CAJ | 학술논문

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)参数在肾脏的良恶性肿瘤鉴别诊断中的应用价值.方法回顾分析解放军总医院2013年9月至2014年2月间临床怀疑肾脏占位并进行磁共振扫描,手术病理结果均为肾脏肿瘤的45例患者.分为3组,每组15例,第1组为良性肿瘤组,病理结果均为血管平滑肌脂肪瘤,第2组为透明细胞癌组,病理均为肾脏透明细胞癌,第3组为非透明细胞癌组,病理为肾脏非透明细胞癌,包括肾嫌色细胞癌(CRCC)9例,乳头状肾细胞痛(PRCC6)6例.以上所有患者均在3.0T磁共振扫描仪上接受了9个b值的IVIM-DWI扫描(b值的设定为0、20、50、100、150、200、400、600、800 s/mm2),应用IVIM模型计算并比较所得的参数在3组之间的差异.结果快速ADC (D*)值依次为(33.31±18.21)×11-3mm2/s,(30.03±18.83)×10-3mm2/s,(17.83±17.30)×10-3mm2/s,其中良性肿瘤组与非透明细胞癌组的差异有统计学意义(P＜0.05),而良性肿瘤组与透明细胞癌组,透明细胞癌组与非透明细胞癌组之间差异无统计学意义.慢速ADC (D)值依次为(0.78 ±0.31)×11-3mm2/s,(1.83±1.56)×10-3mm2/s,(0.96 ±0.25)×10-3mm2/s,3组中良性肿瘤组与透明细胞癌组,以及透明细胞癌组与非透明细胞癌组的差异均有统计学意义(均P＜0.05),而良性肿瘤组与非透明细胞癌组的差异无统计学意义.灌注相关体积分数ADC(f)值在3组的数值依次为33.5％±0.12％、25.2％ ±0.09％、25.7％±0.15％,3组之间的差异均无统计学意义.结论 IVIM-DWI的3个不同参数中,快速ADC值在肾脏肿瘤的良性与恶性(非透明细胞癌)的鉴别诊断中具有一定的意义,慢速ADC值在肾脏恶性肿瘤的透明细胞癌与非透明细胞癌的鉴别诊断中具有一定的意义,两者的综合应用可以为肾脏肿瘤的定性诊断提供一定的依据.
목적 탐토체소내불상간운동확산가권성상(IVIM-DWI)삼수재신장적량악성종류감별진단중적응용개치.방법 회고분석해방군총의원2013년9월지2014년2월간림상부의신장점위병진행자공진소묘,수술병리결과균위신장종류적45례환자.분위3조,매조15례,제1조위량성종류조,병리결과균위혈관평활기지방류,제2조위투명세포암조,병리균위신장투명세포암,제3조위비투명세포암조,병리위신장비투명세포암,포괄신혐색세포암(CRCC)9례,유두상신세포통(PRCC6)6례.이상소유환자균재3.0T자공진소묘의상접수료9개b치적IVIM-DWI소묘(b치적설정위0、20、50、100、150、200、400、600、800 s/mm2),응용IVIM모형계산병비교소득적삼수재3조지간적차이.결과 쾌속ADC (D*)치의차위(33.31±18.21)×11-3mm2/s,(30.03±18.83)×10-3mm2/s,(17.83±17.30)×10-3mm2/s,기중량성종류조여비투명세포암조적차이유통계학의의(P＜0.05),이량성종류조여투명세포암조,투명세포암조여비투명세포암조지간차이무통계학의의.만속ADC (D)치의차위(0.78 ±0.31)×11-3mm2/s,(1.83±1.56)×10-3mm2/s,(0.96 ±0.25)×10-3mm2/s,3조중량성종류조여투명세포암조,이급투명세포암조여비투명세포암조적차이균유통계학의의(균P＜0.05),이량성종류조여비투명세포암조적차이무통계학의의.관주상관체적분수ADC(f)치재3조적수치의차위33.5％±0.12％、25.2％ ±0.09％、25.7％±0.15％,3조지간적차이균무통계학의의.결론 IVIM-DWI적3개불동삼수중,쾌속ADC치재신장종류적량성여악성(비투명세포암)적감별진단중구유일정적의의,만속ADC치재신장악성종류적투명세포암여비투명세포암적감별진단중구유일정적의의,량자적종합응용가이위신장종류적정성진단제공일정적의거.
Objective To evaluate the performance of intravoxel incoherent motion (IVIM) diffusion-weighted MR imaging in the differential diagnosis of Angiomyolipoma (AML),clear cell renal cell carcinoma(clear cell RCC) and non-clear cell renal cell carcinoma(non-clear cell RCC).Method Forty-five patients were enrolled and classified into three groups according to the surgical pathology results.There were even amount of subjects (15) in each group of AML group,clear cell RCC group and non-clear cell RCC group(including 6 Papillary RCC and 9 Chromophobe RCC).ALL the patients underwent respiratory-triggered DWI on 3.0T MR system using multi b-values of 0,20,50,100,150,200,400,600,800 sec/mm2.Pure molecular-based (D),perfusion-related (D*) and vascular fraction(f) were calculated using a biexponential model.Comparisons of derived parameters derived by IVIM-DWI among three groups were performed using One-way ANOVA.Results D in clear cell RCC (1.8 ± 1.5) × 10-3 mm2/s was significantly higher than that in AML (0.7 ± 0.3) × 10-3mm2/s or non-clear cell RCC (0.9 ± 0.3) × 10-3 mm2/s(P ＜0.05),while no statistical difference was observed between AML and non-clear cell RCC(P =0.807).D* demonstrated significant difference between AML (33.3 ± 18.2) × 10-3mm2/s and non-clear cell RCC (17.8 ± 17.3) × 10-3mm2/s,(P ＜ 0.05).No observed significant difference in f was revealed between any two groups.Conclusion Pure water molecules (true diffusion) and capillary microcirculation (pseudo-diffusion) may result in the observed difference of parameters in these three types of reaal tumors.D value can contribute to differentiate the clear cell RCC from AML,and between clear cell and non-clear cell RCC as well.D * value may be applied to differentiate AML from non-clear cell RCC.