【摘要】 目的 定量评估体素内不相干运动扩散加权成像（IVIM）对Ⅰ型与Ⅱ型卵巢上皮性癌（EOC）的鉴别诊断价值。资料与方法 收集2018年6月—2020年12月于河北省沧州中西医结合医院就诊的75例EOC患者，术前均接受常规MRI序列和IVIM序列扫描，对临床病理及影像学资料进行回顾性分析，其中Ⅰ型EOC组27例，Ⅱ型EOC组48例。对两组患者的临床基本情况、国际妇产科联合会分期、MRI表现进行比较，采用第三方后处理软件（IMAge/enGINE）测量肿瘤部位IVIM[真实扩散系数（D）、假性扩散系数（D*）和灌注分数（f）]和表观扩散系数（ADC），采用受试者工作特征曲线及其曲线下面积（AUC）评估诊断效能。结果 在MRI表现上，Ⅰ型EOC的肿瘤多表现囊性或囊性成分为主（占48.1%,13/27），而Ⅱ型以实性或实性成分为主[占47.9%(23/48)（χ~2=10.36,P=0.006）；Ⅰ型EOC病灶单侧分布最多[占81.5%(22/27)]，而Ⅱ型EOC肿瘤发生在双侧比例为41.7%(20/48)（χ~2=4.167,P=0.041）；Ⅰ型病灶囊壁结节的发生率明显高于Ⅱ型（χ~2=14.67,P<0.001），而淋巴结转移则低于Ⅱ型（χ~2=11.91,P=0.001）。Ⅰ型EOC中ADC值[（1.79±0.37）×10~-(3) mm~2/s比（1.56±0.41）×10~-(3) mm~2/s,t=2.514,P=0.014]和D值[（1.80±0.26）×10~-(3) mm~2/s比（1.42±0.34）×10~-(3) mm~2/s;t=4.769,P<0.001]均数明显高于Ⅱ型；而f值低于Ⅱ型（0.27±0.09比0.32±0.09;t=2.309,P=0.017），且D值（AUC=0.804）诊断效能明显高于ADC值（AUC=0.650,Z=2.672,P=0.008）和f值（AUC=0.675;Z=2.094,P=0.036）。结论 Ⅰ型和Ⅱ型EOC在影像学表现上具有一定的差异，而IVIM能够提供定量指标区分两者，结合D值及特征性影像学表现，对术前EOC亚型有一定的鉴别诊断价值。更多还原

【Abstract】 Purpose To quantitatively evaluate the differential diagnostic value of intravoxel incoherent motion diffusion weighted imaging（IVIM） for type Ⅰ and type Ⅱ epithelial ovarian cancer（EOC）. Materials and Methods The clinical and imaging data of 75patients with EOC confirmed by pathology from June 2018 to December 2020 were retrospectively analyzed, including 27 cases of type Ⅰand 48 cases of type Ⅱ EOC. All patients underwent conventional MRI and IVIM sequences before surgery. Clinical information,International Federation of Gynecology and Obstetrics staging, and MRI parameters of the two groups were compared. The quantitative parameters of IVIM（f, D, D*） and DWI（ADC） were measured by using a third-party post-processing software（IMAge/enGINE）. Receiver operating characteristic curve and area under the curve（AUC） was established for accessing efficacy of relative data. Results Type ⅠEOC tumors were mainly cystic（48.1%, 13/27）, while type Ⅱ tumors were mainly solid（47.9%, 23/48）（χ²=10.36, P=0.006）. Type I EOC lesions distributed more unilateral（81.5%, 22/27）, while type Ⅱ EOC tumors occurred more bilaterally（41.7%, 20/48）（χ²=4.167, P=0.041）.The incidence of cystic wall nodules in type I was significantly higher than that in type Ⅱ（χ²=14.67, P<0.001）, while lymph node metastasis was lower in type Ⅰ group than in type Ⅱ（χ²=11.91, P=0.001）. The mean ADC value [（1.79±0.37）×10^-（3） mm²/s vs.（1.56±0.41）×10^-（3） mm²/s,P=0.014] and D value [（1.80±0.26） mm²/s.01^-3 vs.（1.42±0.34）×10^-（3） mm²/s; t=4.769, P<0.001] of type I EOC were significantly higher than those of type Ⅱ EOC, while the mean value of f was lower than that of type Ⅱ（0.27±0.09 vs. 0.32±0.09, P=0.017）. The diagnostic efficiency of D value（AUC=0.804） was significantly higher than ADC value（AUC=0.650; Z=2.672, P=0.008） and f value（AUC=0.675;Z=2.094, P=0.036）. Conclusion There are some differences in imaging performance between the two types of EOC, and IVIM can provide quantitative indicators to distinguish EOC typing. Combined with D value and characteristic imaging findings, IVIM has certain differential diagnosis value to preoperatively determine the EOC subtypes.更多还原