酰胺质子转移成像与体素内不相干运动成像评估子宫内膜腺癌组织学分级的价值  

Value of amide proton transfer imaging and intravoxel incoherent motion imaging in estimating histologic grades of endometrial adenocarcinoma

作　　者：孔雅晴 曲倩倩 明蕾[1] 王哲 邓凯[1] KONG Yaqing;QU Qianqian;MING Lei;WANG Zhe;DENG Kai(Department of Radiology,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qian Foshan Hospital),Jinan 250014,China;Shandong First Medical University(Shandong Academy of Medical Sciences),Jinan 271016,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)放射科,济南250014 [2]山东第一医科大学(山东省医学科学院),济南271016

出　　处：《磁共振成像》2022年第9期46-52,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：山东省科技发展计划(编号:2012YD18060)。

摘　　要：目的 探讨酰胺质子转移(amide proton transfer, APT)成像和体素内不相干运动(intravoxel incoherent motion, IVIM)成像在评估子宫内膜腺癌(endometrial adenocarcinoma, EA)组织学分级中的价值。材料与方法 39名病理证实EA的患者接受了盆腔磁共振检查(其中Ⅰ级16例,Ⅱ级14例,Ⅲ级9例),扫描序列包括APT、IVIM。测量并比较各级别之间APT值和IVIM各衍生参数值(f,D,D*)的差异,然后采用受试者工作特征(receiver operating characteristic, ROC)曲线和DeLong检验评估差异具有统计学意义的参数的鉴别效能。最后通过Spearman相关分析评估APT值、IVIM各衍生参数值和组织学分级两两之间的相关性。结果 Ⅱ级和Ⅲ级EA的APT值(3.17%±0.43%、3.45%±0.42%)显著高于Ⅰ级EA的APT值(2.66%±0.63%),差异具有统计学意义(P=0.012,P=0.001),Ⅱ级和Ⅲ级EA的f值(0.170%±0.049%、0.150%±0.011%)显著低于Ⅰ级EA的f值(0.220%±0.080%),差异具有统计学意义(P=0.027,P=0.010)。APT值、f值以及二者联合诊断Ⅰ级与Ⅱ级、Ⅰ级与Ⅲ级EA的曲线下面积(area under the curve, AUC)分别为0.78、0.70、0.83;0.86、0.81、0.92,差异无统计学意义。Spearman相关性分析结果显示APT值与EA组织学分级相关系数rs=0.578(95%CI:0.27,0.79;P<0.001),f值与EA组织学分级相关系数rs=-0.416(95%CI:-0.66,-0.11;P=0.008)。结论 APT值和f值与EA组织学分级相关,APT值和f值对EA病理级别的鉴别效能无显著差异,APT成像和IVIM成像有助于术前预测EA组织学分级。Objective: To investigate the effect of amide proton transfer(APT) imaging and intravoxel incoherent motion(IVIM)imaging in estimating histologic grades of endometrial adenocarcinoma(EA). Materials and Methods: A total of 39 patients with pathologically confirmation of EA underwent pelvic magnetic resonance imaging(grade Ⅰ, n=16;grade Ⅱ, n=14;grade Ⅲ, n=9),including APT and IVIM sequences. APT values and IVIM-derived parameters(f, D, D*) of lesions were calculated respectively by two radiologists. We used a Shapiro-Wilk test to evaluate whether the APT values and IVIM-derived parameters were normally distributed.The intraclass correlation coefficient(ICC) was calculated to describe the correlations of the measurements of each parameter between two readers. The differences of APT values and IVIM-derived parameters were calculated and compared among three grades. Then the receiver operating characteristic(ROC) curves and DeLong test were used to evaluate the efficiency of the parameters with statistically differences. Spearman’s correlation analysis was also used between APT values and histologic grades, between IVIM-derived parameters and histologic grades, and between APT values and IVIM-derived parameters. Results: All parameters in our research were normally distributed. The ICC of APT values and IVIM-derived parameters between the two readers showed excellent interobserver agreements(APT: 0.955;f: 0.958;D: 0.964;D*: 0.825). The APT values for grade Ⅱ and grade Ⅲ(3.17%±0.43%, 3.45%±0.42%) were significantly higher than grade Ⅰ(2.66%±0.63%), with statistically significant differences(P=0.012, P=0.001). The f values for gradeⅡ and grade Ⅲ(0.170%±0.049%, 0.150%±0.011%) were significantly lower than grade Ⅰ(0.220%±0.080%), with statistically significant differences(P=0.027, P=0.010). The ROC analysis showed the AUC(area under the curve) of the APT values, f values and the combined diagnosis of both were as follows: grade Ⅰ vs. grade Ⅱ: 0.78, 0.70, 0.83;grade Ⅰ vs. grade Ⅲ: 0.86, 0.

关 键 词：酰胺质子转移成像 体素内不相干运动 子宫内膜腺癌 病理分级 功能磁共振成像 

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]