动态对比增强磁共振成像定量灌注直方图参数对子宫肌瘤病理分型的诊断价值  

Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify different pathological types of uterine leiomyoma

作　　者：王苏波[1] 赵振华[2] 章俞 杨立铭[2] 黄亚男 阮雅文[2] 王诚[2] WANG Subo;ZHAO Zhenhua;ZHANG Yu;YANG Liming;HUANG Yanan;RUAN Yawen;WANG Cheng(Department of Radiology,Shaoxing Hospital of Traditional Medicine,Shaoxing 312000,Zhejiang Province,China;Department of Radiology,Shaoxing People’s Hospital,Shaoxing 312000,Zhejiang Province,China)

机构地区：[1]绍兴市中医院放射科,浙江绍兴312000 [2]绍兴市人民医院放射科,浙江绍兴312000

出　　处：《浙江大学学报（医学版）》2021年第1期97-105,共9页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省公益性技术应用研究(2014C33151);浙江省医药卫生科技计划(2014KYA215);浙江省自然科学基金(LY16H180006);绍兴市公益性技术应用研究(2018C30086,2018C30119,2020A13045)。

摘　　要：目的:探讨动态对比增强磁共振成像(DCE-MRI)定量灌注直方图参数在子宫肌瘤病理分型诊断中的价值及其与Ki-67蛋白表达的相关性。方法:回顾性分析2015年10月至2017年9月在绍兴市人民医院经手术后病理检查证实为子宫肌瘤35例患者(普通型15例,富细胞型8例,退变型12例)的资料。所有患者术前行盆腔DCE-MRI检查,计算各定量灌注参数包括容量转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e))、血管间隙容积分数(V_(p))的直方图参数(中位数、平均值、偏度、峰度、能量、熵),并采用受试者操作特征(ROC)曲线评估不同参数在鉴别子宫肌瘤病理分型中的效能。免疫组织化学方法测定子宫肌瘤Ki-67蛋白表达,比较不同病理类型Ki-67蛋白表达的差异,并采用Pearson和Spearman相关性分析法分析直方图参数与Ki-67蛋白表达的相关性。结果:富细胞型组K^(trans)、K_(ep)、V_(e)、V_(p)的中位数和平均值均大于退变型组和普通型组(P<0.05或P<0.01);V_(e)的偏度、K_(ep)的偏度和峰度均小于普通型组(均P<0.05);K^(trans)的熵高于退变型组和普通型组(均P<0.05);V_(p)的熵高于普通型组(P<0.01)。K^(trans)的中位数、平均值和偏度,K_(ep)的中位数和平均值,V_(e)的中位数和平均值,V_(p)的中位数、平均值、能量和熵均与Ki-67表达水平相关(均P<0.05)。ROC曲线分析结果显示,当K^(trans)中位数阈值为0.994/min时,其诊断富细胞型子宫肌瘤的敏感度为100.0%,特异度为77.8%,ROC曲线下面积为0.949;当K^(trans)平均值阈值为1.170/min时,其诊断富细胞型子宫肌瘤的敏感度为100.0%,特异度为77.8%,ROC曲线下面积为0.958;K^(trans)的熵,K_(ep)的中位数和平均值,V_(p)的中位数、平均值和熵诊断富细胞型子宫肌瘤的ROC曲线下面积也较高(0.755~0.907)。结论:DCE-MRI定量灌注直方图参数对不同病理类型子宫肌瘤尤其是富细胞型子宫肌瘤具有较高�Objective:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression.Methods:Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People’s Hospital from October 2015 to September 2017 were analyzed retrospectively,including 15 cases of ordinary type,8 cases of cellular type and 12 cases of degenerative type.All patients were examined by pelvic DCE-MRI before operation,and the histogram parameters(median,mean,skewness,kurtosis,energy,entropy)of various quantitative perfusion parameters,including volume transport constant(K^(trans)),rate constant(K_(ep)),extravascular extracellular space distribute volume per unit tissue volume(V_(e)),blood plasma volume per unit volume of tissue(V_(p))were calculated,and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve.The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical method,and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis.Results:The median and mean values of K^(trans),K_(ep),V_(e) and V_(p) in the cellular group were higher than those in the degenerative group and the ordinary group(P<0.05 or P<0.01),while the skewness of V_(e),the skewness and kurtosis of K_(ep) in the cellular group were lower than those in the ordinary group(all P<0.05).The entropy of K^(trans) in the cellular group was higher than that in the degenerative group and the ordinary group(all P<0.05).The entropy of V_(p) in the cellular group was higher than that in the ordinary group(P<0.01).The median,mean,skewness of K^(trans),median and mean of K_(ep),median and mean of V_(e),median,mean,energy and entropy of V_(p) were correlated with Ki-67 expression(all P<0.05).The results of ROC curve analysis showed th

关 键 词：子宫肌瘤 病理分型 动态增强磁共振成像 KI-67 诊断 

分 类 号：R73[医药卫生—肿瘤]