CAJ | 학술논문

目的：探究磁共振扩散加权成像(DWI)表观扩散系数(ADC)与胰腺导管腺癌分化程度之间的关系。方法回顾性分析术后病理证实的75名胰腺导管腺癌患者(男性39名，女性36名，年龄36-76岁；中分化55名，低分化20名)及胰腺正常志愿者49名(男性29名，女性20名，年龄21-62岁)DWI(b值为0，600s/mm2)，计算及测量正常胰腺头、体及尾部ADC和胰腺癌实性组织ADC。采用独立样本非参数Mann-Whitney U检验比较胰腺癌组与正常胰腺组ADC、胰腺癌中分化与低分化组ADC差异。ROC分析ADC诊断胰腺癌效能。结果胰腺癌平均ADC(1.36±0.14)×10-3mm2/s，与正常胰腺头、体及尾部ADC(分别为1.66±0.34、1.77±0.36、1.62±0.38×10-3mm2/s)差异皆具有统计学意义(P值皆=0.000)。胰腺癌中分化组与低分化组ADC(分别为1.36±0.14和1.35±0.13×10-3mm2/s)差异不具有统计学意义(P=0.657)。以正常胰腺平均ADC为参考，ROC分析胰腺癌ADC曲线下面积为0.863，95%可信区间为79.5%-93.1%， ADC≤1.492×10-3mm2/s作为诊断胰腺癌的临界值，敏感度和特异度分别为75.5%和85.3%。结论 DWI对胰腺导管腺癌有较好的诊断价值；ADC值不能用于预测胰腺导管腺癌分化程度。
목적：탐구자공진확산가권성상(DWI)표관확산계수(ADC)여이선도관선암분화정도지간적관계。방법회고성분석술후병리증실적75명이선도관선암환자(남성39명，녀성36명，년령36-76세；중분화55명，저분화20명)급이선정상지원자49명(남성29명，녀성20명，년령21-62세)DWI(b치위0，600s/mm2)，계산급측량정상이선두、체급미부ADC화이선암실성조직ADC。채용독립양본비삼수Mann-Whitney U검험비교이선암조여정상이선조ADC、이선암중분화여저분화조ADC차이。ROC분석ADC진단이선암효능。결과이선암평균ADC(1.36±0.14)×10-3mm2/s，여정상이선두、체급미부ADC(분별위1.66±0.34、1.77±0.36、1.62±0.38×10-3mm2/s)차이개구유통계학의의(P치개=0.000)。이선암중분화조여저분화조ADC(분별위1.36±0.14화1.35±0.13×10-3mm2/s)차이불구유통계학의의(P=0.657)。이정상이선평균ADC위삼고，ROC분석이선암ADC곡선하면적위0.863，95%가신구간위79.5%-93.1%， ADC≤1.492×10-3mm2/s작위진단이선암적림계치，민감도화특이도분별위75.5%화85.3%。결론 DWI대이선도관선암유교호적진단개치；ADC치불능용우예측이선도관선암분화정도。
Objective To evaluate the clinical usefulness of diffusion-weighted magnetic resonance imaging (DWI) in patients with pancreatic cancer by comparing the apparent diffusion coefficient (ADC) value with tumor differentiation. Methods 75 patients (39 Males, 26 Females; age range 36-76 years) with histologically confirmed pancreatic ductal adenocarcinoma (55 with moderately differentiated tumors and 20 with poorly differentiated tumors) and 49 healthy volunteers (29 Males, 20 Females;age range 21-62 years) underwent respiratory triggered DWI at 3.0 T before surgery. Apparent diffusion coefficient (ADC) values of normal pancreas head, body and tail as well as ADC values of the pancreatic adenocarcinomas were calculated and measured. The ADC values of normal pancreas and tumors were statistically analyzed and compared using Mann-Whitney U test. Comparison of two data sets of the tumor differentiation was also performed using Mann-Whitney U test. ROC curve was used to analyze the diagnostic power of ADC value. Results Mann-Whitney U tests showed ADC values differed significantly between pancreatic adenocarcinoma group [(1.36±0.14)×10-3mm2/s] and normal pancreas head, body or tail groups[(1.66±0.34), (1.77±0.36), (1.62±0.38)×10-3mm2/s, respectively] (all of the P=0.000). However, no association between ADC values of pancreatic adenocarcinoma and tumor differentiation was observed. With the global ADC values of normal pancreas as a reference, the area under the curve and the 95%confidence interval of ROC analysis were 0.863 and 79.5%-93.1%, respectively. The sensitivity and specificity were 75.5% and 85.3%, when ADC≤1.815×10-3mm2/s was used as the cutoff value for the differential diagnosis of pancreatic adenocarcinoma from normal pancreas. Conclusion DWI had a better diagnostic accuracy in the diagnosis of pancreatic ductal adenocarcinoma. Although ADC values are significantly different between benign pancreas and pancreatic adenocarcinoma, no associations between ADC values and tumor differentiation were observed.