CAJ | 학술논문

目的：评估感兴趣区（ROI）不同设置方法对肝癌（HCC）患者 TACE术治疗前后ADC值测量及观察者之间变异的影响。方法36例经病理证实中晚期肝癌患者于肝动脉栓塞化疗（TACE）术前、术后1个月行扩散加权成像检查（ b ＝1000）。两位有经验的放射科医生通过三种不同 ROI 设置方法对肝癌病灶行 ADC 值测量，这三种方法分别为：整体容积法、最大层面法、多个小样本法，最后对不同 ROI 设置方法测量的平均 ADC ± SD 值及观察者之间变异的差异用组内相关系数（ICC）进行对比分析。结果三种 ROI 设置方法在不同观察者间均存在较好的一致性（ P ＞0．05，ICC ＝0.99）。整体容积法 ROI 的 ICC 在 TACE 术前非常好（0．91），在 TACE 术后良好（0．79），单层最大层面法在 TACE 术前、后的 ICC 分别为 0．77 和 0．63，多个小样本法的 ICC 分别为 0．76 和 0．37。多个小样本法 TACE 术前 ADC 值低于整体容积法或最大层面法。 TACE 术后的 ADC 值在整体容积、最大层面或多个小样本 ROI 间差异无统计学意义。整体容积和最大层面 ROI 的 SD 显著大于多个小样本 ROI 。结论 ROI 设置大小和位置对肿瘤的 ADC 值测量和观察者间变异有相当大的影响。 TACE 术后观察者间变异性更大。整体容积法获得的肿瘤 ADC 值最具可重复性的结果。
목적：평고감흥취구（ROI）불동설치방법대간암（HCC）환자 TACE술치료전후ADC치측량급관찰자지간변이적영향。방법36례경병리증실중만기간암환자우간동맥전새화료（TACE）술전、술후1개월행확산가권성상검사（ b ＝1000）。량위유경험적방사과의생통과삼충불동 ROI 설치방법대간암병조행 ADC 치측량，저삼충방법분별위：정체용적법、최대층면법、다개소양본법，최후대불동 ROI 설치방법측량적평균 ADC ± SD 치급관찰자지간변이적차이용조내상관계수（ICC）진행대비분석。결과삼충 ROI 설치방법재불동관찰자간균존재교호적일치성（ P ＞0．05，ICC ＝0.99）。정체용적법 ROI 적 ICC 재 TACE 술전비상호（0．91），재 TACE 술후량호（0．79），단층최대층면법재 TACE 술전、후적 ICC 분별위 0．77 화 0．63，다개소양본법적 ICC 분별위 0．76 화 0．37。다개소양본법 TACE 술전 ADC 치저우정체용적법혹최대층면법。 TACE 술후적 ADC 치재정체용적、최대층면혹다개소양본 ROI 간차이무통계학의의。정체용적화최대층면 ROI 적 SD 현저대우다개소양본 ROI 。결론 ROI 설치대소화위치대종류적 ADC 치측량화관찰자간변이유상당대적영향。 TACE 술후관찰자간변이성경대。정체용적법획득적종류 ADC 치최구가중복성적결과。
Objective To assess the influence of region of interest (ROI) size and positioning on tumour ADC measure‐ments and interobserver variability in patients with liver tumors before and after Transcatheter arterial chemoembolization (TACE) .Methods Thirty‐six cases confirmed by pathology terminal‐stage liver cancer patients were included .Patients underwent MRI including DWI ( b = 0 ,600 ,1000) before and one months after TACE .Two readers measured mean tumour ADCs (pre‐ and post‐TACE) according to three ROI protocols :whole‐volume ,single‐slice or small solid samples . The three protocols were compared for differences in ADC ,SD and interobserver variability (measured as the intraclass correlation coefficient ;ICC) .Results Three methods of ROI set there were good consistency between different observers ( P > 0.05 ,ICC = 0 .99) .ICC for the whole‐volume ROIs was excellent (0 .91) pre‐CRT versus good (0 .79) post‐CRT . ICCs were 0 .77 and 0 .63 for the single‐slice ROIs versus 0 .76 and 0 .37 for the sample ROIs .Pre‐CRT ADCs for the sample ROIs were significantly lower than for the whole‐volume or single‐slice ROIs .Post‐CRT there were no significant differences between the whole‐volume ROIs and the single‐slice or sample ROIs ,respectively .The SDs for the whole‐vol‐ume and single‐slice ROIs were significantly larger than for the sample ROIs .Conclusion ROI size and positioning have a considerable influence on tumour ADC values and interobserver variability .Interobserver variability is worse after TACE . ADCs obtained from the whole tumour volume provide the most reproducible results .