动态对比增强MRI和体素内不相干运动预测子宫内膜癌临床分型  

Prediction of clinical type of endometrial cancer by dynamic contrast-enhanced MRI and intravoxel incoherent motion

作　　者：任继鹏[1] 周凤梅[1] 王帅娜 段金辉 刘旺毅 韩东明[1] REN Jipeng;ZHOU Fengmei;WANG Shuaina;DUAN Jinhui;LIU Wangyi;HAN Dongming(Department of Magnetic Resonance,the First Affiliated Hospital of Xinxiang Medical University,Weihui,He’nan Province 453100,China)

机构地区：[1]新乡医学院第一附属医院磁共振科,河南卫辉453100

出　　处：《实用放射学杂志》2023年第10期1642-1646,共5页Journal of Practical Radiology

基　　金：河南省医学科技公关计划联合共建项目(2018020357)。

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)和体素内不相干运动(IVIM)成像鉴别雌激素依赖型(Ⅰ型)和非依赖型(Ⅱ型)子宫内膜癌(EC)的作用。方法64例EC患者接受了DCE-MRI和IVIM扫描,其中Ⅰ型EC 39例,Ⅱ型EC 25例。分别测量容量转移常数(K^(trans))、速率常数(K_(ep))、血管外细胞外组织间隙容积分数(V_(e))、真性扩散系数(D)、假性扩散系数(D^(*))和灌注分数(f)值并进行组间对比,之后评估各参数诊断效能、寻找独立预测因子并进行联合诊断。结果Ⅰ型EC组的D和f值均高于Ⅱ型EC组(P<0.001),Ⅱ型EC组的K^(trans)和V_(e)值均显著低于Ⅰ型EC组(P<0.001),Ⅰ、Ⅱ型EC间K_(ep)、D^(*)值无明显差异(P=0.158、0.196)。D、K^(trans)、V_(e)和f的曲线下面积(AUC)依次为0.837、0.804、0.781和0.751。D和K^(trans)是Ⅰ、Ⅱ型EC鉴别的独立预测因子,两者结合的AUC为0.950,敏感性为88.00%,特异性为92.31%。DeLong分析显示,D+K^(trans)的AUC与D、K^(trans)、V_(e)和f的AUC之间的差异均有统计学意义(Z=2.437、2.943、3.147和3.304;P=0.015、0.003、0.002和0.001)。结论DCE-MRI和IVIM部分定量参数可用于EC临床分型的预测,其中K^(trans)和D的组合可能是有效的影像学标记物。Objective To explore the role of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and intravoxel incoherent motion(IVIM)in identifying estrogen-dependent(type Ⅰ)and nonestrogen-dependent(type Ⅱ)endometrial cancer(EC).Methods A total of 64 EC patients underwent DCE-MRI and IVIM scans,including 39 cases of typeⅠand 25 cases of type Ⅱ EC.The volume transfer constant(K^(trans)),rate transfer constant(K_(ep)),volume of extravascular extracellular space per unit volume of tissue(V_(e)),diffusion coefficient(D),pseudo diffusion coefficient(D^(*)),and perfusion fraction(f)values were measured separately and compared between different groups,after which the diagnostic efficacy of each parameter was assessed,independent predictors were sought and a joint diagnosis was made.Results The D and f values in the type Ⅰ EC group were higher than those in the type Ⅱ EC group(P<0.001),and the K^(trans) and V_(e) values in the type Ⅱ EC group were lower than those in the type Ⅰ EC group(P<0.001).No significant differences were found in K_(ep) and D* values between type Ⅰ and type Ⅱ EC(P=0.158,0.196).The area under the curve(AUC)of D,K^(trans),V_(e),and f were 0.837,0.804,0.781,and 0.751,respectively.The D and K^(trans) were independent predictors,and the diagnostic efficiency,specificity,and sensitivity of the combination of them were 0.950,92.31%,and 88.00%,respectively.DeLong analysis demonstrated that the differences between AUC(D+K^(trans))and AUC(D),AUC(K^(trans)),AUC(V_(e)),and AUC(f)were all significant(Z=2.437,2.943,3.147,and 3.304;P=0.015,0.003,0.002,and 0.001,respectively).Conclusion Partial quantitative parameters of DCE-MRI and IVIM can be utilized for the prediction of the clinical type of EC,and the combination of K^(trans) and D may be a valid imaging marker.

关 键 词：子宫内膜癌 动态对比增强磁共振成像 体素内不相干运动 

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