磁共振扩散张量成像对宫颈癌的诊断价值  

The study of diagnostic value of DTI on cervical cancer

作　　者：李凤致 李菲 王宗英 程启超 陈常胜[1] 王锡臻[1] LI Fengzhi;LI Fei;WANG Zongying;CHENG Qichao;CHEN Changsheng;WANG Xizhen(Department of Medical Imaging,Weifang Medical University,Imaging Center of Affiliated Hospital of Weifang Medical University,Weifang 261053,China)

机构地区：[1]潍坊医学院医学影像学系潍坊医学院附属医院影像中心

出　　处：《实用医学杂志》2019年第18期2942-2945,共4页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81641074,81171303,30470518,81771828);山东省自然科学基金项目(编号:ZR2009CL046,ZR2010HQ029,ZR2016HL40,ZR2017MH037);山东省优秀中青年科学家科研奖励基金项目(编号:BS2012YY038);山东省医药卫生科技发展计划项目(编号:2017WS408,2017WS579);潍坊医学院博士科研启动基金(2009);潍坊医学院大学生科技创新基金项目(编号:KX2015011,KX2016038,KX2017041);潍坊市科技发展计划项目(编号:2017YX054);山东省高校科研计划项目(科技类)(编号:J18KA288,J18KA284)

摘　　要：目的对比宫颈癌与正常子宫肌层磁共振扩散张量成像(diffusion tensor imaging,DTI)参数值差异,明确DTI对宫颈癌的诊断价值。方法对29例经病理证实的宫颈癌患者行盆腔常规MRI和DTI检查,测量宫颈癌与子宫底部未被侵及的正常子宫肌层的表观弥散系数(apparent diffusion coefficient,ADC)、各向异性分数(fractional anisotropy,FA)、容积比各向异性(volume ratio anisotropy,VRA)、T2加权迹线(T2-weighted trace,T2-WT)值。两种组织间数值的差异采用配对样本t检验进行比较,使用受试者工作特性曲线(receiver operating characteristic curve,ROC曲线)分析DTI参数值诊断宫颈癌的敏感性、特异性。通过扩散张量纤维束成像(diffusion tensor tractography,DTT)观察组织纤维束结构特点。结果宫颈癌的测量值分别为ADC值[(145.86±59.96)× 10^-11mm^2/s]、FA值(0.15±0.08)、VRA值(0.14±0.08)、T2-WT值(479.06±257.18)。正常子宫肌层的测量值分别为ADC值[(178.69±21.89)× 10^-11mm^2/s]、FA值(0.23±0.05)、VRA值(0.08±0.03)、T2-WT值(241.53±83.62)。宫颈癌的ADC及FA值低于正常子宫肌层,VRA和T2-WT值则高于正常子宫肌层,结果差异有显著统计学意义(P <0.05)。宫颈癌ROC曲线下面积(AUC值)按照ADC、FA、VRA、T2WT的顺序分别为0.721、0.893、0.879、0.785;敏感度分别为55.2%、86.2%、86.2%和55.2%;特异度在ADC、FA、VRA均为100%,T2-WT为96.6%。DTT显示,正常子宫肌层纤维排列紧密、有序、走形自然;宫颈癌纤维排列疏松,走行紊乱。结论 DTI检查结合DTT图像能够更好地辅助宫颈癌的影像诊断。Objective To determine the value of DTI in the diagnosis of cervical cancer by comparing the differences of the parameters of cervical cancer and the normal diffusion tensor imaging(DTI). Methods 29 patients with cervical cancer were examined by conventional MRI and DTI examination. Apparent diffusion coefficient(ADC),fractional anisotropy(FA),volume ratio anisotropy(VRA)and T2 weighted trace(T2-WT)of cervical cancer and normal myometrial layer were measured. The differences in values between the two tissues were compared by paired sample t test,and the sensitivity and specificity of DTI parameter values in the diagnosis of cervical cancer were analyzed by Receiver operating characteristic curve(ROC curve). The structure of tissue fiber bundles were observed by diffusion tensor tractography(DTT). Results The DTI values of cervical cancer were ADC(145.86 ± 59.96)× 10^-11mm^2/s,FA 0.15 ± 0.08,VRA 0.14 ± 0.08,T2-WT 479.06 ± 257.18,respectively. The DTI values of normal myometrium were ADC(174.69 ± 21.89)× 10^-11mm^2/s,FA 0.23 ± 0.05,VRA 0.08 ± 0.03,T2-WT 241.53 ± 83.62,respectively. The ADC and FA values of cervical cancer were lower than those of normal myometrium,while the VRA and T2-WT values were higher than those of normal myometrium(P < 0.05). The area under curve(AUC)of ADC,FA,VRA and T2-WT were 0.721,0.893,0.897 and 0.785 respectively. The sensitivity of ADC,FA,VRA,T2-WT were of 55.2%,86.2%,86.2% and 55.2%,respectively. The specificity was100% in ADC,FA and VRA,and 96.6% in T2-WT. DTT showed that the normal myometrium fibers were closely arranged and orderly,and the cervical cancer fibers were loose and disorderly. Conclusion DTI examination combined with DTT can better assist the imaging diagnosis of cervical cancer.

关 键 词：宫颈癌 扩散张量成像 磁共振成像 ROC曲线 

分 类 号：R445.2[医药卫生—影像医学与核医学]