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目的对直肠癌高b值(>200 s/mm~2)进行初步的优化,观察高b值变化对直肠癌体素内不相干运动成像(IVIM)参数的影响。方法前瞻性研究22例直肠腺癌患者。由一名从事消化道肿瘤影像诊断专业10年的医生,选取全部16个b值(A组:0、10、20、30、40、60、80、100、150、200、400、800、1000、1200、1500、2000)后,在b值=800的IVIM序列图像上选取肿瘤实性成分最大的层面用于测量。保持感兴趣区(ROI)不变,分别再次重新选取14个b值(B组:0、10、20、30、40、60、80、100、150、200、400、800、1000、1200)和12个b值(C组:0、10、20、30、40、60、80、100、150、200、400、800),软件分别自动生成相应的IVIM参数图及参数,同样的步骤间隔一周后由同一医生分别再重复测量一次。取每次测量的平均值用于分析。采用Bland-Altman图对同一医生间隔1周前后两次测量数据的一致性及可重复性进行分析。对A、B、C三组IVIM参数的平均值进行单因素方差分析(ANOVA),同时进行Bonferroni组间比较,以P<0.05认为差异有统计学意义。结果三组间比较,D*值95%一致性界限在A、B组和A、C组组间波动相对较大。ADC、D值95%一致性界限组间波动均不明显。ADC、D、D*值的单因素方差分析结果 P值均<0.05,差异具有统计学意义。f值A、B、C三组单因素方差分析P值>0.05,差异没有统计学意义。Bonferroni组间比较,D、D*、f值在A组和B组间均没有统计学差异。随着高b值数目的减少,ADC、D、D*值及标准误增加,f值变化不明显。结论直肠癌IVIM成像高b值变化对参数测量的可重复性影响不明显。b值>1500的选取价值有待进一步研究。
Objective To optimize the high b value (> 200 s / mm ~ 2) of rectal cancer and observe the influence of high b value on the parameters of IVIM in rectum. Methods Prospective study of 22 patients with rectal adenocarcinoma. By a doctor engaged in imaging diagnosis of gastrointestinal tumors for 10 years, select all 16 b values (A group: 0,10,20,30,40,60,80,100,150,200,400,800,1000 , 1200, 1500, 2000), the slice with the largest solid component of the tumor was selected for measurement on the IVIM sequence image with b value = 800. Keeping ROI unchanged, re-select 14 b values again (group B: 0,10,20,30,40,60,80,100,150,200,400,800,1000,1200) And 12 b values (group C: 0,10,20,30,40,60,80,100,150,200,400,800). The software automatically generates the corresponding IVIM parameter maps and parameters, and the same step interval One week later, the same doctor repeated the measurements again. Take the average of each measurement for analysis. The Bland-Altman plot was used to analyze the consistency and repeatability of the two measurements taken by the same physician one week apart. One-way analysis of variance (ANOVA) was performed on the mean values of IVIM parameters in groups A, B, and C, and Bonferroni groups were compared at the same time. The difference was statistically significant at P <0.05. Results Among the three groups, the 95% consistency threshold of D * value fluctuated relatively between A, B and A, C groups. ADC, D value of 95% consistency between the limits of the group fluctuations are not obvious. The single factor ANOVA results of ADC, D, D * were P <0.05, the difference was statistically significant. f value A, B, C three groups ANOVA P value> 0.05, the difference was not statistically significant. Bonferroni comparison between groups, D, D *, f value in the A and B groups were not statistically different. With the decrease of the number of high b values, the values of ADC, D, D * and standard errors increase, but the changes of f values are not obvious. Conclusion The high b value of IVIM imaging in rectal cancer has no obvious effect on the repeatability of parameter measurement. The value of b> 1500 is for further study.