MR体素内不相干运动成像用于评价宫颈癌恶性程度和组织血供的价值  

Value of introvoxel incoherent motion model in assessment of differentiation and blood supply of cervical cancer

作　　者：周延[1] 刘剑羽[1] 刘从容[3] 贾静[3] 车树楠 李楠[2] 周振宇 

机构地区：[1]北京大学第三医院放射科,100191 [2]北京大学第三医院临床流行病学研究中心,100191 [3]北京大学医学部病理学系 [4]通用电气医疗中国有限公司研发中心

出　　处：《中华放射学杂志》2015年第5期354-359,共6页Chinese Journal of Radiology

摘　　要：目的探讨体素内不相干运动成像（IVIM）对宫颈癌恶性程度和组织血供的显示情况。方法回顾性分析经术前活检病理诊断为宫颈癌（病灶直径≥1 cm）并进行IVIM检查的31例患者（31个病灶）。将患者病灶按照病理分级分为高分化（G1）、中分化（G2）和低分化（G3）3级，每组分别6、17和8例。患者均行盆腔MRI平扫、多b值DWI（b值分别为0、30、50、100、150、200、400、800、1000、1500 s/mm2）和动态增强MRI（DCE-MRI）检查。测量计算以下参数：肿瘤体积；肿瘤DWI单指数成像ADC值；IVIM成像参数，包括慢扩散系数（D）值、灌注分数（f）值和快扩散系数（D＊）值；肿瘤DCE-MRI曲线半定量参数，包括曲线上升斜率（Slop）、最大上升斜率（Maxslop）、对比增强比（CER）、对比剂清除率（Washout）和前90 s增强曲线下面积（AUC90）。不同病理级别宫颈癌组间肿瘤体积、DWI参数和半定量DCE-MRI参数的比较采用单因素ANOVA检验（正态分布）或Kruskal-Wallis H检验（非正态分布），采用Pearson相关分析研究MRI扫描参数和病理分级的相关性。并绘制不同病理分级组间差异有统计学意义的MRI定量参数诊断G3级宫颈癌的ROC曲线，计算诊断的最佳截断值。结果G1、G2和G3级组肿瘤体积分别为（33.8±31.1）、（19.6±16.9）和（31.2±29.1）cm3，差异无统计学意义（F=1.147，P=0.332）。上述3组肿瘤的ADC值分别为（1.03±0.11）×10^-3、（1.00±0.10）×10^-3和（0.90±0.05）×10^-3mm2/s，D值分别为（0.80±0.11）×10^-3、（0.77±0.06）×10^-3和（0.69±0.06）×10^-3mm2/s，f值分别为0.20±0.02、0.22±0.03和0.24±0.03，差异均有统计学意义（F值分别为4.619、5.272和3.524，P均〈0.05）。不同病理分级组间其余MRI定量参数的差异均无统计学意义（P均〉0.05）。ADC值和D值与病理分级为负相关（r值分别为－0.464和－0.493，P值分别为0.009和0.005），f�Objective To investigate the value of intravoxel incoherent motion （IVIM） model of diffusion weighted MRI in assessing grades and enhancement patten of uterine cervical cancer. Methods Thirty one patients with pathologically proven cervical cancer, who underwent MRI scan preoperatively, were analyzed retrospectively and were divided into 3 groups according to their pathological grading of cacer, including 6 with G1 cancer, 17 with G2 and 8 with G3. The diameter of each lesion was≥1 cm. 10 b values （0, 30, 50, 100, 150, 200, 400, 800, 1 000, 1 500 s/mm2） were used in DWI, and DCE-MRI was performed with a time resolution of 9.8 s. Parameters of DWI （ADC, D, f, D＊） and semiquantitative parameters of DCE-MRI （Slop, Maxslop, CER, Washout, AUC90） were measured. One-way ANOVA analysis of variance and Pearson correlation were used to analyze normally distributed continuous data. Kruskal-Wallis H test and Spearman correlation were used to analyze abnormally distributed continuous data. Tumor volume and all of the MRI parameters were compared as well as correlated with pathological grading.The perfusion parameters derived from IVIM were correlated with those derived from dynamic enhanced MR imaging. The sensitivity and specificity of f value to to diagnose G3 cervical cancer and the best cutoff were calculated from areas under the ROC curves.Results Tumor volume of G1,G2 and G3 cancers were（33.8±31.1）,（19.6±16.9）and（31.2±29.1）cm3（F=1.147,P=0.332）, respectively.ADC values of the three groups were（1.03 ± 0.11）× 10^-3,（1.00 ± 0.10）× 10^-3 and（0.90 ± 0.05）× 10^-3mm2/s,respectively（F=4.619,P=0.018）.D values of the three groups were （0.80 ± 0.11） × 10^-3, （0.77 ± 0.06） × 10^-3and （0.69 ± 0.06） × 10^-3mm2/s ,respectively（F=5.272, P=0.011）.f values of the three groups were 0.20±0.02, 0.22±0.03 and 0.24± 0.03, respectively （F=3.524, P=0.043）.All of the others were of no significant difference （P〉0.05）.Both ADC and D correlated negatively

关 键 词：宫颈肿瘤 磁共振成像 对比分析 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]