动态增强磁共振成像不同药代动力学模型预测子宫肌瘤高强度聚焦超声消融效果的比较

Comparison of Different Pharmacokinetic Models in Dynamic Contrast-enhanced Magnetic Resonance Imaging for Predicting High Intensity Focused Ultrasound Ablation of Uterine Fibroids

目的探讨动态增强磁共振成像(DCE-MRI)定量分析中,不同药代动力学模型预测高强度聚焦超声(HIFU)治疗子宫肌瘤消融的效果。资料与方法收集2015年8月-2017年8月重庆医科大学附属第一医院收治的56例子宫肌瘤患者的临床资料。所有患者行HIFU术前均行DCE-MRI检查。分别用ETL和RR模型计算获得定量参数后,按术后消融效果分为高消融率组和低消融率组。分析各参数值与消融率的相关性以及各组参数的差异,并采用受试工作特征曲线进行评价。结果 ETL模型中容量转移常数(K^(trans))、速率常数(K_(ep))、血管外细胞外容积分数(V_e)、血浆容积分数(V_p)和RR模型中RR K^(trans)、RR K_(ep)、RR V_p均与消融率呈负相关(R^2=0.116～0.285,P<0.05)。低消融率组K^(trans)与RR K^(trans)、K_(ep)与RR K_(ep)、V_e、RR V_p值均小于高消融率组,差异均有统计学意义(P<0.05)。两组V_p差异无统计学意义(P>0.05)。K^(trans)、K_(ep)、V_e与RR K^(trans)、RR K_(ep)、RR V_p最佳预测值分别为1.0349、1.0625、0.7000与2.9380、1.0619、0.6606。ROC曲线下面积分别为0.781、0.725、0.722与0.728、0.824、0.790。结论 ETL模型和RR模型定量分析均可有效预测HIFU治疗子宫肌瘤的消融率,RR模型中RR K_(ep)的预测效能最佳。

Purpose To investigate the effect of different pharmacokinetic models in the prediction of high intensity focused ultrasound(HIFU)on the ablation rate of uterine fibroids in dynamic quantitative magnetic resonance imaging(DCE-MRI)quantitative analysis.Materials and Methods Fifty-six patients with uterine fibroids admitted to the First Affiliated Hospital of Chongqing Medical University from August 2015 to August 2017 were enrolled in this study.All these patients underwent DCE-MRI before HIFU,and were divided into high ablation rate group and low ablation rate group according to the postoperative ablation rate after the ETL and RR models were used to calculate the quantitative parameters.The correlation among each parameter value and ablation rate,the differences among the parameters of each group were analyzed and evaluated by the receiver operating characteristic curve.Results K^trans、Kep、Ve、Vp of the ETL and RR K^trans,RR Kep,RR Vp of the RR model were negatively correlated with ablation rate(R^2=0.116-0.285,P<0.05).The values of K^trans and RR K^trans,Kep and RR Kep,Ve、RR Vp in the low ablation rate group were all lower than those in the high ablation rate group with statistically significant difference(P<0.05).There was no statistically significant difference in the values of V p between the above two groups(P>0.05).The best predicted values of K^trans,Kep,Ve and RR K^trans,RR Kep,RR Vp were 1.0349,1.0625,0.7000 and 2.9380,1.0619,0.6606,and the area under the corresponding ROC curve were 0.781,0.725,0.722 and 0.728,0.824,0.790,respectively.Conclusion Both of the quantitative analysis of the ETL model and RR model can effectively predict the ablation rate of HIFU in the treatment of uterine fibroids.RR K ep of the RR model has the best prediction performance.