CAJ | 학술논문

目的分析肝细胞癌(HCC)的表观扩散系数(ADC)值与组织学分化程度之间的关系,探讨ADC值评价HCC组织学分化程度的价值.方法收集2006年8月至2013年12月中山大学第三附属医院病理证实的229例HCC患者,按照肿瘤分化程度分为3组,高分化组(34例)、中分化组(170例)、低分化组(25例).所有患者均行MRI平扫、增强和DWI(1.5T,b值为0,600 s/mm2)检查,测量HCC的ADC值,并分析ADC值与组织学分化程度的关系.结果高、中、低分化HCC的ADC值分别为(1.68 ±0.13)、(1.31±0.16)、(1.08±0.11)×10-3 mm2/s,低分化组低于中、高分化组,中分化组低于高分化组(均P ＜0.05),HCC的ADC值与组织学分化程度呈显著正相关关系(r=0.693,P＜ 0.05);ROC曲线分析显示ADC值用于诊断高分化HCC的最佳临界点为1.5×10-3 mm2/s,其敏感度和特异度分别为100％和94.36％;用于诊断低分化HCC的最佳临界点为1.235×10-3 mm2/s,其敏感度和特异度分别为73.5％和96％.结论 ADC值在预测HCC的组织学分化程度方面具有重要价值.
목적 분석간세포암(HCC)적표관확산계수(ADC)치여조직학분화정도지간적관계,탐토ADC치평개HCC조직학분화정도적개치.방법 수집2006년8월지2013년12월중산대학제삼부속의원병리증실적229례HCC환자,안조종류분화정도분위3조,고분화조(34례)、중분화조(170례)、저분화조(25례).소유환자균행MRI평소、증강화DWI(1.5T,b치위0,600 s/mm2)검사,측량HCC적ADC치,병분석ADC치여조직학분화정도적관계.결과 고、중、저분화HCC적ADC치분별위(1.68 ±0.13)、(1.31±0.16)、(1.08±0.11)×10-3 mm2/s,저분화조저우중、고분화조,중분화조저우고분화조(균P ＜0.05),HCC적ADC치여조직학분화정도정현저정상관관계(r=0.693,P＜ 0.05);ROC곡선분석현시ADC치용우진단고분화HCC적최가림계점위1.5×10-3 mm2/s,기민감도화특이도분별위100％화94.36％;용우진단저분화HCC적최가림계점위1.235×10-3 mm2/s,기민감도화특이도분별위73.5％화96％.결론 ADC치재예측HCC적조직학분화정도방면구유중요개치.
Objective To determine the relationship between apparent diffusion coefficient (ADC) and histopathological differentiation of hepatocellular carcinoma (HCC).Methods Magnetic resonance examinations of magnetic resonance imaging (MRI) plain scan,LAVA dynamic enhanced scan and diffusion weighted imaging (DWI) (1.5 T,b values:0 and 600 s/mm2) were retrospectively reviewed for 229 surgically resected HCCs.Histopathology revealed 34 well,170 moderately and 25 poorly-differentiated HCCs.The incidence of each ADC value was measured.The relationship between ADC and histopathological differentiation was also evaluated.Results The ADC value of well-differentiated HCCs (1.68 ± 0.13 × 10-3 mm2/s) was significantly higher those of moderately HCCs (1.31 ±0.16 × 10-3 mm2/s) (P ＜0.05) and poorly-differentiated HCCs (1.08 ± 0.11 × 10-3 mm2/s) (p ＜ 0.05).There was a significant positive correlation between ADC value and differentiation of HCCs (r =0.693,P ＜ 0.05).ROC analysis showed that the optimal cutoff point of ADC value was 1.500 × 10 3 mm2/s in diagnosing well-differentiated HCCs.A cutoff ADC value equal to or under 1.5 × 10-3 mm2/s was used to differentiate well-differentiated HCC from moderately and poorly-differentiated ones with a sensitivity of 100％ and a specificity of 94.36％.ROC analysis showed that the optimal cutoff point of ADC value was 1.235 × 10 3 mm2/s in diagnosing poorlydifferentiated HCCs.A cutoff ADC value equal to or above 1.235 × 10-3 mm2/s was used for differentiating poorly-differentiated HCC from well and moderately-differentiated ones with a sensitivity of 73.5％ and a specificity of 96％.Conclusion In clinical practice,ADC value is important for predicting histopathological differentiation of HCC and improving its diagnostic accuracy.