多模态磁共振成像在评估宫颈鳞癌病理分级和分期中的价值  

Multiparametric magnetic resonance imaging to characterize pathological grading and stage of cervical squamous cell carcinoma

作　　者：刘济人 胥毅[2] 郭丽美 司鹏 郭娟[3] LIU Jiren;XU Yi;GUO Limei;SI Peng;GUO Juan(Department of Cancer Center,Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences),Taiyuan 030032,China;Department of Radiology,Second Hospital of Shanxi Medical School,Taiyuan 030001,China;Department of Medical Imaging Center,Third Hospital of Shanxi Medical University(Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences),Taiyuan 030032,China)

机构地区：[1]山西医科大学第三医院(山西省白求恩医院山西医学科学院)肿瘤中心,太原030032 [2]山西医科大学第二医院影像科,太原030001 [3]山西医科大学第三医院(山西省白求恩医院山西医学科学院)影像中心,太原030032

出　　处：《磁共振成像》2021年第12期29-33,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨T1 mapping、扩散加权成像(diffusion weighted imaging,DWI)以及动态对比增强(dynamic contrast enhanced,DCE)磁共振成像定量参数在宫颈鳞癌病理分级和分期诊断中的应用价值。材料与方法收集经病理证实的65例宫颈鳞癌患者,病理分级:高分化组11例、中分化组32例和低分化组22例,FIGO分期为早期组(ⅠB-ⅡA期) 37例和晚期组(ⅡB-Ⅳ期)28例。所有患者术前行T1 mapping、DWI和DCE序列扫描并获得肿瘤组织纵向弛豫时间(T1-relaxation time)、表观扩散系数(apparent diffusion coefficient,ADC)以及容积转运常数(K^(trans))和速率常数(K_(ep))值。采用单因素方差分析(one-way ANOVA)分析各定量参数在评估不同病理分级间的差异。采用独立样本t检验评估早期组与晚期组间的差异。筛选出差异有统计学意义的参数,绘制ROC曲线评价定量参数的诊断效能。结果 T1、ADC、K^(trans)值在高分化、中分化及低分化宫颈鳞癌中的差异具有统计学意义(P<0.05)。早期宫颈鳞癌组的T1值高于晚期宫颈鳞癌,K^(trans)值低于晚期宫颈鳞癌,差异具有统计学意义(P<0.05)。T1、ADC及K^(trans)值诊断宫颈鳞癌病理分级的ROC曲线下面积(area under the curve,AUC)分别为0.83、0.74和0.79。三参数联合的诊断效能最高,AUC为0.91。T1和K^(trans)值诊断宫颈鳞癌分期的AUC分别为0.67和0.65,两参数联合的诊断效能为0.69。结论 T1 mapping、DWI和DCE-MRI技术的定量参数可作为预测因子评估宫颈鳞癌病理分级和分期,多参数联合可提高宫颈鳞癌诊断的敏感度,具有较高的临床应用价值。Objective:To investigate the value of quantitative parameters derived from T1 mapping,diffusion weighted imaging (DWI)and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in pathologically grading and staging of cervical squamous cell carcinoma (CSCC).Materials and Methods:A total of 65 patients with pathology confirmed CSCC were enrolled in this study,including 11 cases of well differentiated,32 cases of moderately differentiated,22 case of poorly differentiated,and 37 case of early-stage (FIGOⅠB-ⅡA),28 case of late-stage (FIGOⅡB-Ⅳ).Patients underwent pretreatment T1 mapping,DWI and DCE-MRI scan and T1,ADC,K^(trans)and K_(ep)values of tumor tissues were obtained.One-way ANOVA was used to compare the differences of quantitative parameters among different pathological grades.The independent sample t test was used to assess the difference between the early-and late-stage group.ROC curves analysis was performed to determine the diagnostic efficacy of quantitative parameters.Results:T1,ADC and K^(trans)values were significant difference in different pathological grade of CSCC (P<0.05).In term of distinguishing early-from late-stage,T1 value in the early-stage CSCC was higher,and K^(trans)values was lower than the late-stage CSCC.The differences were significant (P<0.05).The area under ROC curve (AUC) of T1,ADC and K^(trans)values in the diagnosis of poorly differentiated CSCC were0.83,0.74 and 0.79,respectively.A combination of these quantitative parameters showed the highest diagnostic efficiency with an AUC of 0.91.The AUC of T1 and K^(trans)values in the diagnosis of early stage CSCC was 0.67 and 0.65,respectively,and a combination of T1 and K^(trans)achieved an AUC of 0.69.Conclusion:T1 mapping,DWI and DCE-MRI quantitative parameters can be used as predictors to evaluate the pathological grade and staging of CSCC.The combination of multiple parameters can improve the diagnostic sensitivity of cervical squamous cell carcinoma,which has high clinical application value.

关 键 词：宫颈鳞癌 磁共振成像 纵向弛豫时间 扩散加权成像 动态对比增强成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]