目的 探讨表观扩散系数(apparent diffusion coefficient,ADC)在预测肝泡状棘球蚴病(hepatic alveolar echinococcosis,HAE)发生远处转移的临床价值.材料与方法 回顾性分析2019年1月到2024年3月青海大学附属医院确诊为HAE的267例患者资料,其中远处转移组88例,无转移组179例,记录其临床及影像信息并在DWI上测量病灶实性部分及边缘带的ADC最大值(ADCmax)、ADC最小值(ADCmin)、ADC平均值(ADCmean).采用统计学方法比较发生远处转移组患者与无转移组患者在年龄、性别、民族、病灶实性部分及边缘带的ADCmax、ADCmin、ADCmean上的差异,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,通过曲线下面积(area under the curve,AUC)评估各参数的诊断效能,计算最佳诊断截断值及其对应的敏感度、特异度.结果 HAE远处转移组与无转移组两组间年龄、性别及民族差异均无统计学意义(P＞0.05);在病灶实性部分,ADCmax、ADCmin、ADCmean在远处转移组与无转移组间差异不具有统计学意义(P＞0.05);在病灶边缘带,两组间ADCmax、ADCmin、ADCmean的差异均具有统计学意义(P＜0.05);且无论是否发生转移,边缘带ADCmax、ADCmin、ADCmean均低于实性成分ADCmax、ADCmin、ADCmean.ROC曲线分析显示边缘带各ADC值均可有效预测HAE的远处转移.其中,联合指标预测HAE是否发生远处转移效能最佳,AUC为0.955(95％CI:0.923～0.977),敏感度为93.2％,特异度86.0％.结论 边缘带ADC值对临床前期评估HAE是否会发生远处转移具有良好的预测价值;各参数联合使用可进一步提高HAE远处转移的预测效能,更有利于个体化、精准化医疗决策的实现.
Clinical value of apparent diffusion coefficient in predicting distant metastasis in hepatic alveolar echinococcosis
Objective:To explore the clinical value of apparent diffusion coefficient(ADC)in predicting distant metastasis of hepatic alveolar echinococcosis(HAE).Materials and Methods:A retrospective analysis was conducted on 267 patients diagnosed with HAE at Qinghai University Affiliated Hospital from January 2019 to March 2024,including 88 cases with distant metastasis and 179 cases without metastasis.Clinical and imaging information was recorded,and the maximum apparent diffusion coefficient(ADCmax),minimum apparent diffusion coefficient(ADCmin),and mean apparent diffusion coefficient(ADCmean)of the solid part and peripheral zone of the lesions were measured on diffusion-weighted imaging(DWI).Statistical methods were used to compare the differences between patients with distant metastasis and those without metastasis in terms of age,sex,ethnicity,ADCmax,ADCmin,and ADCmean of the solid part and peripheral zone of the lesions.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated to evaluate the diagnostic performance of each parameter.The optimal diagnostic cutoff values and their corresponding sensitivities and specificities were calculated.Results:There were no statistically significant differences in age,sex,or ethnicity between the group with distant metastasis of HAE and the group without metastasis(P＞0.05).Regarding the solid part of the lesions,there were no significant differences in ADCmax,ADCmin,or ADCmean between the group with distant metastasis and the group without metastasis(P＞0.05).However,significant differences in ADCmax,ADCmin,and ADCmean were observed between the two groups in the peripheral zone of the lesions(P＜0.05).Additionally,regardless of metastasis occurrence,ADCmax,ADCmin,and ADCm an in the peripheral zone were lower than those in the solid component.ROC curve analysis demonstrated that ADC values in the peripheral zone could effectively predict distant metastasis of HAE.Among them,the combined index showed the best efficacy in predicting distant metastasis of HAE,the AUC is 0.955(95％CI:0.923-0.977),with a sensitivity of 93.2％and a specificity of 86.0％.Conclusions:The ADC values in the peripheral zone have good predictive value for assessing whether HAE will develop distant metastasis in the clinical setting.The combined use of various parameters can further enhance the predictive efficacy of distant metastasis in HAE,facilitating the realization of individualized and precise medical decision-making.
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