小视野扩散峰度成像技术在子宫内膜样腺癌分级评估中的价值研究  

Study the value of reduced field-of-view diffusion kurtosis imaging in histological evaluation of endometrial adenocarcinoma

作　　者：朱柳红 路伟宏 王艳微 吴仆射 王福南 刘豪 周建军 ZHU Liuhong;LU Weihong;WANG Yanwei;WU Puye;WANG Funan;LIU Hao;ZHOU Jianjun(Department of Radiology,Zhongshan Hospital(Xiamen),Fudan University,Xiamen 361015,China;Department of Gynaecology,Zhongshan Hospital(Xiamen),Fudan University,Xiamen 361015,China;Department of Radiology,The Second Affiliated Hospital of Xiamen Medical College,Xiamen 361012,China;Department of Magnetic Resonance Research,GE Healthcare,Beijing 100176,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院放射诊断科,厦门361015 [2]复旦大学附属中山医院厦门医院妇科,厦门361015 [3]厦门医学院附属第二医院放射影像科,厦门361012 [4]通用电气医疗(中国)有限公司磁共振科研部,北京100176 [5]复旦大学附属中山医院放射诊断科,上海200032

出　　处：《磁共振成像》2025年第2期77-82,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：福建省自然科学基金项目(编号:2022J011425)。

摘　　要：目的探讨小视野扩散峰度成像(reduced field-of-view diffusion kurtosis imaging,rFOV-DKI)技术在鉴别子宫内膜样腺癌组织学分级中的潜力。材料与方法本研究共纳入48例经病理证实的子宫内膜样腺癌患者。依据国际妇产科联盟(The International Federation of Gynecology and Obstetrics,FIGO)分级法,受试者分为低级别组(G1、G1~2和G2,n=30)和高级别组(G3,n=18)。所有受试者均于3.0 T MRI扫描仪下行常规盆腔平扫加增强及rFOV-DKI序列扫描。参照常规矢状位T2加权图像在rFOV-DKI序列图像手动勾画感兴趣区(region of interest,ROI)。计算ROI的扩散峰度成像(diffusion kurtosis imaging,DKI)衍生参数,包括平均扩散率(mean diffusivity,MD)、轴向扩散率(axial diffusivity,Da)、径向扩散率(radial diffusivity,Dr)、平均峰度(mean kurtosis,MK)、轴向峰度(axial kurtosis,Ka)和径向峰度(radial kurtosis,Kr)。比较分析各rFOV-DKI参数在低级别组和高级别组间的差异,同时采用受试者工作特征(receiver operating characteristic,ROC)曲线方法评估每个参数的诊断性能。采用DeLong方法对比各参数ROC曲线下面积(area under the curve,AUC)的差异。结果低级别组MD、Da和Dr的平均值[(0.93±0.08)μm^(2)/ms、(1.14±0.10)μm^(2)/ms、(0.83±0.08)μm^(2)/ms]高于高级别组的平均值[(0.80±0.08)μm^(2)/ms、(1.05±0.07)μm^(2)/ms、(0.74±0.06)μm^(2)/ms;P<0.05],而MK、Ka和Kr的平均值(1.15±0.10、1.36±0.10、0.97±0.13)则低于高级别组(1.33±0.11、1.64±0.11、1.08±0.09)(P<0.05)。Ka值在区分低级别组和高别级组时具有最高的诊断准确性,ROC曲线下面积(area under the curve,AUC)为0.98(95%CI:0.89~1.00),其次是MK[AUC=0.90(95%CI:0.78~0.97)]和MD[AUC=0.88(95%CI:0.76~0.96)]。MK与Ka和MD的AUC间差异均没有统计学意义(Z=1.81和0.53,P=0.07和0.59),而Ka和MD的AUC间差异具有统计学意义(Z=2.40,P=0.02)。在所有DKI衍生参数中,Ka在区分低级别组和高级别组方面表现最好,截断值为1.46,敏�Objective:To explore the potential performance of reduced field-of-view diffusion kurtosis imaging(rFOV-DKI)in the differentiating the different histological grades of endometrial adenocarcinoma.Materials and Methods:A total of 48 patients with pathologically confirmed endometrial adenocarcinoma were enrolled in our study after getting institutional review board approval.According to the two-rank classification method of the International Federation of Gynecology and Obstetrics(FIGO),the participants were divided to low-grade group(G1,G1-2 and G2,n=30)and high-grade group(G3,n=18).All participants underwent contrast enhancement MR examinations including routine sequences and additional rFOV-DKI sequence on a 3.0 T MRI scanner.The data was postprocessed by the functional tool on the workstation(AW4.6,GE Healthcare).With the reference of sagittal T2WI images,the lesion ROI(region of interest)was outlined.Derived parameters of DKI,including mean diffusivity(MD),axial diffusivity(Da),radial diffusivity(Dr),mean kurtosis(MK),axial kurtosis(Ka),and radial kurtosis(Kr)were all calculated.The DKI parameters of low-grade group and high-grade group were compared.The receiver operating characteristic(ROC)curve was used to evaluate each parameter's diagnostic performance.Results:Mean values of MD,Da and Dr of low-grade group[(0.93±0.08)μm^(2)/ms,(1.14±0.10)μm^(2)/ms,(0.83±0.08)μm^(2)/ms]were significantly higher than those of high-grade group[(0.80±0.08)μm^(2)/ms,(1.05±0.07)μm^(2)/ms,(0.74±0.06)μm^(2)/ms;all P<0.05].While mean values of MK,Ka and Kr of low-grade group(1.15±0.10,1.36±0.10,0.97±0.13)were significantly lower than those of high-grade group(1.33±0.11,1.64±0.11,1.08±0.09).The Ka values had the highest diagnostic accuracy in differentiating low-grade group from high-grade group,AUC=0.98(95%CI:0.89 to 1.00),followed by MK[AUC=0.90(95%CI:0.78 to 0.97)]and MD[AUC is 0.88(95%CI:0.76 to 0.96)].There were no significant differences between AUCs of MK and Ka(Z=1.81,P=0.07),and AUCs of MK and MD(Z=0.53,P=

关 键 词：子宫内膜样腺癌 磁共振成像 小视野扩散峰度成像 组织学分级 平均峰度 轴向峰度 

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]