表观扩散系数及其离散系数在诊断子宫内膜良恶性病变中的应用  

Application of apparent diffusion coefficient value and its coefficient variance in diagnosis of benign and malignant endometrial lesions

作　　者：柳丽[1] 何悦明[1] 杨振涛[1] LIU Li;HE Yueming;YANG Zhentao(Department of Radiology, Fuxing Hospital, Capital Medical University, Beijing 100038, China)

机构地区：[1]首都医科大学附属复兴医院放射科,北京100038

出　　处：《医学影像学杂志》2022年第6期1010-1014,共5页Journal of Medical Imaging

摘　　要：目的探讨表观扩散系数(ADC)及其离散系数(CV)在鉴别子宫内膜良恶性病变中的应用。方法分析经病理证实的36例Ⅰa期子宫内膜腺癌及33例子宫内膜良性病变患者的磁共振影像资料,分别由2位医师测量病灶的ADC均值、标准差及闭孔内肌对应的ADC值,计算平均表观扩散系数(mADC)、相对表观扩散系数(rADC)(以闭孔内肌为参照部位)及离散系数。比较子宫内膜良恶性病变mADC、rADC及CV值的差异。结果1)子宫内膜良性病变的mADC值为(1.13±0.21)×10^(-3) mm^(2),rADC值为0.87±0.17,CV值为0.14±0.04;Ⅰa期子宫内膜腺癌的mADC值为(0.76±0.11)×10^(-3) mm^(2),rADC值为0.59±0.10,CV值为0.20±0.04;宫腔内恶性病变的mADC、rADC值明显低于良性病变,CV值则高于良性病变,且差异有统计学意义(P<0.001);2)通过受试者工作特征曲线(ROC曲线)分析,mADC、rADC、CV诊断子宫内膜良恶性病变的曲线下面积(AUC)分别为0.93,0.92、0.89(P<0.001),三者曲线下面积比较差异无统计学意义(P>0.05);rADC值的约登指数(YI)最大为0.83,对应诊断阈值为≤0.70,鉴别子宫内膜良恶性病变的敏感度、特异度、准确率最高,分别为91.70%,90.90%,91.30%。结论DWI的量化指标mADC、rADC及CV值均可作为有效的定量参数鉴别子宫内膜的良恶性病变,rADC值的诊断效能优于mADC及CV值。Objective To investigate the application of apparent diffusion coefficient(ADC)value and its coefficient variance(CV)in differentiating benign from malignant endometrial lesions.Methods The MRI data of 36 patients with stage Ia endometrial cancer and 33 patients with benign lesions of the endometrium confirmed by pathology were retrospectively analyzed.The mean value of ADC and standard deviation of the lesion and the ADC value corresponding to the obturator internus muscle were measured by two doctors respectively.The values of mean apparent diffusion coefficient(mADC),relative apparent diffusion coefficient(rADC)(with obturator internus as reference site)and coefficient variance of ADC were calculated.The differences of mADC,rADC and CV's value in benign and malignant endometrial lesions were compared.Results 1)The mADC value of benign endometrial lesions was(1.13±0.21)×10^(-3) mm^(2),rADC value was 0.87±0.17,CV value was 0.14±0.04.The mADC value of stage Ia endometrial cancer was(0.76±0.11)×10^(-3) mm^(2),rADC value was 0.59±0.10,CV value was 0.20±0.04.The mADC and rADC values of intrauterine malignant lesions were significantly lower than those of benign lesions,the value of CV was higher than that of benign lesions,and the difference was statistically significant(P<0.001);2)Through receiver operating characteristic curve(ROC)analysis,the yodea index(y2)of rADC value was the largese,which was 0.83.The AVC of mADC,rADC and CV in the diagnosis of benigu and maliguant endometrial lesions were 0.93,0.92 and 0.89(P<0.001)respectively.There was no statistical significance(P>0.05)in the area under the curve.The yoden index(YI)of rADC value was at most 0.83,and the corresponding diagnostic threshold was≤0.70.The sensitivity,specificity and accuracy of differentiating endometrial benign and malignant lesions were 91.70%,90.90%and 91.30%,respectively.Conclusion The quantitative indexes of DWI including value of mADC,rADC and CV can be used to differentiate benign and malignant endometrial lesions.The diagnost

关 键 词：子宫内膜良恶性病变 平均表观扩散系数 相对表观扩散系数 离散系数 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R722.1[医药卫生—诊断学]