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值与胰腺纤维化问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、D8、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。
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 panereaticoduodenectomy 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 IV1M 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.