动态对比增强MRI在早期舌鳞癌浸润深度测量中的价值  

Assessment of depth of invasion in early tongue squamous cell carcinoma based on dynamic contrast-enhanced MRI

作　　者：朱韵菁 唐为卿[1] 袁瑛[1] 陶晓峰[1] Zhu Yunjing;Tang Weiqing;Yuan Ying;Tao Xiaofeng(Department of Radiology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院放射科,上海200011

出　　处：《中华放射学杂志》2022年第10期1097-1102,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(91859202,81771901)。

摘　　要：目的探讨动态对比增强(DCE)-MRI测量早期舌鳞癌浸润深度(DOI)的可行性。方法回顾性分析2016年1月至2020年12月于上海交通大学医学院附属第九人民医院经病理证实的早期舌鳞癌100例,其中病理分期T1期48例、T2期52例。所有患者术前行常规MRI平扫、DCE-MRI及对比增强T_(1)WI(CE-T_(1)WI)。由2名医师分别独立在横断面不同时相的DCE-MRI(注射对比剂后30、60、120 s)和CE-T_(1)WI图像上测量DOI(MRI-DOI)。采用组内相关系数(ICC)评价测量结果的一致性。采用重复测量的方差分析比较DCE-MRI 30、60、120 s和CE-T_(1)WI测量MRI-DOI与基于病理切片测量的DOI(病理-DOI)的差异,两两比较采用LSD法。采用Pearson相关分析MRI-DOI和病理-DOI的相关性。使用受试者操作特征(ROC)曲线评估MRI-DOI诊断T1与T2期舌鳞癌的效能。结果2名医师基于DCE-MRI 30、60、120 s和CE-T_(1)WI测量MRI-DOI的一致性良好,ICC分别为0.752、0.875、0.883、0.841,MRI-DOI分别为(8.35±3.52)、(6.88±2.41)、(7.52±2.65)和(8.60±3.39)mm,病理-DOI为(5.75±2.01)mm,总体差异有统计学意义(F=69.25,P<0.001);MRI-DOI均大于病理-DOI(P均<0.05)。基于DCE-MRI 30、60、120 s和CE-T_(1)WI测量的MRI-DOI与病理-DOI均呈正相关(r值分别为0.574、0.851、0.731、0.663,P均<0.001)。基于DCE-MRI 60 s测得MRI-DOI诊断T1与T2分期舌鳞癌的效能最高,ROC曲线下面积为0.931(95%CI 0.881~0.982),以6.0 mm为诊断阈值,诊断准确度为88.0%,灵敏度和特异度分别为96.2%和79.2%。结论DCE-MRI能有效用于测量早期舌鳞癌DOI,基于DCE-MRI 60 s测得的MRI-DOI与病理测量值相关性最佳,有助于术前准确评估早期舌鳞癌临床T分期。Objective To investigate the feasibility of dynamic contrast-enhanced(DCE)-MRI in assessing the depth of invasion(DOI)of early tongue squamous cell carcinoma.Methods From January 2016 to December 2020,a total of 100 patients with early tongue squamous cell carcinoma confirmed by postoperative pathology were retrospectively analyzed in the Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine.The study included 48 cases of T1 stage and 52 cases of T2 stage.All patients underwent routine MRI,DCE-MRI and contrast-enhanced T_(1)WI(CE-T_(1)WI)before surgery.The DOI was measured on images at different phases of axial DCE-MRI(30,60 and 120 s after contrast injection)and CE-T_(1)WI(MRI-DOI)by 2 doctors independently.The intraclass correlation coefficient(ICC)was applied to evaluate the consistency of the measurements.MRI-DOI measured on DCE-MRI 30,60,120 s,CE-T_(1)WI and pathological DOI measured on biopsies were statistically analyzed with analysis of variance for repeated measurement and least significant difference t test.Pearson correlation coefficient was used to compare the correlation between MRI-DOI and pathological DOI.Receiver operation characteristic(ROC)curve analysis was used to explore the performance of MRI-DOI for clinical T1 and T2 staging.Results There was a good consistency in MRI-DOI measured on DCE-MRI 30,60,120 s,and CE-T_(1)WI images with ICC of 0.752,0.875,0.883,and 0.841,respectively.The values of MRI-DOI were(8.35±3.52),(6.88±2.41),(7.52±2.65)and(8.60±3.39)mm,respectively,and pathological DOI was(5.75±2.01)mm.There was statistically significant difference in the overall comparison among different phases of MRI-DOI and pathological DOI(F=69.25,P<0.001).MRI-DOI were significantly higher than pathological DOI(P<0.05).All MRI-DOI measured on DCE-MRI 30,60,120 s and CE-T_(1)WI correlated positively with pathological DOI(r=0.574,0.851,0.731,0.663,all P<0.001).MRI-DOI derived from DCE-MRI 60 s showed the highest diagnostic efficiency for T1 and T2 staging(area under the ROC cu

关 键 词：舌肿瘤 癌 鳞状细胞 磁共振成像 肿瘤浸润 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.86[医药卫生—诊断学]