子宫内膜癌的DWI成像特征及其与PCNA、Ki-67表达相关性研究

Diffusion-weighted MR imaging in uterine endometrial cancer: the characterization of DWI and its correlation study with the expressions of PCNA and Ki-67

目的:本研究拟利用PCNA及Ki-67的特殊标记物功能,通过测定不同恶性程度子宫内膜癌组织中的PCNA和Ki-67不同表达程度,及其与DWI图像ADC值及rADC值的相关性研究,探讨应用DWI对于子宫内膜癌恶性程度分子水平定量研究的鉴别诊断价值。方法:对23例子宫内膜癌患者在术前行常规MRI检查并进行ADC值的测定(b值为800s/mm2)。闭孔内肌作参比部位,测量内膜癌的rADC值。所有病例均经病理证实,包括高分化8例,中分化10例,低分化5例。用免疫组织化学染色方法(SP法)检测23例子宫内膜癌标本中PCNA及Ki-67的表达情况。结果:子宫内膜癌随着肿瘤恶性分化程度降低,各组的ADC及rADC值存在下降趋势。低分化组ADC、rADC值〔(0.79±0.14)×10-3mm2/s、0.55±0.11〕显著低于高分化组〔(1.05±0.18)×10-3 mm2/s、0.80±0.22〕,中分化组〔(0.89±0.15)×10-3 mm2/s、0.66±0.16〕ADC、rADC值与低分化组及高分化组相比均无统计学差异。子宫内膜癌PCNA、Ki-67表达程度与肿瘤ADC、rADC值呈显著性负相关。结论:子宫内膜癌DWI成像ADC、rADC值的测量有助于评价并鉴别肿瘤不同病理级别并有潜力作为评价肿瘤增殖程度的无创性方法。子宫内膜癌PCNA、Ki-67表达程度与ADC、rADC值显著性负相关,提示核磁共振扩散加权成像有潜力从分子水平反映细胞增殖程度。

Objective：To identify the diagnostic value of ADC and rADC in detecting endometrial cancer by investigating the characterization of DWI and the correlation with the expressions of PCNA and Ki67 in endometrial cancer. Methods：Study population included 23 females with surgically proven endometrial cancer.ADC and rADC measurement were performed in endometrial cancer with MR（Internal obturator muscle as the reference site）.There were three differentiated types in the endometrial cancer of this study,including highly differentiated in 8 of 23 patients,moderately differentiated in 10 of 23 patients and lowly differentiated in 5 of 23 ones.The expressions of PCNA and Ki-67 were detected in these 23 cases by immunohistochemical（SP） staining.There were significant negative correlation coefficients between the ADC and rADC values with the expressions of PCNA and Ki-67 of endometrial cancer. Results：There was a descending trend in the ADC and rADC values in the endometrial cancer along with the differentiation of it.The ADC and rADC values（（0.79±0.14）×10（-3） mm2/s,0.55±0.11） of lowly differentiated group were significantly lower than those of the highly differentiated group（（1.05±0.18） ×10（-3） mm2/s,0.80±0.22）.There was no difference between the moderately differentiated group（（0.89±0.15）×10（-3） mm2/s,0.66±0.16） and other differentiated groups in ADC and rADC values.There were significant negative correlation coefficients between the ADC and rADC values with the expressions of PCNA and Ki-67 of endometrial cancer. Conclusion：It is potential to identify the various differentiated endometrial cancer using the ADC and rADC measurement and DWI.It could become a real noninvasive diagnostic tool on molecule level.There is a significant negative correlation between the ADC/r ADC of endometrial cancer with the expresses of PCNA/Ki-67.And the ADC/rADC of endometrial cancer is potential to be a monitoring tool.