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目的比较全身扩散加权成像(WB-DWI)与PET/CT对胃肠道肿瘤患者复发和转移诊断的准确率;并评估转移灶和正常组织的ADC值。方法通过28例被确诊为胃肠道癌和怀疑肿瘤复发患者WB-DWI和PET/CT检查结果比较,评估两种方法在检测淋巴结和远处转移的效能。以PET/CT和组织学和/或3~6个月的临床随访作为评估参考标准。两位影像诊断医生和一位核医学科医师对MR和PET/CT图像分别进行评估。用Kappa统计比较WB-DWI和FDG-PET/CT用于检测复发和远处转移的一致性。同时对18名健康志愿者的正常组织与转移灶之间的ADC值的差异进行比较。根据受试者工作特征曲线(ROC)分析确定正常组织与转移瘤之间的最佳鉴别诊断阈值(OTV)。结果 28例患者中,5例检出肿瘤复发。PET/CT检出20例淋巴结阳性共72个病灶,WB-DWI检出18例共64个病灶。远处转移部位包括肝脏、肺、肾上腺、腹腔和骨。WB-DWI发现1处脑转移灶。WB-DWI与PET/CT总体诊断性能之间无显著统计学差别(t=1.332,P=0.194)。WB-DWI在显示局部复发和远处转移方面与PET/CT有很好的一致性,κ=0.877。在b值为600 s/mm2的WB-DWI中,淋巴结、肝、骨转移与各自正常组织之间的ADC值差异有显著统计学意义(P<0.05)。通过ROC得出其ADC值分别为1.67×10-3、1.95×10-3和1.30×10-3 mm2/s时,诊断转移的准确率最高、效能最佳。结论在胃肠道肿瘤分期应用方面,WBDWI是一种可靠的无电离辐射的成像方法,可以达到与PET/CT一致的诊断性能。此外,ADC值是一种定量值,它在转移瘤的诊断方面有很高的价值。
Objective To compare the accuracy of WB-DWI with PET / CT in the diagnosis of gastrointestinal cancer patients with recurrence and metastasis, and to evaluate the ADC values of metastatic lesions and normal tissues. Methods We compared the results of WB-DWI and PET / CT in 28 patients diagnosed with gastrointestinal cancer and suspected tumor recurrence to evaluate the efficacy of the two methods in detecting lymph node and distant metastasis. Clinical evaluation of PET / CT and histology and / or 3-6 months was used as a reference standard for evaluation. Two diagnostic radiologists and one nuclear medicine physician evaluated MR and PET / CT images respectively. Comparison of WB-DWI and FDG-PET / CT with Kappa statistics was used to detect the consistency of recurrence and distant metastasis. Differences in ADC values between normal tissues and metastases in 18 healthy volunteers were also compared. The best differential diagnosis threshold (OTV) between normal tissues and metastases was determined based on the receiver operating characteristic curve (ROC) analysis. Results Of the 28 patients, tumor recurrence was detected in 5 cases. A total of 72 lesions positive in 20 cases were detected by PET / CT and 18 lesions were detected by WB-DWI in 64 lesions. Distant metastases include the liver, lung, adrenal gland, abdominal cavity and bone. WB-DWI found 1 brain metastases. There was no statistically significant difference between the overall diagnostic performance of WB-DWI and PET / CT (t = 1.332, P = 0.194). WB-DWI showed good agreement with PET / CT in displaying local recurrence and distant metastasis, κ = 0.877. In WB-DWI with a b value of 600 s / mm2, there was significant difference in ADC value between lymph node, liver and bone metastasis and normal tissues (P <0.05). The ROC showed that ADC values of 1.67 × 10-3, 1.95 × 10-3 and 1.30 × 10-3 mm2 / s were the best, and the highest diagnostic accuracy was obtained. Conclusion WBDWI is a reliable non-ionizing radiation imaging method in gastrointestinal cancer staging applications, which can achieve the same diagnostic performance as PET / CT. In addition, the ADC value is a quantitative value that is of great value in the diagnosis of metastases.