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目的:探讨IVIM-DWI诊断和鉴别胰腺癌和胰腺神经内分泌肿瘤的最佳量化参数。材料与方法:应用GE Discovery MR750 3.0T磁共振扫描仪对手术证实的22例胰腺癌和17例胰腺神经内分泌肿瘤患者行胰腺多b值DWI。应用IVIM双指数模型测量胰腺癌和胰腺神经内分泌肿瘤与非瘤区胰腺组织的表观扩散系数(ADC)、纯扩散系数(D)、假扩散系数(D~*)和灌注分数(f),并应用单因素方差分析进行统计学分析。结果:胰腺癌的ADC和f低于非癌区胰腺组织(0.803×10~(-3)mm~2/s vs0.974×10~(-3)mm~2/s:54.527%vs 64.486%),D高于非癌区胰腺组织(0.659×10~(-3)mm~2/s vs 0.535×10~(-3)mm~2/s),鉴别胰腺癌和非癌区胰腺组织时D诊断效能最高。胰腺神经内分泌肿瘤的ADC、D和f均高于非瘤区胰腺组织(0.933×10~(-3)mm~2/s vs 0.753×10~(-3)mm~2/s;0.549×10~(-3)mm~2/s vs 0.429×10~(-3)mm~2/s:67.275%vs 59.655%).鉴别胰腺神经内分泌肿瘤和非瘤区胰腺组织时ADC诊断效能最高。胰腺癌的ADC、D~*和f低于胰腺神经内分泌肿瘤(0.803×10~(-3)mm~2/s vs 0.933×10~(-3)mm~2/s;4.852×10~(-3)mm~2/s vs 11.301×10~(-3)mm~2/s;54.527%vs 67.275%),鉴别胰腺癌和神经内分泌肿瘤是D~*诊断效能最高。胰腺癌的D~*明显低于G2~3期胰腺神经内分泌肿瘤(4 852×10~(-3)mm~2/s vs 11.937×10~(-3)mm~2/s)。结论:IVIM-DWI相关参数(ADC、D~*、D、f)可以有效鉴别胰腺癌和胰腺神经内分泌肿瘤与非瘤区胰腺组织.IVIM-DWI是无创性诊断和鉴别胰腺癌和胰腺神经内分泌肿瘤的理想方法之一。
Objective: To investigate the best quantitative parameters of IVIM-DWI in the diagnosis and differential diagnosis of pancreatic and pancreatic neuroendocrine tumors. Materials and Methods: Multi-b value DWI was performed on 22 cases of pancreatic cancer and 17 cases of pancreatic neuroendocrine tumors confirmed by surgery with the GE Discovery MR750 3.0T magnetic resonance scanner. The IV diffusion coefficient (ADC), pure diffusion coefficient (D), pseudodiffusion coefficient (D ~ *) and perfusion score (f) of pancreatic and pancreatic neuroendocrine tumors and non-tumorous pancreatic tissues were measured by IVIM double exponential model. One-way ANOVA was used for statistical analysis. Results: The ADC and f of pancreatic adenocarcinoma were lower than those in non-cancerous pancreas (0.803 × 10 -3 mm 2 / s vs 0.944 × 10 -3 mm 2 / s: 54.527% vs 64.486% ), D was higher than that in non-cancer pancreatic tissue (0.659 × 10 -3 mm 2 / s vs 0.535 × 10 -3 mm 2 / s) D highest diagnostic efficiency. ADC, D and f in pancreatic neuroendocrine tumors were significantly higher than those in non-tumorous pancreatic tissues (0.933 × 10 -3 mm 2 / s vs 0.753 × 10 -3 mm 2 / s, 0.549 × 10 ~ (-3) mm ~ 2 / s vs 0.429 × 10 ~ (-3) mm ~ 2 / s: 67.275% vs 59.655%, respectively) .It was found that ADC was the most effective in differentiating pancreatic neuroendocrine tumors from non-neoplastic pancreatic tissues. The ADC, D *, and f of pancreatic adenocarcinoma were lower than those of pancreatic neuroendocrine tumors (0.803 × 10 -3 mm 2 / s vs 0.933 × 10 -3 mm 2 / s, 4.852 × 10 -3 -3) mm ~ 2 / s vs 11.301 × 10 ~ (-3) mm ~ 2 / s, 54.527% vs 67.275%, respectively. The differential diagnosis of pancreatic cancer and neuroendocrine tumors was the highest. D * of pancreatic cancer was significantly lower than that of G2 ~ 3 pancreatic neuroendocrine tumors (4 852 × 10 ~ (-3) mm ~ 2 / s vs 11.937 × 10 ~ (-3) mm ~ 2 / s). Conclusion: IVIM-DWI related parameters (ADC, D ~ *, D, f) can effectively differentiate between pancreatic and pancreatic neuroendocrine tumors and non-neoplastic pancreatic tissues.IVIM-DWI is a noninvasive diagnosis and differential diagnosis of pancreatic cancer and pancreatic neuroendocrine One of the ideal methods of cancer.