酰胺质子转移成像和扩散峰度成像评估子宫内膜癌微卫星不稳定状态  

Evaluation of microsatellite instability in endometrial carcinoma by amide proton transfer imaging and diffusion kurtosis imaging

作　　者：田士峰[1] 刘爱连[1] 陈丽华[1] 王楠[1] 林良杰 王家正 张祎 TIAN Shi-feng;LIU Ai-lian;CHEN Li-hua;WANG Nan;LIN Liang-jie;WANG Jia-zheng;ZHANG Yi(Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian Liaoning 116011;Philips(China)Investment Co.,Ltd,Shanghai 200040,China;College of Biomedical Engineering and Instrument Science,Zhejiang University,Hangzhou 310012,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]飞利浦(中国)投资有限公司,上海200040 [3]浙江大学生物医学工程与仪器科学学院,浙江杭州310012

出　　处：《中国临床医学影像杂志》2022年第5期345-349,共5页Journal of China Clinic Medical Imaging

基　　金：首都科技领军人才培养工程(Z181100006318003)。

摘　　要：目的:探讨酰胺质子转移(APT)和扩散峰度成像(DKI)定量参数评估子宫内膜癌(EC)微卫星不稳定(MSI)状态的价值。方法:回顾性分析30例经手术病理证实为EC的患者资料,其中MSI 12例,微卫星稳定(MSS)18例,术前均行3.0T MR检查,扫描序列包括APT和DKI,经后处理获得APT以及DKI序列的平均扩散峰度(MK)、平均扩散系数(MD)、各向异性分数(FA)图。由两位观察者分别测量两组病变的APT、MK、MD和FA值,采用同类相关系数(ICC)检验两位观察者对两组病变各参数值测量结果的一致性,采用独立样本t检验或Mann-Whitney U检验比较两组病变各参数值的差异,采用ROC曲线(计算曲线下面积,AUC)评估有统计学差异的参数对两组病变鉴别诊断的效能。结果:两位观察者测量各组数据的一致性良好(ICC>0.75)。MSI组的APT、MK、MD和FA值分别为(2.733±0.509)%、0.743±0.107、(0.803±0.156)μm2/ms和0.324±0.110,MSS组的上述参数值分别为(2.317±0.444)%、0.646±0.114、0.955(0.806,1.139)μm2/ms和0.339±0.134,MSI组的APT、MK值大于MSS组,MD值小于MSS组(P<0.05),两组之间的FA值无统计学差异(P>0.05)。APT、MK、MD值鉴别EC MSI与MSS状态的AUC分别为0.729、0.731、0.722,敏感度分别为66.7%、75.0%、75.0%,特异度分别为77.8%、61.1%、72.2%。结论:APT和DKI技术可定量评估EC MSI状态,具有一定临床应用价值。Objective:To investigate the value of quantitative parameters of amide proton transfer(APT) and diffusion kurtosis imaging(DKI) in the assessment of microsatellite instability(MSI) in endometrial carcinoma(EC).Methods:The data of30 patients with EC confirmed by surgery and pathology were retrospectively analyzed,included 12 cases of MSI and 18cases of microsatellite stability(MSS).All patients underwent 3.0T MR examination before operation.The scanning sequences included APT and DKI.The mean kurtosis(MK),mean diffusivity(MD) and fractional anisotropy(FA) maps of APT and DKI sequences were obtained by post-processing.The APT,MK,MD and FA values of both two groups were measured by two observers.The intra-class correlation coefficients(ICC) was used to test the measurement consistency between the two observers.The independent-samples t-test or Mann-Whitney U test was performed to analyze the differences of each parameter values between the two groups.Receiver operator characteristic(ROC) curves were plotted and area under curve(AUC) was performed calculated to evaluate the differential diagnosis efficiency.Results:The consistency of data measured by the two observers were good(ICC>0.75).The APT,MK,MD and FA values of MSI group were(2.733±0.509)%,0.743±0.107,(0.803±0.156)μm2/ms and 0.324±0.110,respectively.The above parameters values of MSS group were(2.317 ±0.444)%,0.646±0.114,0.955(0.806,1.139)μm2/ms and 0.339±0.134,respectively.The values of APT and MK values in MSI group were higher than those in MSS group,and the values of MD was lower than that in MSS group(P <0.05).There was no significant difference of FA value between the two groups(P >0.05).The AUC of APT,MK and MD values in distinguishing EC MSI from MSS were 0.729,0.731,and 0.722,respectively.The sensitivity were 66.7%,75.0%,and 75.0%,respectively.The specificity were 77.8%,61.1%,and 72.2%,respectively.Conclusion:APT and DKI can be used to quantitatively evaluate the status of EC MSI,which has the certain clinical value.

关 键 词：子宫内膜肿瘤 微卫星不稳定性 磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤] R730.261[医药卫生—临床医学] R445.2