Diagnostic Value Of IVIM - DWI And DKI In Pathological Grade Of Extrahepatic Cholangiocarcinoma

The first part:application of IVIM-DWI in grading of extrahepatic cholangiocarcinomaObjective To evaluate the association of DWI derived apparent diffusion coefficient(ADC) and intravoxel incoherent motion(IVIM) derived parameters BF、D、D*、? value with the histologic grade of extrahepatic cholangiocarcinoma and compare the diagnostic potential of parameters. Methods Thirty-eight consecutive patients with surgically resected and pathologically confirmed extrahepatic cholangiocarcinoma were included in this study. All patients underwent preoperative upper abdomen 3.0-T magnetic resonance imaging, including IVIM diffusion-weighted imaging. The ADC and IVIM derived parameters BF, D, D*, ?were calculated. Compared with histologic grade(well-differentiated, moderately differentiated and poorly differentiated adenocarcinoma), evaluate the association and compare the diagnostic potential of parameters by using receiver operating characteristic(ROC) analysis. Results 38 cases of extrahepatic cholangiocarcinoma(EHCC) include: grade I(well-differentiated adenocarcinoma) 11 cases, grade II(moderately differentiated adenocarcinoma) 15 cases, grade III(poorly differentiated adenocarcinoma) 12 cases. Grade I group lesions parameters ADC, BF, D, D*, ?values were(1.33±0.22) ×10-3mm2/s,(2.40±1.01) ×10-3mm2/s,(1.30±0.13) ×10-3mm2/s,(5.67±0.70) ×10-3mm2/s and(38.03±10.02) %; grade II group were(1.21±0.18) ×10-3mm2/s,(2.37±1.19) ×10-3mm2/s,(1.15±0.13) ×10-3mm2/s,(6.58±1.82) ×10-3mm2/s and(31.36±8.34) %; grade III group were(0.98±0.10)×10-3mm2/s,(1.64±0.46) ×10-3mm2/s,(0.87±0.11) ×10-3mm2/s,(5.43±2.82)×10-3mm2/s and(22.04±7.93) %. ADC value was significantly different in well,moderately and poorly differentiated adenocarcinoma(P=0.000). With the reduction of histological differentiation degree, ADC values decreased, r=0.624; IVIM parameters D and ? were both significantly correlated with histologic grade:r=0.809(P=0.000) and r=0.580(p=0.000), respectively. D and ? values were both significantly lower in poorly differentiated adenocarcinoma than in well differentiated adenocarcinoma. Besides, ROC analysis demonstrated a higher area under the ROC curve value for D than for ADC in differentiating different pathological grade of EHCC(0.889 vs 0.785). Conclusion(1) ADC, D, ? value showed significant difference in different histologic grade, with a lower degree of differentiation, the three values decrease.IVIM-derived D values of EHCC showed significantly better diagnostic performance than ADC values in differentiating different grade EHCC;While the parameters BF and D* were not correlated with pathological grade.(2)Using IVIM-DWI technology for EHCC, which could evaluate diffusion and perfusion effects of the lesions independently through relevant parameters, without introduction of contrast agent, easy to operate; while providing preoperative prediction of clinical diagnosis for tumor grade, and with great prospects.The second part:Preliminary application and researches of DKI in grading of extrahepatic cholangiocarcinomaObjective To evaluate the association of diffusion kurtosis imaging(DKI)derived parameters D 、 K value with the histologic grade of extrahepatic cholangiocarcinoma and compare the diagnostic potential of parameters. Methods Thirty-five consecutive patients surgically resected and pathologically confirmed extrahepatic cholangiocarcinoma were included in this study. All patients underwent upper abdomen 3.0-T magnetic resonance imaging, including traditional magnetic resonance imaging and diffusion kurtosis imaging with five b values used(from 0 to 2400 sec/mm2). The DKI derived parameters D, K were calculated by using post-processing software. Compared with histologic grade(well-differentiated,moderately differentiated and poorly differentiated adenocarcinoma), evaluating the association and compare the diagnostic potential of parameters by using receiver operating characteristic(ROC) analysis. Results 35 cases of extrahepatic cholangiocarcinoma(EHCC) include: grade I(well-differentiated adenocarcinoma)11 cases, grade II(moderately differentiated adenocarcinoma) 11 cases and grade III(poorly differentiated adenocarcinoma) 13 cases. Grade I group lesions parameter D,k values were(1.56±0.08) ×10-3mm2/s、0.38±0.07; grade II group were(1.47±0.09) ×10-3mm2/s、0.51±0.08; grade II group were(1.39±0.07) ×10-3mm2/s、0.66± 0.08. D value was significantly different in well, moderately and poorly differentiated adenocarcinoma(P=0.000). With the reduction of histological differentiation degree, DKI parameters D values decreased, r=0.672; and K was significantly correlated with histologic grade: r=0.848(P=0.000). D values was significantly lower in poorly differentiated adenocarcinoma than in well differentiated adenocarcinoma and K values was significantly higher in poorly differentiated adenocarcinoma than in well differentiated adenocarcinoma. ROC analysis demonstrated a higher area under the ROC curve value for K than for D for differentiating different pathological grade of EHCC(0.860 vs 0.951). Conclusion D,K value showed significant difference in different histologic grade, and K values of EHCC showed significantly better diagnostic performance than D values in differentiating different grade EHCC.