摘要目的：探讨IVIM-DWI诊断和鉴别胰腺癌和胰腺神经内分泌肿瘤的最佳量化参数。材料与方法：应用GE Discovery MR750 3.0T磁共振扫描仪对手术证实的22例胰腺癌和17例胰腺神经内分泌肿瘤患者行胰腺多b值DWI。应用IVIM双指数模型测量胰腺癌和胰腺神经内分泌肿瘤与非瘤区胰腺组织的表观扩散系数（ADC）、纯扩散系数（D）、假扩散系数（D*）和灌注分数（?覼），并应用单因素方差分析进行统计学分析。结果：胰腺癌的ADC和?覼低于非癌区胰腺组织（0.803×10-3 mm2/s vs 0.974×10-3 mm2/s；54.527% vs 64.486%），D高于非癌区胰腺组织（0.659×10-3 mm2/s vs 0.535×10-3 mm2/s），鉴别胰腺癌和非癌区胰腺组织时D诊断效能最高。胰腺神经内分泌肿瘤的ADC、D和?覼均高于非瘤区胰腺组织（0.933×10-3 mm2/s vs 0.753×10-3 mm2/s；0.549×10-3 mm2/s vs 0.429×10-3 mm2/s；67.275% vs 59.655%），鉴别胰腺神经内分泌肿瘤和非瘤区胰腺组织时ADC诊断效能最高。胰腺癌的ADC、D*和?覼低于胰腺神经内分泌肿瘤（0.803×10-3 mm2/s vs 0.933×10-3 mm2/s；4.852×10-3 mm2/s vs 11.301×10-3 mm2/s；54.527% vs 67.275%），鉴别胰腺癌和神经内分泌肿瘤是D*诊断效能最高。胰腺癌的D*明显低于G2～3期胰腺神经内分泌肿瘤（4.852×10-3 mm2/s vs 11.937×10-3 mm2/s）。结论：IVIM-DWI相关参数（ADC、D*、D、?覼）可以有效鉴别胰腺癌和胰腺神经内分泌肿瘤与非瘤区胰腺组织，IVIM-DWI是无创性诊断和鉴别胰腺癌和胰腺神经内分泌肿瘤的理想方法之一。
Abstract：Objective: To explore the optimal quantitative parameters obtained from IVIM-DWI for diagnosing and differentiating pancreatic cancer and neuroendocrine tumor. Methods: Subjects comprised 22 patients with pancreatic cancer and 17 patients with pancreatic neuroendocrine tumors, All the patients were confirmed by surgery. Pancreas multiple b value DWI was performed using GE Discovery MR750 3.0T scanner. Apparent diffusion coefficient(ADC), pure diffusion constant(D), pseudodiffusion coefficient(D*) and perfusion fraction(f) were calculated by using IVIM model. Parameters obtained from IVIM-DWI were tested by One-Way ANOVA. Results: ADC and f values of pancreatic cancer were lower than non-cancerous pancreatic tissue(0.803×10-3 mm2/s vs 0.974×10-3 mm2/s; 54.527% vs 64.486%, respectively). D of pancreatic cancer was higher than non-cancerous pancreatic tissue(0.659×10-3 mm2/s vs 0.535×10-3 mm2/s). D is superior to ADC and f for the differentiation between pancreatic cancer and non-cancerous pancreas. ADC, D and f values of pancreatic neuroendocrine tumor were higher than non-tumorous pancreatic tissue(0.933×10-3 mm2/s vs 0.753×10-3 mm2/s; 0.549×10-3 mm2/s vs 0.429×10-3 mm2/s; 67.275% vs 59.655%, respectively). ADC is superior to D and f for the differentiation between pancreatic neuroendocrine tumor and non-tumorous pancreas. ADC, D* and f values of pancreatic cancer were lower than pancreatic neuroendocrine tumor(0.803×10-3 mm2/s vs 0.933×10-3 mm2/s; 4.852×10-3 mm2/s vs 11.301×10-3 mm2/s; 54.527% vs 67.275%, respectively). D* is superior to ADC and f for the differentiation between pancreatic cancer and neuroendocrine tumor. D* value of pancreatic cancer was significantly lower than G2～3 grade pancreatic neuroendocrine tumor(4.852×10-3 mm2/s vs 11.937×10-3 mm2/s). Conclusion: Quantitative parameters ADC, D, D* and f obtained from IVIM-DWI can diagnose and differentiate pancreatic cancer, neuroendocrine tumor and non-cancerous pancreatic tissue. IVIM-DWI may be a promising and non-invasive tool for diagnosing and differentiating pancreatic carcinoma and neuroendocrine tumor.
马婉玲，赵娓娓，宦 怡，魏梦绮，任 静，杨 勇，张劲松，潘 奇，张广文，董军强. IVIM-DWI在胰腺癌和神经内分泌肿瘤诊断和鉴别中的应用价值[J]. 中国临床医学影像杂志, 2017, 28(1): 49-54.
MA Wan-ling, ZHAO Wei-wei, HUAN Yi, WEI Meng-qi, REN Jing, YANG Yong, ZHANG Jin-song,PAN Qi, ZHANG Guang-wen, DONG Jun-qiang. The application value of IVIM-DWI for diagnosing and differentiating pancreatic cancer and neuroendocrine tumor. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(1): 49-54.
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