分享:
分享到微信朋友圈
X
临床研究
磁共振体素内不相干运动成像鉴别肝细胞癌与肝内胆管细胞癌的价值
王曦 冯苏 李红 徐敬星 胡爽 王申

Cite this article as: WANG X, FENG S, LI H, et al. The value of MRI IVIM in identifying hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Chin J Magn Reson Imaging, 2023, 14(7): 49-52, 85.本文引用格式:王曦, 冯苏, 李红, 等. 磁共振体素内不相干运动成像鉴别肝细胞癌与肝内胆管细胞癌的价值[J]. 磁共振成像, 2023, 14(7): 49-52, 85. DOI:10.12015/issn.1674-8034.2023.07.009.


[摘要] 目的 探讨磁共振基于体素内不相干运动(intravoxel incoherence motion, IVIM)成像鉴别肝细胞癌(hepatocellular carcinoma, HCC)和肝内胆管细胞癌(intrahepatic cholangiocarcinoma, ICC)的价值。材料与方法 回顾性分析我院经病理确诊的43例HCC和17例ICC患者的影像学图像和临床资料。所有患者均在3.0 T MRI上完成IVIM检查,测量并比较病灶的慢扩散系数(slow apparent diffusion coefficient, Dslow)、快扩散系数(fast apparent diffusion coefficient, Dfast)、灌注分数(perfusion fraction, f)、分布扩散系数(distributed diffusion coefficient, DDC)和水分子扩散异质性(water diffusion heterogeneity index, α)值。采用受试者工作特征(receiver operating characteristic, ROC)曲线比较各参数在HCC和ICC组间的诊断效能。结果 HCC组病灶Dslow、DDC值均低于ICC组,Dfast值高于ICC组(P均<0.05),f和α值在两组间的差异无统计学意义(P均>0.05)。当Dslow、Dfast和DDC值的最佳阈值分别为0.88×10-3 mm2/s、20.82×10-3 mm2/s和1.30×10-3 mm2/s时,敏感度分别为94.1%、82.4%和82.4%,特异度分别为72.1%、65.1%和67.4%,曲线下面积(area under the curve, AUC)分别为0.846、0.756和0.803。结论 基于IVIM的双指数模型和拉伸指数模型有利于鉴别HCC和ICC,其中Dslow的诊断效能最高。
[Abstract] Objective To explore the value of MRI intravoxel incoherence motion (IVIM) in differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).Materials and Methods This study included 60 patients with malignant hepatic nodules. All patients underwent IVIM scans on a 3.0 T MRI scanner. The slow apparent diffusion (Dslow), fast diffusion coefficient (Dfast), perfusion fraction (f), distributed diffusion coefficient (DDC) and water diffusion heterogeneity index (α) were obtained. Receiver operating characteristic (ROC) curve analysis was used to compare the efficacy of each parameter in differentiating HCC from ICC.Results The Dslow and DDC values of lesions in the HCC group were significantly lower than in the ICC group (all P<0.05), the Dfast of lesions in the HCC group were significantly higher than in the ICC group, f and α values did not statistically differ between the HCC and ICC groups. When the cut-off values of Dslow, Dfast and DDC were 0.88×10-3 mm2/s, 20.82×10-3 mm2/s, and 1.30×10-3 mm2/s, respectively, and the sensitivity was 94.1%, 82.4%, 82.4%, the specificity was 72.1%, 65.1%, 67.4%, and the area under the curve (AUC) was 0.846, 0.756 and 0.803, respectively.Conclusions The biexponential model and the stretched exponential model can be used to differentiate HCC from ICC, and the Dslow had the highest diagnostic efficiency.
[关键词] 肝细胞癌;肝内胆管细胞癌;鉴别诊断;磁共振成像;体素内不相干运动;双指数模型;拉伸指数模型
[Keywords] hepatocellular carcinoma;intrahepatic cholangiocarcinoma;differential diagnosis;magnetic resonance imaging;intravoxel incoherence motion;biexponential model;stretched model

王曦    冯苏    李红 *   徐敬星    胡爽    王申   

三峡大学附属仁和医院放射科,宜昌 443001

通信作者:李红,E-mail:1741433022@qq.com

作者贡献声明:李红设计本研究的方案,对稿件重要内容进行了修改;王曦起草和撰写稿件,获取、分析或解释本研究的数据;冯苏、徐敬星、胡爽、王申获取、分析或解释本研究的数据,对稿件重要内容进行了修改;全体作者都同意发表最后的修改稿,同意对本研究的所有方面负责,确保本研究的准确性和诚信。


收稿日期:2022-09-10
接受日期:2023-06-25
中图分类号:R445.2  R735.7 
文献标识码:A
DOI: 10.12015/issn.1674-8034.2023.07.009
本文引用格式:王曦, 冯苏, 李红, 等. 磁共振体素内不相干运动成像鉴别肝细胞癌与肝内胆管细胞癌的价值[J]. 磁共振成像, 2023, 14(7): 49-52, 85. DOI:10.12015/issn.1674-8034.2023.07.009.

0 前言

       肝细胞癌(hepatocellular carcinoma, HCC)和肝内胆管细胞癌(intrahepatic cholangiocarcinoma, ICC)是原发性肝癌最常见的两种病理类型,但两者的诊疗方案和临床预后显著不同,因此在术前精准诊断HCC和ICC有重要价值[1, 2, 3]。MRI具有丰富的成像序列,能清楚地显示病灶结构、周围胆管和血供类型等,有助于二者的诊断、分级和治疗效果评估等。然而,研究报道[4, 5, 6, 7, 8]在一些情况下HCC和ICC的影像表现常相互重叠,仅通过常规MRI难以明确区分两种肿瘤。LE BINHAN等[9, 10]提出体素内不相干运动(intravoxel incoherence motion, IVIM)的概念,其中双指数模型使用最为广泛,双指数模型可重建反映纯水分子扩散的慢扩散系数(slow apparent diffusion coefficient, Dslow),反映毛细血管微循环灌注所致的快扩散系数(fast apparent diffusion coefficient, Dfast),表示局部微循环灌注效应与整体微循环灌注效应体积比的灌注分数(perfusion fraction, f)。拉伸指数模型通过拟合分布扩散系数(distributed diffusion coefficient, DDC)和代表水分子扩散异质性的(water diffusion heterogeneity index, α)值来进一步反映生物组织的复杂结构[11, 12]。部分研究报道扩散相关参数(apparent diffusion coefficient, ADC)在两类肿瘤间的差异无统计学意义(P>0.05),常规扩散加权成像(diffusion weighted imaging, DWI)对肝脏恶性病变的鉴别没有明显的帮助[6, 7]。目前尚未有人体研究同时选用了双指数模型和拉伸指数模型,本研究的目的是探讨两种模型鉴别HCC和ICC的诊断价值,为原发性肝癌患者后续治疗方案的制订提供客观的依据。

1 材料与方法

1.1 一般资料

       本回顾性研究遵守《赫尔辛基宣言》,得到三峡大学附属仁和医院伦理委员会批准,免除受试者知情同意,批准文号:2022ky14。收集2020年10月至2022年8月期间在我院经穿刺活检或手术确诊的60例患者病例资料,所有患者均在3.0 T MRI扫描仪上完成检查。纳入标准:(1)扫描过程中无明显运动伪影,病灶显示清晰并能准确测量;(2)无上腹部手术史;(3)无肿瘤相关治疗史。排除标准:已经形成脉管内瘤栓。

1.2 检查方法

       采用上海联影uMR 780 3.0 T超导型MRI扫描仪,8通道相控阵体表软线圈。所有患者检查前禁食禁水8~10 h,并指导呼吸训练2~3次。扫描体位均为仰卧位,脚先进;扫描范围均包含肝脏上下缘。MRI扫描序列及参数见表1

表1  MRI扫描序列及参数
Tab. 1  The sequence and parameters of MRI scan

1.3 图像处理

       将IVIM-DWI序列数据导入医学后处理工作站(uWS-MR R005)。由两名分别具有8年和30年经验的主治医师和主任医师独立对图像进行处理分析,临床资料对两名医师保密。通过双指数模型重建Dslow、Dfast和f参数图;通过拉伸指数模型拟合DDC和α参数图。当患者肝脏具有多个病灶时选取最大者勾画,在b=0 s/mm2的DWI序列上绘制感兴趣区(region of interest, ROI),ROI将自动复制到各参数图,大小为50~250 mm2,尽量避免胆管、血管、坏死囊变区和伪影区域。

1.4 统计学分析

       采用SPSS 26.0软件进行数据统计分析。两名医师的测量值通过计算组内相关系数进行一致性检验;所有正态定量数据以均数±标准差(x¯±s)表示,偏态分布采用Mann-Whitney秩和检验,P<0.05为差异有统计学意义。使用二项logistic回归结合受试者工作特征(receiver operating characteristic, ROC)曲线对有统计学意义的参数进行诊断效能的分析。

2 结果

2.1 两组患者的一般资料

       最终纳入经病理确诊的43例HCC(男31例,女12例)和17例ICC(男8例,女9例)。HCC组患者年龄33~81(63.52±13.29)岁;ICC组患者年龄49~74(65.34±10.39)岁,两组间患者年龄差异无统计学意义(P>0.05)。

2.2 各IVIM-DWI参数一致性检验

       两名观察者对HCC和ICC组中Dslow和DDC值的一致性较好,组内相关系数均大于0.75,具体结果见表2

表2  两名观察者各参数一致性检验结果
Tab. 2  The cosistency test results of the parameters of the two observers

2.3 两组病例各参数比较

       Dslow、Dfast、f、DDC和α参数图清晰无伪影(图12)。各参数均符合正态分布,从而采用独立样本t检验分析组间差异。两组间Dslow、DDC和Dfast值的差异均有统计学意义(P<0.05);f和α值在两组间的差异无统计学意义(P>0.05),见表3

图1  男,55岁,肝内胆管细胞癌(ICC)。1A:T2WI肝左叶ICC,伴周围胆管扩张;1B~1F:分别为Dslow、Dfast、f、DDC和α参数图。
图2  男,57岁,肝细胞癌(HCC)。2A:T2WI肝S8段HCC;2B~2F:分别为Dslow、Dfast、f、DDC和α参数图。Dslow:慢扩散系数快扩散系数;Dfast:快扩散系数;f:灌注分数;DDC:分布扩散系数;α:水分子扩散异质性。
Fig. 1  Male, 55 years old, intrahepatic cholangiocarcinoma (ICC). 1A: A T2-weighted images shows an ICC lesion in the left lobe of liver with biliary dilatation; 1B-1F: Dslow map, Dfast map, f map, DDC map and α map, respectively.
Fig. 2  Male, 57 years old, hepatocellular carcinoma (HCC). 2A: A T2-weighted images shows an HCC lesion in the right lobe of liver; 2B-2F: Dslow map, Dfast map, f map, DDC map and α map, respectively. Dslow: slow apparent diffusion coefficient; Dfast: fast apparent diffusion coefficient; f: perfusion fraction; DDC: distributed diffusion coefficient; α: water diffusion heterogeneity index.
表3  两组间双指数和拉伸指数模型参数比较
Tab. 3  Comparison of biexponential and stretched model parameters among two groups

2.4 IVIM-DWI各参数鉴别HCC和ICC的诊断效能

       当Dslow、Dfast和DDC值的最佳阈值分别为0.88×10-3 mm2/s、20.82×10-3 mm2/s和1.30×10-3 mm2/s时,敏感度分别为94.1%、82.4%和82.4%,特异度分别为72.1%、65.1%和67.4%,曲线下面积(area under the curve, AUC)分别为0.846、0.756和0.803,其中Dslow的AUC最大(表4图3)。

图3  Dslow、Dfast、DDC鉴别HCC和ICC的ROC曲线。Dslow:慢扩散系数;Dfast:快扩散系数;DDC:分布扩散系数;HCC:肝细胞癌;ICC:肝内胆管细胞癌;ROC:受试者工作特征。
Fig. 3  ROC curves of Dslow, Dfast and DDC for differentiating HCC and ICC. Dslow: slow apparent diffusion coefficient; Dfast: fast apparent diffusion coefficient; DDC: distributed diffusion coefficient; HCC: hepatocellular carcinoma; ICC: intrahepatic cholangiocarcinoma; ROC: receiver operating characteristic.
表4  各参数组间诊断效能
Tab. 4  The diagnostic performance of parameters

3 讨论

       目前,运用IVIM-DWI鉴别肝脏恶性占位性病变的研究十分罕见,探讨水分子扩散异质性与肝癌病理亚型间的研究更是少见[13, 14, 15]。本研究发现HCC组的Dslow值和DDC值均低于ICC组,HCC组的Dfast值显著高于ICC组,为无创评估肝癌的病理亚型提供了新的方法。

3.1 双指数模型对肝癌亚型的评估

       本研究发现Dslow和Dfast在HCC和ICC间的差异具有统计学意义,而f值的差异无统计学意义。HCC组Dslow值显著低于ICC组(P<0.001),这与之前的研究结果一致[14, 15]。原因可能是在病理上ICC病灶富含纤维组织,癌细胞主要分布在边缘的纤维组织间,水分子扩散较自由,而HCC结构更加致密,水分子扩散减慢,Dslow值降低。本研究中ICC组Dfast显著低于HCC组,这与PENG等[15]的研究一致,但与WEI等[14]和CHOI等[16]的结果相互矛盾。分析Dfast值在各研究结果间相互矛盾的原因,其一,可能是各研究间肝硬化的发病率不尽相同,肝硬化者Dfast值显著低于正常肝实质[17]。在肝纤维化的进程中,毛细血管重塑、门静脉压力升高,从而导致肝窦血流速度减慢,毛细血管灌注减低。本研究中共23名患者确诊有肝硬化,其中18名在HCC组。其二,以往多项研究均报道过Dfast值的稳定性较差[13, 18],最终导致各研究间结果不一致。f值是灌注相关的参数,表示局部微循环灌注效应与整体微循环灌注效应体积比[9],本研究中f值在两组间的差异无统计学意义。然后在WANG等[19]的研究中f值在HCC和ICC中表现出良好的诊断效能(AUC=0.973),ICC组织富含纤维成分、血流较贫乏,但是HCC总体上属于富血供肿瘤,这是f值能区分两种肿瘤的基础。f值在鉴别肝癌亚型中的价值有待进一步的研究和证实。

3.2 拉伸指数模型对肝癌亚型的评估

       拉伸指数模型考虑了组织内扩散速率的异质性,KIM等[20]和NODA等[21]发现DDC值能有效鉴别肝脏结节的良恶性。DDC代表分布扩散系数,从数学角度而言与ADC关系密切[22],在本研究中DDC和Dslow的变化趋势相似,其在两组间的差异均有统计学意义。α的取值在0~1之间,α越小表示水分子的扩散异质性越高[23, 24]。理论上HCC的α值应较高,因为HCC在病理上容易发生坏死,坏死组织的结构更均质。但在本研究中α值在两组间的差异无统计学意义,可能是因为肝纤维化背景会影响α值,从而增加病灶的异质性,而HCC组肝硬化率较高。在XIE等[25]研究中,α值有助于区分裸鼠模型的HCC和ICC,拥有良好的诊断效能(AUC=0.890)。有研究[26]报道α值可以反映肿瘤组织的空间异质性。相信随着研究的丰富与深入,拉伸指数模型能进一步提高鉴别HCC和ICC的效能,并建立影像指标与病理学的联系。

3.3 本研究的局限性

       本研究存在以下的局限性:(1)本研究中ICC组的样本量较小,这有待于以后大样本、多中心的研究,以期在后续论文中得到更可靠的数据;(2)本研究由两位医师进行ROI独立勾画,但无法完全避免选择主观性;(3)IVIM参数可能会受b值的影响,目前对于b值的选择标准尚在探索中,本文作者在阅读大量文献后选择了由较多的低b值和较少的中、高b值组成的12个b值组合,以尽可能提高参数的准确性;(4)因不是所有患者都适合增强检查,本研究没有比较IVIM-DWI与MRI动态增强的有效性。

4 结论

       综上所述,基于IVIM-DWI的双指数和拉伸指数模型有助于鉴别HCC和ICC,其中D值的诊断价值最高,本研究为无创评估肝癌的病理亚型提供了新的思路。

[1]
中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2022年版)[J]. 肝癌电子杂志, 2022, 9(1): 1-22. DOI: 10.19538/j.cjps.issn.1005-2208.2022.03.01.
Department of Medical Affairs of National Health Commission of the People's Republic of China. Guidelines for diagnosis and treatment of primary liver cancer (2022 edition)[J]. Electron J Liver Tumor, 2022, 9(1): 1-22. DOI: 10.19538/j.cjps.issn.1005-2208.2022.03.01.
[2]
FERLAY J, COLOMBET M, SOERJOMATARAM I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods[J]. Int J Cancer, 2019, 144(8): 1941-1953. DOI: 10.1002/ijc.31937.
[3]
安澜, 冉显会, 郑荣寿, 等. 中国肝细胞癌和肝内胆管细胞癌临床诊疗情况比较研究[J]. 中国癌症防治杂志, 2021, 13(2): 126-132. DOI: 10.3969/j.issn.1674-5671.2021.02.03.
AN L, RAN X H, ZHENG R S, et al. A comparative study on clinical diagnosis and treatment of hepatocellular carcinoma and intrahepatic cholangiocarcinoma in China[J]. Chin J Oncol Prev Treat, 2021, 13(2): 126-132. DOI: 10.3969/j.issn.1674-5671.2021.02.03.
[4]
HUANG B, WU L, LU X Y, et al. Small intrahepatic cholangiocarcinoma and hepatocellular carcinoma in cirrhotic livers may share similar enhancement patterns at multiphase dynamic MR imaging[J]. Radiology, 2016, 281(1): 150-157. DOI: 10.1148/radiol.2016151205.
[5]
VIGANÒ L, LLEO A, MUGLIA R, et al. Intrahepatic cholangiocellular carcinoma with radiological enhancement patterns mimicking hepatocellular carcinoma[J]. Updates Surg, 2020, 72(2): 413-421. DOI: 10.1007/s13304-020-00750-5.
[6]
ÇELEBI F, YAGHOUTI K, CINDIL E, et al. The role of 18F-FDG PET/MRI in the assessment of primary intrahepatic neoplasms[J]. Acad Radiol, 2021, 28(2): 189-198. DOI: 10.1016/j.acra.2020.01.026.
[7]
ASAYAMA Y, NISHIE A, ISHIGAMI K, et al. Distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma using precontrast and gadoxetic acid-enhanced MRI[J]. Diagn Interv Radiol, 2015, 21(2): 96-104. DOI: 10.5152/dir.2014.13013.
[8]
LI F, LI Q, LIU Y B, et al. Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017[J]. Eur Radiol, 2020, 30(1): 461-470. DOI: 10.1007/s00330-019-06317-2.
[9]
LE BIHAN D, BRETON E, LALLEMAND D, et al. MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders[J]. Radiology, 1986, 161(2): 401-407. DOI: 10.1148/radiology.161.2.3763909.
[10]
LE BIHAN D. What can we see with IVIM MRI?[J/OL]. Neuroimage, 2019, 187: 56-67 [2022-09-01]. https://www.sciencedirect.com/science/article/pii/S1053811917310868?via%3Dihub. DOI: 10.1016/j.neuroimage.2017.12.062.
[11]
BENNETT K M, SCHMAINDA K M, BENNETT R T, et al. Characterization of continuously distributed cortical water diffusion rates with a stretched-exponential model[J]. Magn Reson Med, 2003, 50(4): 727-734. DOI: 10.1002/mrm.10581.
[12]
IIMA M, KATAOKA M, KANAO S, et al. Intravoxel incoherent motion and quantitative non-Gaussian diffusion MR imaging: evaluation of the diagnostic and prognostic value of several markers of malignant and benign breast lesions[J]. Radiology, 2018, 287(2): 432-441. DOI: 10.1148/radiol.2017162853.
[13]
韩铮, 刘爱连, 刘泽群, 等. DWI不同指数模型在肝细胞癌及肝血管瘤鉴别诊断中的应用价值[J]. 磁共振成像, 2017, 8(7): 519-525. DOI: 10.12015/issn.1674-8034.2017.07.008.
HAN Z, LIU A L, LIU Z Q, et al. Multiple exponential models of diffusion weighted imaging in differentiating hepatocellular carcinoma from hepatic hemangioma[J]. Chin J Magn Reson Imaging, 2017, 8(7): 519-525. DOI: 10.12015/issn.1674-8034.2017.07.008.
[14]
WEI Y, GAO F F, ZHENG D D, et al. Intrahepatic cholangiocarcinoma in the setting of HBV-related cirrhosis: differentiation with hepatocellular carcinoma by using Intravoxel incoherent motion diffusion-weighted MR imaging[J]. Oncotarget, 2018, 9(8): 7975-7983. DOI: 10.18632/oncotarget.23807.
[15]
PENG J, ZHENG J, YANG C, et al. Intravoxel incoherent motion diffusion-weighted imaging to differentiate hepatocellular carcinoma from intrahepatic cholangiocarcinoma[J/OL]. Sci Rep, 2020, 10(1): 7717 [2022-09-01]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206040.
[16]
CHOI I Y, LEE S S, SUNG Y S, et al. Intravoxel incoherent motion diffusion-weighted imaging for characterizing focal hepatic lesions: correlation with lesion enhancement[J]. J Magn Reson Imaging, 2017, 45(6): 1589-1598. DOI: 10.1002/jmri.25492.
[17]
WU C H, HO M C, JENG Y M, et al. Assessing hepatic fibrosis: comparing the intravoxel incoherent motion in MRI with acoustic radiation force impulse imaging in US[J]. Eur Radiol, 2015, 25(12): 3552-3559. DOI: 10.1007/s00330-015-3774-4.
[18]
SEO N, CHUNG Y E, PARK Y N, et al. Liver fibrosis: stretched exponential model outperforms mono-exponential and bi-exponential models of diffusion-weighted MRI[J]. Eur Radiol, 2018, 28(7): 2812-2822. DOI: 10.1007/s00330-017-5292-z.
[19]
WANG J H, YANG Z X, LUO M, et al. Value of intravoxel incoherent motion (IVIM) imaging for differentiation between intrahepatic cholangiocarcinoma and hepatocellular carcinoma[J/OL]. Contrast Media Mol Imaging, 2022, 2022, 1504463 [2023-04-21]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9113914. DOI: 10.1155/2022/1504463.
[20]
KIM H C, SEO N, CHUNG Y E, et al. Characterization of focal liver lesions using the stretched exponential model: comparison with monoexponential and biexponential diffusion-weighted magnetic resonance imaging[J]. Eur Radiol, 2019, 29(9): 5111-5120. DOI: 10.1007/s00330-019-06048-4.
[21]
NODA Y, GOSHIMA S, FUJIMOTO K, et al. Comparison of the diagnostic value of mono-exponential, Bi-exponential, and stretched exponential signal models in diffusion-weighted MR imaging for differentiating benign and malignant hepatic lesions[J]. Magn Reson Med Sci, 2021, 20(1): 69-75. DOI: 10.2463/mrms.mp.2019-0151.
[22]
BENNETT K M, HYDE J S, SCHMAINDA K M. Water diffusion heterogeneity index in the human brain is insensitive to the orientation of applied magnetic field gradients[J]. Magn Reson Med, 2006, 56(2): 235-239. DOI: 10.1002/mrm.20960.
[23]
LEMKE A, LAUN F B, KLAUSS M, et al. Differentiation of pancreas carcinoma from healthy pancreatic tissue using multiple b-values: comparison of apparent diffusion coefficient and intravoxel incoherent motion derived parameters[J]. Invest Radiol, 2009, 44(12): 769-775. DOI: 10.1097/RLI.0b013e3181b62271.
[24]
BAI Y, LIN Y S, TIAN J, et al. Grading of gliomas by using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging and diffusion kurtosis MR imaging[J]. Radiology, 2016, 278(2): 496-504. DOI: 10.1148/radiol.2015142173.
[25]
XIE J H, LI C H, CHEN Y D, et al. Potential value of the stretched exponential and fractional order Calculus model in discriminating between hepatocellular carcinoma and intrahepatic cholangiocarcinoma: an animal experiment of orthotopic xenograft nude mice[J/OL]. Curr Med Imaging, 2023 [2023-04-21]. https://www.eurekaselect.com/214867/article. DOI: 10.2174/1573405619666230322123117.
[26]
郭然, 林江, 杨烁慧, 等. 磁共振(MRI)扩散峰度成像(DKI)与拉伸指数模型(SEM)评价裸鼠原位肝细胞癌(HCC)异质性[J]. 复旦学报(医学版), 2019, 46(3): 285-293. DOI: 10.3969/j.issn.1672-8467.2019.03.001.
GUO R, LIN J, YANG S H, et al. Diffusion kurtosis imaging (DKI) and stretched exponential model (SEM) of magnetic resonance imaging (MRI) for evaluating sequential tumor heterogeneity in an orthotopic hepatocellular carcinoma (HCC) xenograft model[J]. Fudan Univ J Med Sci, 2019, 46(3): 285-293. DOI: 10.3969/j.issn.1672-8467.2019.03.001.

上一篇 基于全病灶的动态增强MRI强度直方图鉴别肺部炎性结节与肺癌
下一篇 瘤周及瘤内表观扩散系数参数对可切除直肠癌的病理因素诊断性能的评估
  
诚聘英才 | 广告合作 | 免责声明 | 版权声明
联系电话:010-67113815
京ICP备19028836号-2