胰腺癌扩散加权成像与在体磁共振质子波谱研究
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摘要
第一部分：胰腺癌小视野高分辨磁共振扩散加权成像研究
目的探讨小视野扩散加权成像（RFOV DWI）在胰腺癌诊断中的应用价值。
方法经术后病理证实的49例胰腺导管腺癌、9例腺鳞癌、6例神经内分泌癌、3例慢性肿块型胰腺炎、1例实性假乳头状瘤患者及36名健康志愿者被纳入研究，行呼吸触发RFOV DWI和常规DWI（Full FOV DWI）扫描，并分别对两者的图像诊断质量和图像伪影进行评分。使用非参数检验比较胰腺肿块组和正常胰腺组的图像RFOVDWI与常规DWI评分；比较胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的RFOV DWI测量ADC值；绘制ROC曲线判断使用RFOV DWI和常规DWI鉴别胰腺导管腺癌的诊断效能。
结果成功获得了胰腺小视野高分辨扩散加权图像，平面分辨力达到1.25x1.25mm~2。胰腺肿块组与正常胰腺组RFOV DWI图像诊断质量高于常规DWI(P=0.000），图像伪影低于常规DWI（P=0.000）。胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的RFOV DWI测量平均ADC值分别为(1.54±0.26) x10~(-3)、(1.77±0.12) x10~(-3)、(1.77±0.21) x10~(-3)、(1.27±0.19) x10~(-3)、(2.02±0.28) x10~(-3)mm~2/s，差异有统计学意义(χ~2=51.835，P=0.000)，其中导管腺癌（χ~2=45.98，P=0.00）和慢性肿块型胰腺炎（χ~2=13.4，P=0.00）的平均ADC值均低于正常胰腺组。以ADC值≤1.615x10~(-3)mm~2/s作为界值，RFOV DWI从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的灵敏度和特异度分别为65.3%和89.1%；以ADC值≤1.865x10~(-3)mm~2/s为界值，常规DWI从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的敏感性、特异性分别为87.8%和61.8%。
结论呼吸触发rFOV DWI较常规DWI图像质量和图像分辨力明显提高，其ADC值能较好反映胰腺肿块与正常胰腺的病理生理特征，可能有助于胰腺癌的早期诊断。
第二部分：胰腺癌多b值磁共振扩散加权成像研究
目的探讨多b值磁共振扩散加权成像在胰腺癌诊断中的应用价值。
方法经术后病理证实的23例胰腺导管腺癌、5例腺鳞癌、3例神经内分泌癌、3例慢性肿块型胰腺炎及20名健康志愿者被纳入研究，行呼吸触发多b值扩散加权成像扫描，b值设定为0，20s/mm~2，50s/mm~2，100s/mm~2，200s/mm~2，400s/mm~2，600s/mm~2，800s/mm~2，1000s/mm~2，应用双指数IVIM模型计算感兴趣区的f、D、D~*值并拟合出表观扩散系数ADCtot值。使用非参数检验比较导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的f、D、D~*和ADCtot值；绘制ROC曲线分别判断使用IVIM相关参数鉴别导管腺癌和正常胰腺、导管腺癌和其他胰腺肿块及正常胰腺的诊断效能。
结果胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的f值分别为(27.67±4.73)%、(28.20±5.35)%、(42.57±4.31)%、(23.83±13.17)%、(43.09±7.88)%，差异有统计学意义(χ2=34.073，P=0.000)；D值分别为0.87±0.23、1.05±0.08、0.87±0.08、0.65±0.29、0.87±0.24μm2/ms，差异无统计学意义(χ2=6.212，P=0.184)；D*值分别为3.87±1.65、3.50±0.85、5.18±1.60、4.64±1.21、9.12±4.23μm2/ms，差异有统计学意义(χ2=24.993，P=0.000)；ADCtot值分别为1.36±0.14、1.49±0.07、1.62±0.04、0.99±0.04、1.66±0.20μm2/ms，差异有统计学意义(χ2=28.092，P=0.000)。两两比较结果显示导管腺癌与正常胰腺、神经内分泌癌与肿块型胰腺炎、肿块型胰腺炎与正常胰腺的ADCtot值有统计学差异；导管腺癌与正常胰腺、腺鳞癌与正常胰腺的D~*值有统计学差异；导管腺癌与神经内分泌癌、导管腺癌与正常胰腺、腺鳞癌与正常胰腺、肿块型胰腺炎与正常胰腺的f值有统计学差异；各组间D值均无统计学差异。f、D~*和ADCtot鉴别导管腺癌和正常胰腺的ROC曲线下面积（AUC）分别为0.925、0.898和0.854，D值不具诊断效能；f、D~*和ADCtot从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的AUC分别为0.804、0.787和0.775，D值不具诊断效能。
结论灌注分数f在鉴别诊断中的价值最大，能够无创性评估组织微循环的灌注水平，可能有利于胰腺癌的早期诊断与鉴别诊断。
第三部分：胰腺癌在体磁共振质子波谱研究
目的分析胰腺癌的~1H MRS代谢特征，初步探讨利用胰腺癌代谢物定量分析对胰腺癌的诊断价值及预测肿瘤增殖活性的可能性。
方法经术后病理证实的22例胰腺导管腺癌和20名健康志愿者被纳入研究，行在体~1H-MRS扫描。分别对胰腺癌和正常胰腺的脂质相对含量（rLip，脂峰下面积与0-6ppm所有峰下面积之比）、胆碱类代谢物（CCM）和谷氨酸盐复合物（Glx）的比值（CCM/Glx）进行比较分析；对比不同分化程度胰腺癌的rLip、CCM/Glx及Ki67并探讨前两者与反映肿瘤增殖活性Ki67标记指数的相关性；绘制ROC曲线判断使用rLip、CCM/Glx鉴别胰腺导管腺癌和正常胰腺的诊断效能。
结果正常胰腺的rLip（0.600±0.078）、CCM/Glx（0.570±0.065）显著高于胰腺癌（rLip0.393±0.118，CCM/Glx0.444±0.095），P=0.000。中-高分化胰腺癌的Ki67（50.71±10.86）%、CCM/Glx（0.407±0.080）显著低于低分化导管腺癌（Ki6763.37±7.73，CCM/Glx0.497±0.092），P值分别为0.007和0.024；不同分化程度间rLip无显著性差异。直线相关分析表明，胰腺癌CCM/Glx与Ki-67标记指数具有相关关系（P=0.002）。rLip、CCM/Glx鉴别导管腺癌和正常胰腺的ROC曲线下面积（AUC）分别为0.916和0.852。
结论胰腺癌的胆碱类化合物、脂质相对含量减低，CCM/Glx比值与Ki67标记指数具有相关性，我们认为1H-MRS在预测肿瘤分化程度、增殖活性方面具有潜在价值。
Part I: Pancreatic Adenocarcinoma：high resolution diffusion-weighted magneticresonance imaging using reduced field of view
Objective: To investigate the value of reduced field-of-view diffusion weighted magneticresonance imaging (RFOV DW-MRI) in the diagnosis of pancreatic adenocarcinoma.
Methods:36healthy volunteers and49patients with pancreatic ductal adenocarcinoma(PDAC),9patients with pancreatic adenosquamous carcinoma (PASC),6patients withpancreatic neuroendocrine carcinoma (PNC),3patients with mass-forming chronicpancreatitis (MFCP),1patient with solid pseudopapillary tumor (SPT)(all proven bypathological results) underwent respiratory-triggered reduced FOV DWI and full FOVDWI at3.0T. Image quality was assessed for RFOV DWI and full FOV (FFOV) DWIwith diagnostic quality and artifacts. Apparent diffusion coefficient (ADC) values ofnormal pancreas and all types of pancreatic lesions were statistically analyzed andcompared with nonparametric test. ROC curve was used to analyze the diagnostic powerof ADC value.
Results: Higher resolution (1.25x1.25mm~2for axial images) diffusion weighted imagesof the pancreas were successfully acquired. The image quality scores for RFOV DWI wassignificantly higher than those for FFOV DWI (P=0.000), and the artifacts scores forRFOV DWI was significantly lower than those of FFOV (P=0.000). ADC values ofPDAC, PASC, PNC, MFCP and normal pancreas (NP) were (1.54±0.26) x10~(-3)、(1.77±0.12) x10~(-3)、(1.77±0.21) x10~(-3)、(1.27±0.19) x10~(-3)、(2.02±0.28) x10~(-3)mm~2/s (χ2=51.835，P=0.000). Nemenyi test showed there were significant statistical differences inADC values between PDAC and NP(χ~2=45.98，P=0.00), MFCP and NP(χ~2=13.4，P=0.00). ROC curve disclosed that the sensitivity and specificity were65.3%and89.1%,respectively, when ADC≤1.615x10~(-3)mm~2/s was used as a cut off value for differentialdiagnosis of PDAC from other pancreatic neoplasms in our study and normal pancreaswith RFOV DWI. It also showed that the sensitivity and specificity were87.8%and61.8%, respectively, when ADC≤1.865x10~(-3)mm~2/s was used as a cut off value for differential diagnosis with FFOV DWI.
Conclusion: The image quality and resolution of respiratory-triggered RFOV DWI wassignificantly higher than normal SS-EPI DWI. The ADC values from RFOV DWI werewell related to pathological features of pancreatic entity, Thus RFOV DWI may behelpful in the early diagnosis of pancreatic adenocarcinoma.
Part II:：Diffusion-weighted magnetic resonance imaging of pancreaticadenocarcinoma using multiple b-values
Objective: To investigate the value of diffusion weighted magnetic resonance imagingwith multiple b-values in the diagnosis of pancreatic adenocarcinoma.
Methods:20healthy volunteers and23patients with pancreatic ductal adenocarcinoma(PDAC),5patients with pancreatic adenosquamous carcinoma (PASC),3patients withpancreatic neuroendocrine carcinoma (PNC),3patients with mass-forming chronicpancreatitis (MFCP)(all proven by pathological results) underwent respiratory-triggeredmultipl b-values (0，20s/mm~2，50s/mm~2，100s/mm~2，200s/mm~2，400s/mm~2，600s/mm~2，800s/mm~2，1000s/mm~2) DWI at3.0T. perfusion fraction (f), pseudodiffudion coefficient(D~*), pure diffusion coefficient (D) and Apparent diffusion coefficient (ADC_tot) werecalculated by IVIM-DWI. Parameters derived by IVIM-DWI were compared amongpancreatic lesions and normal pancreas. ROC curve was used to analyze the diagnosticpower of each parameter.
Results: f of PDAC, PASC, PNC, MFCP and normal pancreas (NP) were (27.67±4.73)%,(28.20±5.35)%,(42.57±4.31)%,(23.83±13.17)%,(43.09±7.88)%,(χ~2=34.073，P=0.000).D~*of PDAC, PASC, PNC, MFCP and NP were3.87±1.65,3.50±0.85,5.18±1.60,4.64±1.21,9.12±4.23μm2/ms,(χ~2=24.993, P=0.000). D of PDAC, PASC, PNC, MFCPand NP were0.87±0.23,1.05±0.08,0.87±0.08,0.65±0.29,0.87±0.24μm~2/ms,(χ~2=6.212，P=0.184). ADC_tot of PDAC, PASC, PNC, MFCP and NP were1.36±0.14,1.49±0.07,1.62±0.04,0.99±0.04,1.66±0.20μm~2/ms,(χ~2=28.092，P=0.000). Nemenyi test showedthere were significant statistical differences in D~*between PDAC and NP, PASC and NP,in f between PDAC and PNC, PDAC and NP, PASC and NP, MFCP and NP, in ADC_tot between PDAC and NP, PNC and MFCP, MFCP and NP. There was no significantdifference berween each of two groups in D. ROC curve disclosed that the area undercurves (AUC) were0.925,0.898,0.854, and0.804,0.787,0.775for differential diagnosisof PDAC from NP, PDAC from other pancreatic neoplasms and normal pancreas with f,D~*and ADCtot, respectively. There was no diagnostic power for D.
Conclusion: f proved to be the best paremeter for differentiation between PDAC from NP,PDAC from other pancreatic neoplasms cand normal pancreas. It was well related toperfusion status in microcirculation of pancreatic entity, Thus f may be helpful in theearly diagnosis of pancreatic adenocarcinoma.
Part III：In vivo~1H Magnetic resonance spectroscopy of pancreatic adenocarcinoma
Objective: To analyze the~1H-MRS features and to explore the value of metabolitequantification in diagnosis of in-vivo pancreatic adenocarcinoma, also to determinewhether there is a correlation of pancreatic metabolism with the Ki-67labling index.
Methods:20healthy volunteers and22patients with pancreatic ductal adenocarcinoma(PDAC, proven by pathological results) underwent in-vivo~1H-MRS. The relative lipidcontent (rLip, the ratio of lipid peak area divided by peak areas from0to6ppm),choline-containing metabolites (CCM) to glutamate and glutamine complex (Glx) ratio(CCM/Glx) were compared between two groups. CCM, rLip and Ki-67labling index oftumors with varied differentiating grades were compared, and the correlation of CCM,rLip and Ki-67labling index were determined using linear regression analysis. ROCcurve was used to analyze the diagnostic power of CCM and rLip.
Results: CCM/Glx (0.570±0.065) and rLip (0.600±0.078) of NP were significantlyhigher than those of pancreatic adenocarcinoma (CCM/Glx0.444±0.095, rLip0.393±0.118), P=0.000. The Ki-67labling index [(50.71±10.86)%], CCM/Glx(0.407±0.080) of well-to-moderately differentiated tumors were significantly lower thanthose of poorly differentiated [Ki67(63.37±7.73)%, CCM/Glx0.497±0.092], P=0.007,P=0.024, respectively. There was no significant statistical differences for rLip betweendifferent grade of tumors. There is a significant linear correlation (P=0.002) between CCM/Glx and Ki-67labling index, but no significant correlation between rLip and Ki-67(P=0.069). ROC curve disclosed that the area under curves (AUC) were0.916,0.852,respectively, for differential diagnosis of PDAC from NP with rLip and CCM/Glx.Conclusion: In vivo~1H-MRS, pancreatic adenocarcinoma presented with a decrease ofCCM concentration and relative lipid content, and CCM/Glx was significantly correlatedwith Ki67labling index. Thus,~1H-MRS may have potential value in predicting thedifferentiation degree and proliferation activity of pancreatic adenocarcinoma.
目的探讨小视野扩散加权成像（RFOV DWI）在胰腺癌诊断中的应用价值。
方法经术后病理证实的49例胰腺导管腺癌、9例腺鳞癌、6例神经内分泌癌、3例慢性肿块型胰腺炎、1例实性假乳头状瘤患者及36名健康志愿者被纳入研究，行呼吸触发RFOV DWI和常规DWI（Full FOV DWI）扫描，并分别对两者的图像诊断质量和图像伪影进行评分。使用非参数检验比较胰腺肿块组和正常胰腺组的图像RFOVDWI与常规DWI评分；比较胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的RFOV DWI测量ADC值；绘制ROC曲线判断使用RFOV DWI和常规DWI鉴别胰腺导管腺癌的诊断效能。
结果成功获得了胰腺小视野高分辨扩散加权图像，平面分辨力达到1.25x1.25mm~2。胰腺肿块组与正常胰腺组RFOV DWI图像诊断质量高于常规DWI(P=0.000），图像伪影低于常规DWI（P=0.000）。胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的RFOV DWI测量平均ADC值分别为(1.54±0.26) x10~(-3)、(1.77±0.12) x10~(-3)、(1.77±0.21) x10~(-3)、(1.27±0.19) x10~(-3)、(2.02±0.28) x10~(-3)mm~2/s，差异有统计学意义(χ~2=51.835，P=0.000)，其中导管腺癌（χ~2=45.98，P=0.00）和慢性肿块型胰腺炎（χ~2=13.4，P=0.00）的平均ADC值均低于正常胰腺组。以ADC值≤1.615x10~(-3)mm~2/s作为界值，RFOV DWI从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的灵敏度和特异度分别为65.3%和89.1%；以ADC值≤1.865x10~(-3)mm~2/s为界值，常规DWI从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的敏感性、特异性分别为87.8%和61.8%。
结论呼吸触发rFOV DWI较常规DWI图像质量和图像分辨力明显提高，其ADC值能较好反映胰腺肿块与正常胰腺的病理生理特征，可能有助于胰腺癌的早期诊断。
第二部分：胰腺癌多b值磁共振扩散加权成像研究
目的探讨多b值磁共振扩散加权成像在胰腺癌诊断中的应用价值。
方法经术后病理证实的23例胰腺导管腺癌、5例腺鳞癌、3例神经内分泌癌、3例慢性肿块型胰腺炎及20名健康志愿者被纳入研究，行呼吸触发多b值扩散加权成像扫描，b值设定为0，20s/mm~2，50s/mm~2，100s/mm~2，200s/mm~2，400s/mm~2，600s/mm~2，800s/mm~2，1000s/mm~2，应用双指数IVIM模型计算感兴趣区的f、D、D~*值并拟合出表观扩散系数ADCtot值。使用非参数检验比较导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的f、D、D~*和ADCtot值；绘制ROC曲线分别判断使用IVIM相关参数鉴别导管腺癌和正常胰腺、导管腺癌和其他胰腺肿块及正常胰腺的诊断效能。
结果胰腺导管腺癌、腺鳞癌、神经内分泌癌、慢性肿块型胰腺炎和正常胰腺的f值分别为(27.67±4.73)%、(28.20±5.35)%、(42.57±4.31)%、(23.83±13.17)%、(43.09±7.88)%，差异有统计学意义(χ2=34.073，P=0.000)；D值分别为0.87±0.23、1.05±0.08、0.87±0.08、0.65±0.29、0.87±0.24μm2/ms，差异无统计学意义(χ2=6.212，P=0.184)；D*值分别为3.87±1.65、3.50±0.85、5.18±1.60、4.64±1.21、9.12±4.23μm2/ms，差异有统计学意义(χ2=24.993，P=0.000)；ADCtot值分别为1.36±0.14、1.49±0.07、1.62±0.04、0.99±0.04、1.66±0.20μm2/ms，差异有统计学意义(χ2=28.092，P=0.000)。两两比较结果显示导管腺癌与正常胰腺、神经内分泌癌与肿块型胰腺炎、肿块型胰腺炎与正常胰腺的ADCtot值有统计学差异；导管腺癌与正常胰腺、腺鳞癌与正常胰腺的D~*值有统计学差异；导管腺癌与神经内分泌癌、导管腺癌与正常胰腺、腺鳞癌与正常胰腺、肿块型胰腺炎与正常胰腺的f值有统计学差异；各组间D值均无统计学差异。f、D~*和ADCtot鉴别导管腺癌和正常胰腺的ROC曲线下面积（AUC）分别为0.925、0.898和0.854，D值不具诊断效能；f、D~*和ADCtot从其他胰腺肿块及正常胰腺中鉴别胰腺导管腺癌的AUC分别为0.804、0.787和0.775，D值不具诊断效能。
结论灌注分数f在鉴别诊断中的价值最大，能够无创性评估组织微循环的灌注水平，可能有利于胰腺癌的早期诊断与鉴别诊断。
第三部分：胰腺癌在体磁共振质子波谱研究
目的分析胰腺癌的~1H MRS代谢特征，初步探讨利用胰腺癌代谢物定量分析对胰腺癌的诊断价值及预测肿瘤增殖活性的可能性。
方法经术后病理证实的22例胰腺导管腺癌和20名健康志愿者被纳入研究，行在体~1H-MRS扫描。分别对胰腺癌和正常胰腺的脂质相对含量（rLip，脂峰下面积与0-6ppm所有峰下面积之比）、胆碱类代谢物（CCM）和谷氨酸盐复合物（Glx）的比值（CCM/Glx）进行比较分析；对比不同分化程度胰腺癌的rLip、CCM/Glx及Ki67并探讨前两者与反映肿瘤增殖活性Ki67标记指数的相关性；绘制ROC曲线判断使用rLip、CCM/Glx鉴别胰腺导管腺癌和正常胰腺的诊断效能。
结果正常胰腺的rLip（0.600±0.078）、CCM/Glx（0.570±0.065）显著高于胰腺癌（rLip0.393±0.118，CCM/Glx0.444±0.095），P=0.000。中-高分化胰腺癌的Ki67（50.71±10.86）%、CCM/Glx（0.407±0.080）显著低于低分化导管腺癌（Ki6763.37±7.73，CCM/Glx0.497±0.092），P值分别为0.007和0.024；不同分化程度间rLip无显著性差异。直线相关分析表明，胰腺癌CCM/Glx与Ki-67标记指数具有相关关系（P=0.002）。rLip、CCM/Glx鉴别导管腺癌和正常胰腺的ROC曲线下面积（AUC）分别为0.916和0.852。
结论胰腺癌的胆碱类化合物、脂质相对含量减低，CCM/Glx比值与Ki67标记指数具有相关性，我们认为1H-MRS在预测肿瘤分化程度、增殖活性方面具有潜在价值。
Part I: Pancreatic Adenocarcinoma：high resolution diffusion-weighted magneticresonance imaging using reduced field of view
Objective: To investigate the value of reduced field-of-view diffusion weighted magneticresonance imaging (RFOV DW-MRI) in the diagnosis of pancreatic adenocarcinoma.
Methods:36healthy volunteers and49patients with pancreatic ductal adenocarcinoma(PDAC),9patients with pancreatic adenosquamous carcinoma (PASC),6patients withpancreatic neuroendocrine carcinoma (PNC),3patients with mass-forming chronicpancreatitis (MFCP),1patient with solid pseudopapillary tumor (SPT)(all proven bypathological results) underwent respiratory-triggered reduced FOV DWI and full FOVDWI at3.0T. Image quality was assessed for RFOV DWI and full FOV (FFOV) DWIwith diagnostic quality and artifacts. Apparent diffusion coefficient (ADC) values ofnormal pancreas and all types of pancreatic lesions were statistically analyzed andcompared with nonparametric test. ROC curve was used to analyze the diagnostic powerof ADC value.
Results: Higher resolution (1.25x1.25mm~2for axial images) diffusion weighted imagesof the pancreas were successfully acquired. The image quality scores for RFOV DWI wassignificantly higher than those for FFOV DWI (P=0.000), and the artifacts scores forRFOV DWI was significantly lower than those of FFOV (P=0.000). ADC values ofPDAC, PASC, PNC, MFCP and normal pancreas (NP) were (1.54±0.26) x10~(-3)、(1.77±0.12) x10~(-3)、(1.77±0.21) x10~(-3)、(1.27±0.19) x10~(-3)、(2.02±0.28) x10~(-3)mm~2/s (χ2=51.835，P=0.000). Nemenyi test showed there were significant statistical differences inADC values between PDAC and NP(χ~2=45.98，P=0.00), MFCP and NP(χ~2=13.4，P=0.00). ROC curve disclosed that the sensitivity and specificity were65.3%and89.1%,respectively, when ADC≤1.615x10~(-3)mm~2/s was used as a cut off value for differentialdiagnosis of PDAC from other pancreatic neoplasms in our study and normal pancreaswith RFOV DWI. It also showed that the sensitivity and specificity were87.8%and61.8%, respectively, when ADC≤1.865x10~(-3)mm~2/s was used as a cut off value for differential diagnosis with FFOV DWI.
Conclusion: The image quality and resolution of respiratory-triggered RFOV DWI wassignificantly higher than normal SS-EPI DWI. The ADC values from RFOV DWI werewell related to pathological features of pancreatic entity, Thus RFOV DWI may behelpful in the early diagnosis of pancreatic adenocarcinoma.
Part II:：Diffusion-weighted magnetic resonance imaging of pancreaticadenocarcinoma using multiple b-values
Objective: To investigate the value of diffusion weighted magnetic resonance imagingwith multiple b-values in the diagnosis of pancreatic adenocarcinoma.
Methods:20healthy volunteers and23patients with pancreatic ductal adenocarcinoma(PDAC),5patients with pancreatic adenosquamous carcinoma (PASC),3patients withpancreatic neuroendocrine carcinoma (PNC),3patients with mass-forming chronicpancreatitis (MFCP)(all proven by pathological results) underwent respiratory-triggeredmultipl b-values (0，20s/mm~2，50s/mm~2，100s/mm~2，200s/mm~2，400s/mm~2，600s/mm~2，800s/mm~2，1000s/mm~2) DWI at3.0T. perfusion fraction (f), pseudodiffudion coefficient(D~*), pure diffusion coefficient (D) and Apparent diffusion coefficient (ADC_tot) werecalculated by IVIM-DWI. Parameters derived by IVIM-DWI were compared amongpancreatic lesions and normal pancreas. ROC curve was used to analyze the diagnosticpower of each parameter.
Results: f of PDAC, PASC, PNC, MFCP and normal pancreas (NP) were (27.67±4.73)%,(28.20±5.35)%,(42.57±4.31)%,(23.83±13.17)%,(43.09±7.88)%,(χ~2=34.073，P=0.000).D~*of PDAC, PASC, PNC, MFCP and NP were3.87±1.65,3.50±0.85,5.18±1.60,4.64±1.21,9.12±4.23μm2/ms,(χ~2=24.993, P=0.000). D of PDAC, PASC, PNC, MFCPand NP were0.87±0.23,1.05±0.08,0.87±0.08,0.65±0.29,0.87±0.24μm~2/ms,(χ~2=6.212，P=0.184). ADC_tot of PDAC, PASC, PNC, MFCP and NP were1.36±0.14,1.49±0.07,1.62±0.04,0.99±0.04,1.66±0.20μm~2/ms,(χ~2=28.092，P=0.000). Nemenyi test showedthere were significant statistical differences in D~*between PDAC and NP, PASC and NP,in f between PDAC and PNC, PDAC and NP, PASC and NP, MFCP and NP, in ADC_tot between PDAC and NP, PNC and MFCP, MFCP and NP. There was no significantdifference berween each of two groups in D. ROC curve disclosed that the area undercurves (AUC) were0.925,0.898,0.854, and0.804,0.787,0.775for differential diagnosisof PDAC from NP, PDAC from other pancreatic neoplasms and normal pancreas with f,D~*and ADCtot, respectively. There was no diagnostic power for D.
Conclusion: f proved to be the best paremeter for differentiation between PDAC from NP,PDAC from other pancreatic neoplasms cand normal pancreas. It was well related toperfusion status in microcirculation of pancreatic entity, Thus f may be helpful in theearly diagnosis of pancreatic adenocarcinoma.
Part III：In vivo~1H Magnetic resonance spectroscopy of pancreatic adenocarcinoma
Objective: To analyze the~1H-MRS features and to explore the value of metabolitequantification in diagnosis of in-vivo pancreatic adenocarcinoma, also to determinewhether there is a correlation of pancreatic metabolism with the Ki-67labling index.
Methods:20healthy volunteers and22patients with pancreatic ductal adenocarcinoma(PDAC, proven by pathological results) underwent in-vivo~1H-MRS. The relative lipidcontent (rLip, the ratio of lipid peak area divided by peak areas from0to6ppm),choline-containing metabolites (CCM) to glutamate and glutamine complex (Glx) ratio(CCM/Glx) were compared between two groups. CCM, rLip and Ki-67labling index oftumors with varied differentiating grades were compared, and the correlation of CCM,rLip and Ki-67labling index were determined using linear regression analysis. ROCcurve was used to analyze the diagnostic power of CCM and rLip.
Results: CCM/Glx (0.570±0.065) and rLip (0.600±0.078) of NP were significantlyhigher than those of pancreatic adenocarcinoma (CCM/Glx0.444±0.095, rLip0.393±0.118), P=0.000. The Ki-67labling index [(50.71±10.86)%], CCM/Glx(0.407±0.080) of well-to-moderately differentiated tumors were significantly lower thanthose of poorly differentiated [Ki67(63.37±7.73)%, CCM/Glx0.497±0.092], P=0.007,P=0.024, respectively. There was no significant statistical differences for rLip betweendifferent grade of tumors. There is a significant linear correlation (P=0.002) between CCM/Glx and Ki-67labling index, but no significant correlation between rLip and Ki-67(P=0.069). ROC curve disclosed that the area under curves (AUC) were0.916,0.852,respectively, for differential diagnosis of PDAC from NP with rLip and CCM/Glx.Conclusion: In vivo~1H-MRS, pancreatic adenocarcinoma presented with a decrease ofCCM concentration and relative lipid content, and CCM/Glx was significantly correlatedwith Ki67labling index. Thus,~1H-MRS may have potential value in predicting thedifferentiation degree and proliferation activity of pancreatic adenocarcinoma.
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