目的：探讨磁共振体素内不相干运动扩散加权成像（IVIM-DWI）在胰腺纤维化评价中的价值。方法：收集15例健康志愿者（对照组）及45例胰头体部或壶腹部病变并行胰十二指肠切除术的患者（病变组），病变组术前一周内均行3.0T IVIM-DWI检查及术后胰腺断端纤维化分期评价（F0期15例，F1期10例，F2期11例，F3期9例），由两名具有5年以上腹部影像诊断经验的放射科医师于胰腺断端处绘制感兴趣区（ROI），测得真实扩散系数（D），假性扩散系数（D*）及灌注分数（f）值，采用Spearman秩相关系数及受试者工作特性曲线（ROC）分析D、D*、f值与胰腺纤维化间的相关性及诊断胰腺纤维化分期的效能。结果：两名测量者间测得受试者的D、D*、f值的一致性良好（ICC：0.925、0.907、0.823）。f值与纤维化分期的相关性略高于D和D*（Spearman相关性检验：r=-0.651、-0.392、-0.523，P分别为<0.001、0.002、<0.001）。f值区分F0/（F1～F3）期、（F0，F1）/（F2，F3）的曲线下面积略高于D及D*（F0比（F1～F3）：0.822、0.662、0.764；（F0，F1）比（F2，F3）：0.876、0.772、0.799），但差异无统计学意义（P均大于0.05）。结论：IVIM-DWI成像是一种良好的胰腺纤维化的分期方法。
Abstract
Objective: To evaluate the diagnostic performance of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI) for the evaluation of pancreatic fibrosis. Methods: A total of 15 healthy volunteers and 45 patients(F0: 15, F1: 10, F2: 11, F3: 9) with pancreatic or ampullary masses and subsequent pancreaticoduodenectomy underwent preoperative 3.0T MR IVIM imaging within less than one week. IVIM-DWI parameters(true diffusion coefficient(D), pseudo-diffusion coefficient(D*), and perfusion fraction(f)) were measured independently by two radiologists with more than 5 years of experience in abdominal imaging diagnosis. Spearman rank correlation coefficient was used to analyze the correlation between D, D*, f values and pancreatic fibrosis. Receiver operating characteristic curve(ROC) analysis was to determine the diagnostic performance of IVIM parameters for staging of pancreatic fibrosis(F0～F3). Results: The D, D* and f values measured by the two subjects were excellent(ICC: 0.925, 0.907, 0.823). f values showed a better negative correlation with fibrosis stages(r=-0.651, P<0.001) than D(r=-0.392, P=0.002) and D*(r=-0.523, P<0.001). f values had higher area under the curve(AUC) than that of D and D*(F0 vs (F1～F3): AUC=0.822, 0.662, 0.764, respectively; (F0, F1) vs (F2, F3): AUC=0.876, 0.772, 0.799, respectively), though without statistical significance(all P>0.05). Conclusion: IVIM-DWI is a promising method for staging of pancreatic fibrosis.
关键词
胰腺疾病 /
纤维化 /
磁共振成像
Key words
Pancreatic diseases /
Fibrosis /
Magnetic resonance imaging
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基金
国家自然科学基金面上项目（81471718，81401376）；中国医科大学国家自然科学基金优秀青年科学基金培育项目
（YQ20160005）；盛京杰出人才计划（Sjjcrc-01）。
