酰胺质子转移加权成像联合体素内不相干运动成像诊断宫颈鳞状细胞癌及评估病理分化程度的价值  

Value of amide proton transfer-weighted imaging with intravoxel incoherent motion imaging for diagnosing and evaluating the differentiation of cervical squamous cell carcinoma

作　　者：辛仲宏[1] 彭建鸿 卢贤德 南江 张亚萍[1] 陈梓娴[1] 王晓慧[2] 朱骏[3] 雷军强[1] Xin Zhonghong;Peng Jianhong;Lu Xiande;Nan Jiang;Zhang Yaping;Chen Zixian;Wang Xiaohui;Zhu Jun;Lei Junqiang(Department of Radiology,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Gynecology and Obstetrics,the First Hospital of Lanzhou University,Lanzhou 730030,China;Department of Pathology,the First Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第一医院放射科,兰州730030 [2]兰州大学第一医院妇产科,兰州730030 [3]兰州大学第一医院病理科,兰州730030

出　　处：《中华放射学杂志》2024年第6期627-632,共6页Chinese Journal of Radiology

基　　金：甘肃省自然科学基金(20JR10RA684)。

摘　　要：目的探讨酰胺质子转移加权(APTw)成像联合体素内不相干运动(IVIM)成像诊断宫颈鳞状细胞癌(CSCC)及评估病理分化程度的价值。方法该文为诊断性试验研究,回顾性收集2021年10月至2022年10月间在兰州大学第一医院经病理确诊为CSCC的56例患者,为CSCC组。招募2021年10月至2023年10月在兰州大学第一医院进行体检的36例女性健康志愿者,为对照组。根据病理结果,CSCC患者分为中高分化组(n=34)和低分化组(n=22)。将感兴趣区放置于CSCC组病灶和对照组正常宫颈基质,获得APTw成像定量参数不对称性磁化转移率(MTR_(asym))和IVIM定量参数纯扩散系数(D)、假扩散系数(D*)和灌注分数(f)。采用独立样本t检验比较2组间定量参数差异,采用logistic回归模型将2组间差异有统计学意义的定量参数建立联合参数,使用受试者操作特征曲线评估单一定量参数和联合参数区分CSCC组与对照组、CSCC患者中高分化组与低分化组的诊断效能,曲线下面积(AUC)的比较采用DeLong检验。结果CSCC组与对照组间MTR_(asym)、D、f差异有统计学意义(t=-9.79、10.09、11.35,P<0.001),中高分化组与低分化组间MTR_(asym)和D差异有统计学意义(t=4.11、-3.76,P<0.001),其他定量参数差异无统计学意义(P>0.05)。在区分CSCC组与对照组方面,MTR_(asym)、D、f和联合参数(MTR_(asym)+D+f)的AUC(95%CI)分别为0.887(0.804~0.944)、0.940(0.871~0.979)、0.968(0.909~0.993)、0.995(0.950~1.000),联合参数的AUC高于MTR_(asym)和D的AUC,差异有统计学意义(Z=3.07、2.06,P=0.002、0.040)。在区分CSCC中高分化组与低分化组方面,MTR_(asym)、D和联合参数(MTR_(asym)+D)的AUC(95%CI)分别为0.789(0.660~0.887)、0.775(0.644~0.876)、0.852(0.731~0.932),两两间差异无统计学意义(P>0.05)。结论APTw和IVIM成像的定量参数可用于CSCC的诊断和初步评估病理分化程度,联合参数可以提高对CSCC的诊断效能。Objective To explore the value of amide proton transfer-weighted(APTw)imaging and intravoxel incoherent motion(IVIM)imaging for diagnosing and evaluating the pathological differentiation of cervix squamous cell carcinoma(CSCC).Methods This study was a diagnostic trial.Totally 56 patients pathologically diagnosed with CSCC at the First Hospital of Lanzhou University from October 2021 to October 2022 were retrospectively collected,as the CSCC group.And 36 female healthy volunteers who underwent physical examinations at the First Hospital of Lanzhou University from October 2021 to October 2023 were recruited as the control group.CSCC patients were divided into well-moderately differentiated(n=34)and poorly differentiated groups(n=22).The region of interest was placed in the lesions of CSCC group and normal cervical stroma of control group,and the quantitative parameters for asymmetric magnetization transfer ratio(MTR_(asym))of APTw imaging and pure diffusion coefficient(D),false diffusion coefficient(D*)and perfusion fraction(f)for IVIM were obtained.The independent sample t test was used to compare the differences in quantitative parameters between the two groups,the logistic regression model was used to establish combined parameters for the quantitative parameters with statistical significance between the two groups.The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of single quantitative parameters and combined parameters to distinguish the CSCC group from the control group,and the well-moderately differentiated group from the poorly differentiated group in CSCC patients.The area under the curve(AUC)was compared using the DeLong test.Results There were significant differences in MTR_(asym),D and f between CSCC group and control group(t=-9.79,10.09,11.35,P<0.001).Also,significant differences were found for MTR_(asym)and D between the well-moderately differentiated and poorly differentiated group(t=4.11,-3.76,P<0.001).There was no significant difference in other quantitative par

关 键 词：宫颈肿瘤 磁共振成像 酰胺质子转移加权成像 体素内不相干运动 

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]