目的：探讨表观弥散系数平均值（ADCmean）、最小值（ADCmin）在鉴别肝癌病理分化程度的价值。方法：回顾性分析46例经病理证实的肝癌患者，包括肝细胞癌（36例）、胆管细胞癌（10例），并将其分为高、中、低分化组（分别为10、24、12例）。所有患者均行MRI平扫、增强及DWI序列扫描，综合各扫描序列，测量病灶实质部分的ADCmean值、ADCmin值，对比ADC值在高、中、低分化肝癌中的差异。采用受试者工作特征曲线（ROC）分析ADCmin值在鉴别低分化与中高分化肝癌的临界值及其敏感度、特异度。结果：低分化组ADCmean值及ADCmin值均低于中分化和高分化组，且差异具有统计学意义（P＜0.05）；在低分化与中高分化肝癌的鉴别中，ADCmin值具有较高的诊断效能，ROC曲线下面积（AUC）为0.842，其敏感度、特异度分别为86.2%、71.4%。结论：ADCmin值在预测肝癌的病理分化程度中的作用要优于ADCmean值。
Abstract
Objective: To investigate the value of ADCmin and ADCmean in determination of liver cancer pathological degree of differentiation. Methods: Forty-six patients with pathologically confirmed liver cancer were analyzed retrospectively, including 36 cases of hepatocellular carcinoma and 10 cases of cholangiocarcinoma(10 well, 24 moderately and 12 poorly differentiated). All patients underwent conventional MRI and DWI examinations. The ADCmin and ADCmean values of well, moderately and poorly differentiated liver cancer were measured and compared. ROC curves are used to evaluate the critical value of ADCmin between poorly differentiated and moderately to well differentiated liver cancer. The sensitivity and specificity of ADCmin are also assessed. Results: The values of ADCmin and ADCmean were lower in poorly differentiated liver cancer than moderately to well differentiated liver cancer, with significantly statistical differences(P<0.05). The sensitivity and specificity of ADCmin for distinguishing poorly differentiated from moderately to well differentiated liver cancer were 86.2% and 71.4% respectively. The calculated area under the curve(AUC) was 0.842. Conclusions: ADCmin is better than ADCmean in discriminating poorly differentiated from moderately to well differentiated liver cancer.
关键词
肝肿瘤 /
病理学 /
磁共振成像
Key words
Liver neoplasms /
Pathology /
Magnetic resonance imaging
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]Jemal A, Bray F, Center MM, et al. Global cancer statistic[J]. CA Cancer J Clin, 2011, 61(2): 69-90.
[2]McDonald K, Sebire NJ, Anderson J, et al. Patterns of shift in ADC distributions in abdominal tumors during chemotherapy-feasibility study[J]. Pediatr Radiol, 2011, 41(1): 99-106.
[3]林宇宁，李辉，陈自谦，等. 采用MR扩散加权成像表观扩散系数值直方图诊断ⅠB期宫颈癌的价值[J]. 中华放射学杂志，2015，49（5）：349-353.
[4]Xue H, Ren C, Yang J, et al. Histogram analysis of apparent diffusion coefficient for the assessment of local aggressiveness of cervical cancer[J]. Arch Gynecol Obstet, 2014, 290(2): 341-348.
[5]陆媛媛，黄群英，孙明华，等. ADC直方图区分宫颈癌常见病理类型的价值[J]. 中国医学计算机成像杂志，2015，21（3）：255-259.
[6]Zhu L, Geng D, Ren G, et al. Correlation between minimal apparent diffusion coefficient and expression of Ki-67 in glioma[J]. Zhonghua Yi Xue Za Zhi, 2015, 95(1): 37-39.
[7]Hayashida Y, Hirai T, Morishita S, et al. Diffusion-weighted imaging of metastatic brain tumors: comparison with histologic type and tumor cellularity[J]. AJNR, 2006, 27(7): 1419-1425.
[8]Guo W, Zhao S, Yang Y, et al. Histological grade of hepatocellular carcinoma predicted by quantitative diffusion-weighted imaging[J]. Int J Clin Exp Med, 2015, 8(3): 4164-4169.
[9]Woo S, Lee JM, Yoon JH, et al. Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma: correlation with enhancement degree and histologic grade[J]. Radiology, 2014, 270(3): 758-767.
[10]Nasu K, Kuroki Y, Tsukamoto T, et al. Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade[J]. AJR, 2009, 193(2): 438-444.
[11]Kato F, Kudo K, Yamashita H, et al. Differences in morphological features and minimum apparent diffusion coefficient values among breast cancer subtypes using 3-tesla MRI[J]. Eur J Radiol, 2016, 85(1): 96-102.
[12]Nakanishi M, Chuma M, Hige S, et al. Relationship between diffusion-weighted magnetic resonance imaging and histological tumor grading of hepatocellular carcinoma[J]. Ann Surg Oncol, 2012, 19(4): 1302-1309.
[13]Le MF, Durieux M, Bancel B, et al. Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver[J]. Magn Reson Imaging, 2012, 30(5): 656-665.
[14]张学琴，陆健，王霄英，等. DWI对乙肝肝硬化背景微小肝癌（≤1 cm）的检测价值[J]. 实用放射学杂志，2015，31（2）：247-250.
[15]詹松华，冯晓源. 肝组织坏死和凋亡MRI鉴别诊断的实验研究[J]. 中国医学计算机成像杂志，2006，12（2）：99-104.
[16]Battal B, Kocaoglu M, Akgun V, et al. Diffusion-weighted imaging in the characterization of focal liver lesions: efficacy of visual assessment[J]. J Comput Assist Tomogr, 2011, 35(3): 326-331.
[17]田霞，谢道海，陆紫微，等. 单双指数信号衰减模型在肝癌诊断中的初步研究[J]. 实用放射学杂志，2015，31（6）：950-954.
[18]刘静静，王劲，颜荣华，等. 常规磁共振成像与磁共振弥散加权成像在不同分化小肝癌中的临床应用[J]. 中华肝胆外科杂志，2012，18（8）：573-577.
