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目的探讨体素内不相干运动磁共振扩散加权成像(IVIM-DWI)对肝外胆管癌(EHCC)病理分级的临床应用价值。方法搜集经手术病理证实为EHCC,并于术前行3.0 T MRI常规序列及IVIM-DWI序列扫描的患者33例。测量计算以下参数:肿瘤DWI单指数成像ADC值;IVIM-DWI成像参数,包括真性扩散系数(D)值、灌注分数(f)值和假性扩散系数(D*)值。不同病理级别EHCC组间参数的比较采用单因素ANOVA检验(正态分布)或Kruskal-Wallis H检验(非正态分布),采用Spearman相关分析研究各参数和病理分级的相关性,通过受试者工作特征曲线(ROC)曲线下面积(AUC)来比较参数的诊断效能。结果 33例EHCC患者按照病理分级分为高分化(Ⅰ级)9例、中分化(Ⅱ级)13例和低分化(Ⅲ级)11例,ADC值分别为(1.34±0.23)×10~(-3)mm~2/s、(1.22±0.19)×10~(-3)mm~2/s、(0.97±0.13)×10~(-3)mm~2/s,D值分别为(1.31±0.15)×10~(-3)mm~2/s、(1.17±0.14)×10~(-3)mm~2/s、(0.86±0.12)×10~(-3)mm~2/s,D*值分别为(5.84±0.73)×10~(-3)mm~2/s、(6.39±1.67)×10~(-3)mm~2/s、(5.56±2.01)×10~(-3)mm~2/s,f值分别为37.35±9.01、30.91±8.55、22.78±7.47。不同病理分级组间D*值的差异无统计学意义(P>0.05)外,其余参数的差异均有统计学意义(P<0.05)。ADC值、D值和f值均与病理分级呈负相关(r值分别为-0.677、-0.821、-0.582,P均<0.05),ROC AUC分别为0.743、0.876、0.691,且差异存在统计学意义(P=0.000)。结论 IVIM-DWI技术可以在一定程度上反映EHCC的组织分化程度和血供,对术前预测肿瘤病理分级具有一定价值。
Objective To investigate the clinical value of non-coherent motion diffusion-weighted imaging (IVIM-DWI) in pathological grade of extrahepatic cholangiocarcinoma (EHCC). Methods Thirty-three patients with EHCC confirmed by surgery and pathology were enrolled and underwent preoperative 3.0 T MRI and IVIM-DWI sequence scan. The following parameters were measured and calculated: tumor DWI single exponential imaging ADC value; IVIM-DWI imaging parameters including true diffusion coefficient (D) value, perfusion fraction (f) value and pseudo diffusivity (D *) values. The parameters of different pathological grades of EHCC were compared by one-way ANOVA test (normal distribution) or Kruskal-Wallis H test (non-normal distribution), using Spearman correlation analysis of the correlation between parameters and pathological grade, The area under the operating characteristic curve (ROC) curve (AUC) was used to compare the diagnostic efficacy of the parameters. Results Thirty-three patients with EHCC were classified into 9 patients with well-differentiated grade Ⅰ, 13 moderately differentiated (grade Ⅱ) and 11 poorly differentiated (grade Ⅲ) according to the pathological grade. The ADC values were (1.34 ± 0.23) × 10 ~ The values of D were ((3) mm ~ 2 / s, (1.22 ± 0.19) × 10 ~ (-3) mm ~ 2 / s and (0.97 ± 0.13) × 10 ~ (-3) mm ~ (1.31 ± 0.15) × 10 ~ (-3) mm ~ 2 / s, (1.17 ± 0.14) × 10 ~ (-3) mm ~ 2 / s and (0.86 ± 0.12) × 10 ~ (-3) / s and D * values were (5.84 ± 0.73) × 10 -3 mm 2 / s, 6.39 ± 1.67 × 10 -3 mm 2 / s and 5.56 ± 2.01 × 10 ~ (-3) mm ~ 2 / s, f values were 37.35 ± 9.01,30.91 ± 8.55,22.78 ± 7.47. There was no significant difference in D * values between different pathological grade groups (P> 0.05), the other parameters had statistical significance (P <0.05). ADC values, D values and f values were negatively correlated with pathological grade (r = -0.677, -0.821, -0.582, P <0.05, respectively), and AUC of ROC were 0.743,0.876,0.691, Significance (P = 0.000). Conclusion IVIM-DWI technique can reflect the degree of tissue differentiation and blood supply of EHCC to a certain extent, which is of certain value for preoperative prediction of tumor pathological grade.