.937,p=0.022)、D*值(F=97.125,p0.001)和 f 值(F=118.917,p0.001)比较均有统计学意义。进一步进行LSD两两比较,D值胰腺癌组、慢性胰腺炎组及癌周相对正常胰腺组织组间均无统计学意义(1.29±0.27vs1.31±0.21×10-3mm2/s,p=0.776;1.29±0.27 vs 1.30 ± 0.21 X 10-3mm2/s,p=0.955;1.31 ± 0.21 vs 1.30 ± 0.21 X 10-3mm2/S,p=0.796);ADC值除了胰腺癌组与癌周相对正常胰腺组织组外其余两两比较均无统计学意义(1.31 ±0.29 vs1.53±0.44X 10-3mm2/s,p=0.008;1.31±0.29 vs 1.38±0.33×10-3mm2/s,p=0.494;1.38±0.33 vs1.53±0.44×10-3mm2/s,p=0.32);D*值除了胰腺癌组与慢性胰腺炎组外其余两两比较均有统计学意义(21.34±9.34 vs24.97±8.09×10-3mm2/s,p=0.324;21.34±9.34 vs57.38±16.19×10-3mm2/s,p0.001;24.97±8.09 vs 57.38±16.19×10-3mm2/s,p0.001);f值胰腺癌组、慢性胰腺炎组及癌周相对正常胰腺组织组间均有统计学意义(0.26±0.054 vs 0.36±0.022,p0.001;0.26±0.054 vs 0.40±0.037,p0.001;0.36±0.022 vs 0.40±0.037,p0.001)。3、胰腺癌组、慢性胰腺炎组及癌周相对正常胰腺组织组D值与ADC值比较均有差异性,有统计学意义(t=-2.784,p0.05;t=-13.095,p0.001;t=-3.386,p0.05),ADC值均大于D值。4、D、ADC、D*、f值对区分胰腺癌与癌周相对正常胰腺组织的AUC分别为0.542、0.705、0.996及0.999,其诊断的最佳临界值分别为1.28×10-3mm2/s、1.30×10-3mm2/s、37.33X 10-3mm2/s、0.34,对应诊断的敏感度分别为 58.2%、81.8%、100%、100%,特异度分别为60.0%、62.9%、97.1%、97.1%,D*、f值的诊断效果较好。D、ADC、D*、f值对鉴别诊断胰腺癌与慢性胰腺炎的AUC分别为0.580、0.589、0.624、0.976,诊断最佳临界值分别为 1.28×10-3mm2/s、1.28×10-3mm2/s、22.8×10-3mm2/s、0.33,对应诊断的敏感度及特异度分别为75%、75%、60%、95%和 60%、57.1%、71.4%、94.3%,D、ADC、D*值的诊断价值较低。D、ADC、D*、f值对区分慢性胰腺炎、癌周相对正常胰腺组织的AUC分别为0.518、0.692、0.985、0.866,诊断最佳临界值分别为 1.32×10-3mm2/s、1.33×10-3mm2/s、38.9×10-3mm2/s、0.36,对应诊断的敏感度分别为49.1%、72.7%、96.4%、89.1%,特异度分别为75%、75%、95.0%、70.0%,ADC及D值的诊断价值较低。结论:1、胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的ADC值、D*值、f值存在差异,提示ADC值、D*值、f值对胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的识别有一定的价值。2、胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的ADC值均大于D值,而D值反映的是组织的纯扩散,证实常规ADC值存在扩散以外的其它信息。3、D*、f值识别胰腺癌与癌周相对正常胰腺组织的诊断效能较好,其诊断最佳临界值分别为 37.33X10-3mm2/s、0.34(AUC=0.996、0.999,p0.001),敏感度和特异度分别为100%、100%和97.1%、97.1%;f值鉴别诊断胰腺癌与慢性胰腺炎的诊断效能最佳,其诊断最佳临界值为0.33,敏感度和特异度分别为95%、94.3%;D*值、f值识别慢性胰腺炎、癌周相对正常胰腺组织的诊断效能较好,其诊断最佳临界值分别为38.9×10-3mm2/s、0.36,敏感度和特异度分别为96.4%、89.1%和95%、70%。D*、f值识别胰腺癌、慢性胰腺炎及癌周相对正常胰腺组织的诊断效能均较常规ADC值更好。
[Abstract]:Objective: To compare the conventional DWI apparent diffusivity (Apparent diffusion coefficient) of pancreatic cancer, chronic pancreatitis, and normal pancreatic tissue by multiple B intravoxel incoherent motion (IVIM) magnetic resonance diffusion weighted imaging (diffusion-weighted imaging, DWI) model. C) is the difference between the derivative parameters (pure diffusion coefficient, D), the pseudodiffusion coefficient (pseudo-diffusion coefficient, D*) and the perfusion fraction (perfusion fraction) with multiple b values IVIM-DWI, and discusses the best diagnosis of the 4 parameters for the differentiation of pancreatic adenocarcinoma, chronic pancreatitis and the relative normal pancreatic tissue. A total of 55 cases of pancreatic cancer and chronic pancreatitis were identified in our hospital from December 2015 to January 2017 by biopsy and (or) clinically confirmed and followed up for 1-6 months, divided into the pancreatic cancer group, the chronic pancreatitis group, and the normal pancreatic tissue as control. All MRI tests were performed. The findings were performed on the Philips Achieva 3.0TTX magnetic resonance scanner. The sequences of the scans included T2WI, T1WI, dynamic enhanced imaging (Dynamic contrast-enhanced magnetic resonance imaging, DCE-MRI), and conventional transverse axial DWI. Through the Philips post processing workstation, the routine ADC map was processed and the region of interest (Region of interest, ROI, including the lesions and the normal pancreatic tissue) was obtained, and the ADC value was obtained by the software (IVIM v1.0, For Philips) developed by Philips company (IVIM v1.0, For Philips). The D value, D* value and F value of the adenoid tissue, and the corresponding parameter pseudo color images. Results the ADC value, the D value, the D* value and the F value of the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group were compared with the single factor variance analysis and t test, and the characteristics of the subjects (receiver operating characteristic, ROC) Qu Xianlai were used. Area under curve (AUC), ADC value, D value, D* value and F value were analyzed to distinguish the sensitivity, specificity and diagnostic value of 4 parameters of pancreatic cancer, chronic pancreatitis and the relative normal pancreatic tissue. Results: 1, 35 cases of pancreatic cancer in this study, 23 cases confirmed by hand pathology, 12 cases confirmed by clinical diagnosis and 1-6 months follow-up. 20 cases of pancreatitis, 11 cases confirmed by operation and pathology, 9 cases of.2 confirmed by clinical diagnosis and 1-6 months of follow-up. The results of single factor analysis of variance showed that there was no significant difference between the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group D value (F=0.045, p=0.956), ADC value (F=3.937, p=0.022), D* value (F=97.125, p0.001) and f (F=118.91) value (F=118.91) 7, p0.001) was statistically significant. Compared with LSD 22, there was no statistical significance between the D value pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group (1.29 + 0.27vs1.31 + 0.21 x 10-3mm2/s, p=0.776; 1.29 + 0.27 vs 1.30 + 0.21 X 10-3mm2/ s, p=0.955; 1.31 + 0.21 vs 1.30 + 0.21 96): there was no significant difference in ADC value between the pancreatic cancer group and the other 22 outside the normal pancreatic tissue group (1.31 + 0.29 vs1.53 + 0.44X 10-3mm2/s, p=0.008; 1.31 + 0.29 vs 1.38 + 0.33 x 10-3mm2/s, p=0.494; 1.38 + 0.33 vs1.53 + 0.44 x 10-3mm2/s, p=0.32), except for the remaining 22 of the pancreatic cancer group and the chronic pancreatitis group. The comparison was statistically significant (21.34 + 9.34 vs24.97 + 8.09 x 10-3mm2/s, p=0.324; 21.34 + 9.34 vs57.38 + 16.19 x 10-3mm2/s, p0.001; 24.97 + 8.09 vs 57.38 + 16.19 x 10-3mm2/s, p0.001); F value of pancreatic cancer group, chronic pancreatitis group and normal pancreatic tissue group had statistical significance (0.26 + 0.054 vs 0.36 + 0.022, p0.001; p0.001; p0.001; p0.001; p0.001; p0.001; p0.001; 0.054 vs 0.40 + 0.037, p0.001; 0.36 + 0.022 vs 0.40 + 0.037, p0.001).3, the D value of the pancreatic cancer group, the chronic pancreatitis group and the normal pancreatic tissue group was different from the ADC value. There were statistical significance (t=-2.784, P0.05; t=-13.095, p0.001; t=-3.386,). The AUC of the normal pancreatic tissue was 0.542,0.705,0.996 and 0.999 respectively. The best critical value of the diagnosis was 1.28 x 10-3mm2/s, 1.30 x 10-3mm2/s, 37.33X 10-3mm2/s, 0.34. The sensitivity of the corresponding diagnosis was 58.2%, 81.8%, 100%, 100% respectively, and the specificity was 60%, 62.9%, 97.1%, 97.1%, D*, F value was better.D, ADC, D*, F values, respectively. The AUC of the differential diagnosis of pancreatic cancer and chronic pancreatitis was 0.580,0.589,0.624,0.976 respectively. The best critical values were 1.28 x 10-3mm2/s, 1.28 x 10-3mm2/s, 22.8 x 10-3mm2/s, 0.33. The sensitivity and specificity of the corresponding diagnosis were 75%, 75%, 60%, 95% and 60%, 57.1%, 71.4%, 94.3%, D, ADC, D* value lower.D, ADC, D*, F value, respectively. To distinguish chronic pancreatitis, the AUC of the cancer weeks relative to the normal pancreatic tissue was 0.518,0.692,0.985,0.866 respectively. The best critical values were 1.32 x 10-3mm2/s, 1.33 x 10-3mm2/s, 38.9 x 10-3mm2/s, 0.36. The sensitivity of the diagnosis was 49.1%, 72.7%, 96.4%, 89.1% respectively, and the specificity was 75%, 75%, 95%, 70%, ADC and D values were compared. Conclusion: 1, the ADC value, D* value and F value of pancreatic cancer, chronic pancreatitis and normal pancreatic tissue are different. It suggests that the value of ADC, D*, and F value for the identification of pancreatic cancer, chronic pancreatitis and the relative normal pancreatic tissue is of certain value.2, and the ADC value of pancreatic cancer, slow pancreatitis and the relative normal pancreatic tissue is greater than the D value. The D value reflects the pure diffusion of the tissue, which confirms that the conventional ADC values other than the diffusion of information.3, D*, F value is better to identify pancreatic cancer and normal pancreatic tissue, and the best critical value of the diagnosis is 37.33X10-3mm2/s, 0.34 (AUC=0.996,0.999, p0.001), sensitivity and specificity are 100%, 100% and 97.1%, 97. respectively. 1%; F value differential diagnosis of pancreatic cancer and chronic pancreatitis is the best, with the best critical value of 0.33, sensitivity and specificity of 95%, 94.3%, D* value, F value to identify chronic pancreatitis, and the diagnostic efficiency is better than normal pancreatic tissue, and the best critical value of the diagnosis is 38.9 x 10-3mm2/s, 0.36, sensitivity and specificity, respectively. They were 96.4%, 89.1% and 95%, respectively. The diagnostic value of 70%.D* and F values for pancreatic cancer, chronic pancreatitis and normal pancreatic tissue were better than those of conventional ADC.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9;R576;R445.2

【参考文献】