扩散加权成像在子宫内膜癌术前组织学分级评估中的价值  

Value of Diffusion-Weighted Imaging in Preoperative Grading of Endometrial Carcinoma

作　　者：刘海东[1] 于红[1] 许相丰[1] 王南飞[1] 王玮[1] 何晓燕[1] 

机构地区：[1]天津市中心妇产科医院放射科,300100

出　　处：《临床放射学杂志》2016年第7期1053-1057,共5页Journal of Clinical Radiology

摘　　要：目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值定量分析对子宫内膜癌术前组织学分级的应用价值。方法回顾性分析105例经手术病理证实的子宫内膜癌患者术前MR资料,比较不同组织学分级间ADC值差异,分析ADC值与组织学分级的相关性,并通过受试者工作特征曲线(ROC)评估ADC对分级的诊断效能。结果不同观察者所测肿瘤的ADC值具有良好一致性,组内相关系数为0.901;子宫内膜癌组织学分级包括:G1 27例,G2 60例,G3 18例,三者的平均ADC值分别为(0.990±0.128)×10^(-3)mm^2/s、(0.915±0.122)×10^(-3)mm^2/s、(0.851±0.104)×10^(-3)mm^2/s,三者间差异具有统计学意义(P=0.001);ADC值与组织学分级呈负相关(r=-0.356,P<0.001);平均ADC值鉴别高低级别子宫内膜癌的ROC曲线下面积为0.693(P=0.003),95%置信区间为0.584~0.802,最佳诊断界值为0.910×10^(-3)mm^2/s,敏感度为74.1%,特异度为61.5%,阳性预测值为85.3%,阴性预测值为45.9%,准确度为71.4%。结论 ADC值定量分析能够在一定程度上反映子宫内膜癌的组织学分级特征,具备无创评估肿瘤组织学分级的潜力。Objective To investigate the utility of diffusion-weighted imaging（ DWI） with apparent diffusion coefficient（ ADC） in the preoperative grading of the endometrial carcinoma. Methods 105 patients with histopathologically confirmed endometrial carcinoma were retrospectively enrolled in this study. According to tumor grade,the average ADC of tumor was compared and the correlation between ADC and tumor grade was analyzed. The diagnostic performance of ADC to the preoperative grading was also assessed by ROC analysis. Results The reader agreement in ADC measurements was excellent（ ICC = 0. 901）. The histological grade of differentiation was G1 in 27 cases（ 25. 8%）,G2 in 60 cases（ 57. 1%）,and G3 in 18 cases（ 17. 1%）. The average ADC of G1,G2 and G3 were（ 0. 990 ± 0. 128） × 10^（-3）mm^2/ s,（ 0. 915 ± 0. 122） × 10^（-3）mm^2/ s and（ 0. 851 ± 0. 104） × 10^（-3）mm^2/ s,respectively. The difference was statistically significant（ P = 0. 001）. There was a negative correlation between ADC and tumor grade（ r =- 0. 356,P〈0. 001）. The average ADC value of the low-grade group was（ 0. 990 ± 0. 128） × 10^（-3）mm^2/ s,which was significantly higher than that of the high-grade group（ 0. 899 ± 0. 121） × 10^（-3）mm^2/ s（ t = 3. 279,P = 0. 001）. Applying a cutoff average ADC value of less than 0. 910 × 10^（-3）mm^2/ s,we obtained a sensitivity,specificity,positive predictive value,negative predictive value and accuracy for the diagnosis of high-grade and low-grade tumor of 74. 1%,61. 5%,85. 3%,45. 9% and 71. 4%,respectively. Conclusion The quantitative analysis of ADC could reflect some histopathological characterizations of endometrial carcinoma and it was a promising method to assess the preoperative grading in the future.

关 键 词：子宫内膜肿瘤 肿瘤分级 扩散加权成像 表观扩散系数 

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