Intravoxel incoherent motion (IVIM) in evaluation of breast lesions: Comparison with conventional DWI
Intravoxel incoherent motion (IVIM) in evaluation of breast lesions: Comparison with conventional DWI
复制标题
体素不相干运动（IVIM）在乳腺病变评估中的应用：与传统 DWI 的比较
DOI：
10.1016/j.ejrad.2013.08.006
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发表时间：
2013-12-01
影响因子：
3.3
通讯作者：
Huang, Biao
中科院分区：
文献类型：
--
作者：
Liu, Chunling;Liang, Changhong;Huang, Biao
目的：通过对多b值扩散加权成像（DWI）进行双指数分析的体素内不相干运动（IVIM）成像，获取正常乳腺组织和乳腺病变的灌注以及扩散信息，并将这些参数与单指数分析所得的表观扩散系数（ADC）在区分良性病变和恶性肿瘤的能力方面进行比较。
材料与方法：在这项前瞻性研究中，获得了所有患者的知情同意。84例患者（其中有40个恶性肿瘤、41个良性病变、30个单纯囊肿和39个正常乳腺组织）在1.5T场强下利用对比增强磁共振成像（MRI）和采用12个b值（范围：0 - 1000 s/mm²）的DWI进行成像。使用分段双指数分析计算组织扩散率（D）、灌注分数（f）和伪扩散系数（D*）。通过对DWI数据进行单指数拟合计算ADC（b = 0和1000 s/mm²）。获取正常乳腺组织、单纯囊肿、良性病变和恶性肿瘤的D、f、D*和ADC值。对所有DWI参数进行受试者工作特征分析。
结果：两位观察者之间的测量结果具有良好的观察者间一致性。恶性肿瘤、良性病变、单纯囊肿和正常乳腺组织之间的D值存在显著差异（P = 0.000），f、D*和ADC值也有相同结果。这4个参数在每一对之间的进一步比较如下。恶性肿瘤的D和ADC值显著小于良性病变、单纯囊肿和正常组织（分别为P = 0.000）。恶性肿瘤的f值显著高于良性病变、单纯囊肿和正常乳腺组织（P = 0.001，P = 0.000和P = 0.000）。D和ADC值在区分良性病变和恶性肿瘤方面表现出更高的敏感性和特异性，曲线下面积（AUC）分别为0.952和0.945，而f和D*的AUC较低，分别为0.723和0.630。结合f和D值的敏感性可达98.75%。
结论：与单纯囊肿的单指数拟合相比，发现恶性肿瘤、良性病变和正常腺纤维组织的DWI响应曲线符合双指数拟合。IVIM为细胞性提供了D的单独定量测量，为血管性提供了f和D*的定量测量，有助于区分乳腺良恶性病变。（C）2013由爱思唯尔爱尔兰有限公司出版
Objectives: To obtain perfusion as well as diffusion information in normal breast tissues and breast lesions from intravoxel incoherent motion (IVIM) imaging with biexponential analysis of multiple b-value diffusion-weighted imaging (DWI) and compare these parameters to apparent diffusion coefficient (ADC) obtained with monoexponential analysis in their ability to discriminate benign lesions and malignant tumors.Materials and methods: In this prospective study, informed consent was acquired from all patients. Eighty-four patients with 40 malignant tumors, 41 benign lesions, 30 simple cysts and 39 normal breast tissues were imaged at 1.5T utilizing contrast-enhanced magnetic resonance imaging (MRI) and DWI using 12 b values (range: 0-1000 s/mm(2)). Tissue diffusivity (D), perfusion fraction (f) and pseudo-diffusion coefficient (D*) were calculated using segmented biexponential analysis. ADC (b = 0 and 1000 s/mm(2)) was calculated with monoexponential fitting of the DWI data. D, f, D* and ADC values were obtained for normal breast tissues, simple cysts, benign lesions and malignant tumors. Receiver operating characteristic analysis was performed for all DWI parameters.Results: There was good interobserver agreement on the measurements between the 2 observers. D values were significantly different among malignant tumors, benign lesions, simple cysts and normal breast tissues (P = 0.000) and it was the same result for f, D* and ADC values. Further comparisons of these 4 parameters between every single pair were as the following. D and ADC values of malignant tumors were significantly smaller than those of benign lesions, simple cysts and normal tissues (P = 0.000, respectively). The f value of malignant tumors was significantly higher than that of benign lesions, simple cysts and normal breast tissues (P = 0.001, P = 0.000, and P = 0.000). D and ADC values demonstrated higher sensitivity and specificity in differentiating benign lesions and malignant tumors, with area under the curve (AUC) of 0.952 and 0.945, respectively, while f and D* with the lower AUC of 0.723 and 0.630, respectively. Combining f and D values had a sensitivity up to 98.75%.Conclusion: DWI response curves in malignant tumors, benign lesions and normal fibroglandular tissues are found to be biexponential fit in comparison with the monoexponential fit for simple cysts. IVIM provides separate quantitative measurement of D for cellularity and f and D* for vascularity and is helpful for differentiation between benign and malignant breast lesions. (C) 2013 Published by Elsevier Ireland Ltd.