目的：探讨单双指数模型扩散加权成像（IVIM-DWI）参数在脏脏富血供良恶性病变鉴别诊断中的应用价值。资料与方法：回顾性分析经穿刺手术病理、临床或随访结果明确诊断的44例患者（48个病灶），其中恶性25例（26个病灶），良性19例（22个病灶）。上述患者行MR常规平扫及增强扫描、并行多b值DWI（b=0、50、100、150、200、400、600、800、1 000、1 200 s/mm2）获得单指数模型参数ADC值（b=0、800 s/mm2）及IVIM双指数模型参数：快速扩散系数Dfast值、慢速扩散系数Dslow值及快速扩散成分所占百分比F值。数据分析包括：肝富血供良恶性病变组的ADC值、Dfast值、Dslow值、F值比较采用独立样本t检验进行统计学分析；应用受试者工作特征（ROC）曲线评价上述参数值对肝脏良恶性病变鉴别及富血供乏血供病变评定中的价值。结果：富血供良性病变组的ADC值、Dslow值、Dfast值、F值分别为（1.75±0.68）×10-3 mm2/s、（1.61±0.39）×10-3 mm2/s、（30.93±20.00）×10-3 mm2/s、（34.01±11.48）%高于恶性病变组（1.21±0.21）×10-3 mm2/s、（0.99±0.19）×10-3 mm2/s、（28.56±18.56）×10-3 mm2/s、（31.37±9.86）%，两者之间ADC值、Dslow值具有统计学差异，Dfast值、F值无统计学差异。ROC曲线评价ADC值、Dslow值、Dfast值、F值鉴别诊断肝脏 富血供良恶性病变阈值、敏感性、特异性、准确性及曲线下面积分别为1.35×10-3 mm2/s、80.76%、86.36%、83.33%、0.875；1.25× 10-3 mm2/s、92.30%、95.45%、95.83%、0.945；20.61×10-3 mm2/s、46.12%、72.72%、60.87%、0.534；32.36%、53.84%、68.18%、60.41%、0.545。结论：单指数模型参数ADC值、IVIM双指数模型参数Dslow值对肝脏富血供良恶性病变具有鉴别诊断价值，其中Dslow值的诊断价值最大。
Abstract
Objective: To investigate the value of monoexponential and biexponential model diffusion-weighted imaging in differentiating benign and malignant hepatic hypervascular lesions. Materials and Methods: Forty-four patients(48 lesions) with pathologically or clinically confirmed hepatic hypervascular lesions, were analyzed retrospectively and categorized into benign and malignant groups. All patients underwent routine MR scan and parallel multi b value DWI(b=0, 50, 100, 150, 200, 400, 600, 800, 1 000, 1 200 s/mm2) to obtain the monoexponential modeling value ADC(b=0, 800 s/mm2) and IVIM parameters of biexponential modeling: fast diffusion coefficient Dfast value, slow diffusion coefficient Dslow value and fast diffusion component percentage of F value. Independent two-samples t test was used to compare ADC value, Dfast value, Dslow value and F value between hypervascular benign and malignant groups. Receiver operating characteristic(ROC) curve was used to evaluate those parameters in differentiating benign and malignant lesions and identifying hyper- or hypovascular. Results: The ADC, Dslow value of benign group((1.75±0.68)×10-3 mm2/s, (1.61±0.39)×10-3 mm2/s) were statistically higher than those of malignant group((1.21±0.21)×10-3 mm2/s, (0.99±0.19)×10-3 mm2/s). The Dfast and F values of benign group((30.93±20.00)×10-3 mm2/s, (34.01±11.48)%) were higher than those of malignant group((28.56±18.56)×10-3 mm2/s, (31.37±9.86)%) with no statistical significance. The sensitivity, specificity, accuracy and the area under ROC in differentiating benign and malignant hypervascular lesions were 80.76%, 86.36%, 83.33%, 0.875; 92.30%, 95.45%, 95.83%, 0.945; 46.12%, 72.72%, 60.87%, 0.534, 53.84%, 68.18%, 60.41%, 0.545 by using a threshold ADC, Dslow, Dfast, F values of 1.35×10-3 mm2/s, 1.25×10-3 mm2/s, 20.61×10-3 mm2/s, 32.36% respectively. Conclusion: The ADC value obtained with monoexponential modeling and Dslow obtained with biexponential modeling are useful in differentiating benign and malignant hepatic hypervascular lesions, and Dslow has the highest diagnostic efficacy.
关键词
肝肿瘤；肝疾病；磁共振成像 /
弥散
Key words
Liver neoplasms /
Liver diseases /
Diffusion magnetic resonance imaging
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基金
浙江省金华市科技局项目，项目编号2013-3-039
