| Objective:To assess the value of tumor vascular endothelial growth factor?VEGF?,microvessel density?MVD?,pathological differentiation grades,T stages,N stages and locations in patients with extrahepatic cholangiocarcinoma?EHCC?using diffusion weighted imaging?DWI?at3.0-T magnetic resonance imaging?MRI?.Materials and Methods:Patients underwent an upper abdominal MR examination no more than 2 weeks before surgical resection at our hospital from August 2011 to December 2017.All records for patients were histologically diagnosed with EHCC and retrospectively analyzed.We observed the lesion signal intensity and location,and measured the apparent diffusion coefficient?ADC?value in DWI images.At the same time,the tumor specimens VEGF,MVD,pathological differentiation grades,T stages and N stages were recorded?All data were imported into a statistical software package for statistical analysis.Concordances of the VEGF between two pathologists and lesion signal intensity between two radiologists were evaluated by using?statistics,inter-observer agreement of the ADC value between the 2 radiologists and MVD between the 2 pathologists were analyzed by computing the interclass correlation coefficient?ICC?.Quantitative data were displayed as mean±standard deviation?x±s?when it satisfied normality,or as median when it dissatisfied.Differences in multi-group quantitative data would be analyzed by using the analysis of variance?ANOVA?,respectively,the parameters between two groups were analyzed using LSD analysis,when the data matched both the normality and homogeneity of variance.Under other conditions,quantitative data would be processed by using the Kruskal-Wallis H Rank-Sum test.Then the two groups were compared using the Mann–Whitney U test.The accuracy of diagnostic criteria for the ADC values value among different VEGF,pathological differentiation grades,T stages,N stages and locations were determined by computing the area under the curve?AUC?from relevant receiver operative characteristics?ROC?curves.The correlation between the lesion ADC value and MVD of EHCC was statistically analyzed by using Pearson analysis.Probability values of P<0.05,determined from two-sided tests,were considered statistically significant.Results:Eighty-eight consecutive patients?age range:29–84years;mean age,57.50±10.21 years?met the inclusion and exclusion criteria,48 men and 37 women.?1?There were excellent agreement in lesion signal intensity??score=0.883?and inter-rater reliability in ADC value?ICC=0.863?between two radiologist,excellent agreement in VEGF??score=0.810?and inter-rater reliability in ADC value?ICC=0.959?between two pathologists.?2?The study of lesion signal intensity in DWI images:eighty-six EHCCs indicated different degree of high-intensity in DWIs with a qualitative diagnostic sensitivity of 97.73%?86/88?.No statistically significant differences were discovered for the lesion ADC value among the groups with different VEGF?P=0.927?,tumor differentiation grades?P=0.680?,T stages?P=0.273?,N stages?P=0.472?,and locations?P=0.928?.?3?The study of lesion ADC value of EHCC:the ADC value in VEGF-negative group were significantly higher than VEGF-positive group?P=0.000?.It means that the higher ADC value of EHCC lesion get,the greater possibility of VEGF-positive will express.The lesion ADC value greater than a cut-off value(1.291×10-3mm2/s)can predict VEGF-positive EHCC?AUC=0.794?.The lesion ADC value of EHCC was negatively correlated with MVD?r=-0.615,P=0.000?.The ADC value of well-differentiated group were higher than moderate-differentiated and poorly-differentiated group,the ADC value of moderate-differentiated group were higher than poorly-differentiated group,comparisons of the ADC values in tumor differentiation grade revealed statistically significant differences?P=0.000?.The lesion ADC value of EHCC was negatively correlated with pathological differentiation grades.The ADC value with a cut-off value(<1.319×10-3mm2/s)can predict well-differentiated EHCC?AUC=0.987?,and another cut-off value(<1.184×10-3mm2/s)can predict poorly-differentiated EHCC?AUC=0.99?.The lesion ADC values in node-negative group were statistically higher than those in node-positive group?P=0.006?.It revealed that the higher ADC value of EHCC lesion get,the greater possibility of node-positive will be.But the ROC curve for the ADC values predicting EHCC with node-positive group with a low diagnosticity?AUC=0,677?.No statistically significant differences were found for the lesion ADC value among the groups with T stages?P=0.235?and locations?P=0.527?.?4?the study of MVD of EHCC tissue specimens:the MVD in VEGF-negative group were significantly lower than VEGF-positive group?P=0.000?.It means that if EHCC expresses VEGF-positive,the higher MVD of lesion will have.The MVD of well-differentiated group were lower than moderate-differentiated and poorly-differentiated group,the MVD of moderate-differentiated group were lower than poorly-differentiated group,comparisons of MVD in tumor differentiation grade revealed statistically significant differences?P=0.000?.When the pathological differentiation grade of EHCC increased,the MVD statistically and gradually increased.No statistically significant differences were found for the MVD among the groups with T stages?P=0.084?,N stages?P=0.122?and locations?P=0.928?.Conclusions:?1?MR-DWI displayed different degree of high-intensity for EHCCs with a qualitative diagnostic sensitivity of 97.73%?86/88?.?2?The lesion ADC value of EHCC is a sensitive parameter to predict the expression of VEGF,pathological differentiation grades and regional lymph node metastasis.The lesion ADC value is negatively correlated with tissue specimen MVD.?3?Tissue specimen MVD of EHCC is connected with the expression of VEGF and the degree of pathological differentiation.The tissue specimen MVD increases as the tumor expresses VEGF-positive and pathological differentiation grade gets worse. |
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