扩散峰度成像定量参数鉴别子宫内膜浆液性腺癌与内膜样腺癌的价值  

Quantitative Parameter of Diffusion Kurtosis Imaging in Differentiating Uterine Serous Adenocarcinoma from Endometrioid Adenocarcinoma

作　　者：田士峰[1] 刘爱连[1] 宋清伟[1] 鞠烨[1] 朱雯[2] 汪禾青[1] 李烨[1] 黄侃[1] TIAN Shifeng;LIU Ailian;SONG Qingwei;JU Ye;ZHU Wen;WANG Heqing;LI Ye;HUANG Kan(Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,辽宁大连116011 [2]大连医科大学附属第一医院病理科,辽宁大连116011

出　　处：《中国医学影像学杂志》2018年第2期120-125,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨MR扩散峰度成像(DKI)定量参数对子宫内膜浆液性腺癌(SA)与内膜样腺癌(EA)的鉴别价值。资料与方法回顾性分析经手术病理证实的14例SA和20例EA患者的资料,所有患者均行1.5T MRI检查,扫描序列包括T1WI、T2WI、DKI和LAVA。应用Functool软件对DKI图像进行重建,由2名观察者分别测量两组病灶实质区各DKI参数值,包括平均扩散峰度值(MK)、平行扩散峰度值(Ka)、垂直扩散峰度值(Kr)、峰度各向异性分数(FAk)、平均扩散系数值(MD)、平行扩散系数值(Da)、垂直扩散系数值(Dr)及各向异性分数(FA)。分析2名观察者各参数测量结果一致性,比较两组各参数值,采用受试者工作特性(ROC)曲线评估各参数值鉴别两组病灶的效能。结果 2名观察者测得两组病灶各参数值的一致性良好(ICC>0.75)。SA组的MK、Ka、Kr、FAk、MD、Da、Dr、FA值分别为1.10±0.23、1.17±0.36、0.91±0.21、0.42±0.11、(1.53±0.43)μm^2/ms、(1.96±0.56)μm^2/ms、(1.32±0.38)μm^2/ms、0.26±0.05,EA组各参数值分别为0.82±0.18、0.84±0.21、0.76±0.18、0.29±0.08、(2.36±0.62)μm^2/ms、(2.89±0.81)μm^2/ms、(2.09±0.53)μm^2/ms、0.21±0.06,SA组的MK、Ka、Kr、FAk、FA值大于EA组,MD、Da、Dr值小于EA组,差异有统计学意义(P<0.05)。MK、Ka、Kr、FAk、MD、Da、Dr、FA值预估SA的曲线下面积分别为0.830、0.754、0.713、0.864、0.893、0.852、0.920、0.779,MK≥0.85、Ka≥1.15、Kr≥0.82、FAk≥0.35、MD≤1.93μm^2/ms、Da≤2.49μm^2/ms、Dr≤1.66μm^2/ms、FA≥0.24为预估SA的界值。结论 DKI定量参数有助于鉴别SA和EA,具有一定的临床应用价值。Purpose To evaluate the diagnostic value of quantitative parameter of diffusion kurtosis imaging（DKI） in differentiating uterine serous adenocarcinoma（SA） from endometrioid adenocarcinoma（EA）. Materials and Methods Fourteen SA and 20 EA patients who were verified by surgical pathology were retrospectively analyzed. All patients received 1.5 T MRI examination and scanning sequence included T1 WI, T2 WI, DKI and LAVA. Functool software was taken to reconstruct DKI images and the DKI parameters of focus area in two groups were measured by two observers, including mean kurtosis（MK）, axial kurtosis（Ka）, radial kurtosis（Kr）, fractional anisotropy of kurtosis（FAk）, mean diffusivity（MD）, axial diffusivity（Da）, radial diffusivity（Dr） and fractional anisotropy（FA）. The consistency of parameters between two observers was analyzed, and the parameters between the two groups were compared. The receiver operating characteristic（ROC） curve was used to evaluate the effectiveness of each parameter in determining focus in each group. Results Each focus parameter in the two groups obtained by two observers were of good consistency（ICC0.75）.Value of MK, Ka, Kr, FAk, MD, Da, Dr and FA in SA group was 1.10±0.23, 1.17±0.36, 0.91±0.21, 0.42±0.11,（1.53±0.43） μm2/ms（1.96±0.56） μm2/ms（1.32±0.38） μm2/msand 0.26±0.05 respectively, and those in EA group were 0.82±0.18, 0.84±0.21, 0.76±0.18,0.29±0.08,（2.36±0.62） μm2/ms（2.89±0.81） μm2/ms（2.09±0.53） μm2/msand 0.21±0.06 respectively. Value of MK, Ka, Kr, FAk and FA in SA group was higher than that in EA group while value of MD, Da and Dr was lower than that in EA group（P〈0.05）. Area under curve of SA estimated through value of MK, Ka, Kr, FAk, MD, Da, Dr and FA was 0.830, 0.754, 0.713, 0.864, 0.893, 0.852, 0.920 and0.779. MK≥0.85, Ka≥1.15, Kr≥0.82, FAk≥ 0.35, MD≤1.93 μm2/ms Da≤2.49 μm2/ms Dr≤1.66 μm2/msand FA≥0.24 was the dividing value of estimated SA. Conclusion Quantitative

关 键 词：子宫内膜肿瘤 腺癌 磁共振成像 扩散加权成像 图像处理 计算机辅助 诊断 鉴别 

分 类 号：R445.2[医药卫生—影像医学与核医学] R711.7[医药卫生—诊断学]