Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?
Can diffusion-weighted imaging distinguish between benign and malignant pediatric liver tumors?
复制标题
DOI：
10.1007/s00247-017-3984-9
复制
发表时间：
2018-01-01
影响因子：
2.3
通讯作者：
Chavhan, Govind B.
中科院分区：
文献类型：
--
作者：
Caro-Dominguez, Pablo;Gupta, Abha A.;Chavhan, Govind B.
目的探讨弥散加权成像（diffusion-weighted imaging，DWI）在小儿肝脏病变诊断中的应用价值，并探讨DWI在小儿肝脏病变诊断中的价值。DWI和表观扩散系数（ADC）图上的低信号，以及两者上的中间信号，并测量ADC值。病理证实或结合临床，实验室和影像学特征，并随访，以确定最终diagnosis.Results我们包括112局灶性肝病变89名儿童（中位年龄11.5岁，51名女性），其中92个病灶是良性和20恶性。观察者间的一致性几乎完美的定性（kappa 0.8735）和定量（组内相关系数[ICC] 0.96）扩散评估。所有恶性病变均表现为弥散受限。大多数良性病变，而非乳腺癌的限制。定性限制与恶性、非限制与良性有显著相关性（Fisher精确检验P < 0.0001）。恶性病变的平均标准化ADC值（1.23 × 10（-3）mm（2）/s）低于良性病变（1.62 × 10（-3）mm（2）/s; Student's t检验，P < 0.015）。但良恶性病变的ADC值有明显重叠，且各诊断范围较大。受试者工作特征（ROC）分析显示，使用ADC截止值0.63预测恶性肿瘤的曲线下面积（AUC）为0.63。
Background There are limited data on utility of diffusion-weighted imaging (DWI) in the evaluation of pediatric liver lesions.Objective To determine whether qualitative and quantitative DWI can be used to differentiate benign and malignant pediatric liver lesions.Materials and Methods We retrospectively reviewed MRIs in children with focal liver lesions to qualitatively evaluate lesions noting diffusion restriction, T2 shine-through, increased diffusion, hypointensity on DWI and apparent diffusion coefficient (ADC) maps, and intermediate signal on both, and to measure ADC values. Pathology confirmation or a combination of clinical, laboratory and imaging features, and follow-up was used to determine final diagnosis.Results We included 112 focal hepatic lesions in 89 children (median age 11.5 years, 51 female), of which 92 lesions were benign and 20 malignant. Interobserver agreement was almost perfect for both qualitative (kappa 0.8735) and quantitative (intraclass correlation coefficient [ICC] 0.96) diffusion assessment. All malignant lesions showed diffusion restriction. Most benign lesions other than abscesses were not restricted. There was significant association of qualitative restriction with malignancy and non-restriction with benignancy (Fisher exact test P < 0.0001). Mean normalized ADC values of malignant lesions (1.23x10(-3) mm(2)/s) were lower than benign lesions (1.62x10(-3) mm(2)/s; Student's t-test, P < 0.015). However, there was significant overlap of ADC between benign and malignant lesions, with wide range for each diagnosis. Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.63 for predicting malignancy using an ADC cut-off value of