Apparent diffusion coefficient-based histogram analysis differentiates histological subtypes of periampullary adenocarcinoma
Apparent diffusion coefficient-based histogram analysis differentiates histological subtypes of periampullary adenocarcinoma
复制标题
基于表观扩散系数的直方图分析区分壶腹周围腺癌的组织学亚型。
DOI：
10.3748/wjg.v25.i40.6116
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发表时间：
2019-10-28
影响因子：
4.3
通讯作者：
Hu, Dao-Yu
中科院分区：
文献类型：
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作者：
Lu, Jing-Yu;Yu, Hao;Hu, Dao-Yu
背景：对于壶腹周围腺癌，组织学亚型比肿瘤起源部位更能预测预后。据报道，肠型壶腹周围腺癌（IPAC）比胰胆型壶腹周围腺癌（PPAC）预后更好。然而，术前很难确定组织学亚型的分类。表观扩散系数（ADC）直方图分析是一种无创、无增强、重复性高的方法，可以帮助区分两种亚型。目的探讨体积ADC直方图分析是否有助于区分IPAC和PPAC。方法：在2015年1月至2018年10月期间，连续476例疑似壶腹周围肿瘤并接受磁共振成像（MRI）检查的患者进行回顾性研究。仅对3.0 T MRI不同弥散加权图像（b值分别为800和1000 s/mm(2)）并确诊壶腹周围腺癌的患者进行进一步分析。然后，通过体积直方图分析得到ADC值的平均值、第5、第10、第25、第50、第75、第90和第95百分位，以及ADC（min）、ADC（max）、峰度、偏度和熵。比较采用独立的学生t检验或Mann-Whitney U检验。采用多类受试者工作特征曲线分析，确定并比较各显著参数的诊断价值。结果共纳入40例经组织病理学证实为IPAC （n = 17）或PPAC （n = 23）的患者。PPAC组的平均值、第5、第25、第50、第75、第90和第95百分位以及ADC（1000）的最大ADC（max）均显著低于IPAC组（P < 0.05）。然而，ADC值（800）在两组之间没有显着差异。ADC值的第75百分位（1000）达到区分IPAC和PPAC的最高曲线下面积（AUC） (AUC = 0.781，灵敏度为91%，特异性为59%，临界值为1.50 x 10（-3) mm(2)/s）。结论b值为1000 s/mm(2)的体积ADC直方图分析有助于术前鉴别壶腹周围腺癌的组织学亚型。
BACKGROUNDFor periampullary adenocarcinoma, the histological subtype is a better prognostic predictor than the site of tumor origin. Intestinal-type periampullary adenocarcinoma (IPAC) is reported to have a better prognosis than the pancreatobiliary-type periampullary adenocarcinoma (PPAC). However, the classification of histological subtypes is difficult to determine before surgery. Apparent diffusion coefficient (ADC) histogram analysis is a noninvasive, nonenhanced method with high reproducibility that could help differentiate the two subtypes.AIMTo investigate whether volumetric ADC histogram analysis is helpful for distinguishing IPAC from PPAC.METHODSBetween January 2015 and October 2018, 476 consecutive patients who were suspected of having a periampullary tumor and underwent magnetic resonance imaging (MRI) were reviewed in this retrospective study. Only patients who underwent MRI at 3.0 T with different diffusion-weighted images (b-values = 800 and 1000 s/mm(2)) and who were confirmed with a periampullary adenocarcinoma were further analyzed. Then, the mean, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values and ADC(min), ADC(max), kurtosis, skewness, and entropy were obtained from the volumetric histogram analysis. Comparisons were made by an independent Student's t-test or Mann-Whitney U test. Multiple-class receiver operating characteristic curve analysis was performed to determine and compare the diagnostic value of each significant parameter.RESULTSIn total, 40 patients with histopathologically confirmed IPAC (n = 17) or PPAC (n = 23) were enrolled. The mean, 5th, 25th, 50th, 75th, 90th, and 95th percentiles and ADC(max) derived from ADC(1000) were significantly lower in the PPAC group than in the IPAC group (P < 0.05). However, values derived from ADC(800) showed no significant difference between the two groups. The 75th percentile of ADC(1000) values achieved the highest area under the curve (AUC) for differentiating IPAC from PPAC (AUC = 0.781; sensitivity, 91%; specificity, 59%; cut-off value, 1.50 x 10(-3) mm(2)/s).CONCLUSIONVolumetric ADC histogram analysis at a b-value of 1000 s/mm(2) might be helpful for differentiating the histological subtypes of periampullary adenocarcinoma before surgery.