腹部DCE-MRI联合IVIM诊断子宫内膜病变的临床价值

Clinical Value of Abdominal DCE-MRI Combined with IVIM in the Diagnosis of Endometrial Lesions

目的探究腹部磁共振成像动态对比增强成像(DCE-MRI)联合体素内不相干运动扩散加权成像(IVIM)诊断子宫内膜病变的临床价值。方法选取2022年1月至2023年2月我院行MRI检查的子宫内膜病变患者82例,以病理结果为“金标准”,将患者分为良性组(49例)和恶性组(33例),比较两组DCEMRI、IVIM参数差异,绘制ROC曲线分析DCE-MRI联合IVIM检测子宫内膜病变的诊断价值。结果良性组体积转运常数(Ktrans)、速率转运常数(Kep)、体积分数(Ve)值低于恶性组(P<0.05)。良性组慢速表观扩散系数(ADC-slow)、灌注分数(f)、水分子扩散分布指数(DDC)、扩散异质性指数(α)值高于恶性组,快速表观扩散系数(ADC-fast)值低于恶性组(P<0.05)。ROC曲线分析显示:当Ktrans、Ke p、Ve、ADCslow、ADC-fast、f、DDC、αAUC分别为0.812、0.762、0.736、0.726、0.666、0.706、0.686、0.777时,约登指数最大,其截断值分别为0.45、0.86、0.51、0.47、12.69、0.37、1.02、0.66时,联合诊断AUC为0.894(95%CI:0.812~0.975)、灵敏度84.8%、特异度93.9%、阳性预测值93.4%、阴性预测值86.2%均高于各参数单项检测(P<0.05),诊断效能最佳。结论腹部DCE-MRI联合IVIM可提高子宫内膜病变的诊断准确性,具有较高临床价值。

Objective To evaluate the clinical value of abdominal dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)combined with intravoxel incoherent motion imaging(IVIM)in the diagnosis of endometrial lesions.Methods Eighty-two patients with endometrial lesions who underwent MRI in our hospital from January 2022 to February 2023 were selected,and categorized into benign group(n=49)and malignant group(n=33)using pathological findings as the gold standard.The DCE-MRI and IVIM parameters were compared between two groups,and receiver operating characteristic curve(ROC)was plotted to evaluate the diagnostic value of DCE-MRI combined with IVIM in detecting endometrial lesions.Results The values of volume transfer constant(Ktrans),rate transfer coefficient(Kep)and extravascular extracellular volume fraction(Ve)of benign group were smaller than those of malignant group(P<0.05).The apparent diffusion coefficient(ADC)of pure diffusion(ADC-slow),perfusion fraction(f),distributed diffusion coefficient(DDC)and diffusion heterogeneity index(α)of benign group were larger than those of malignant group,while the ADC of pseudo-diffusion(ADC-fast)was smaller than that of malignant group(P<0.05).ROC curve indicated that an area under the curve(AUC)of 0.812,0.762,0.736,0.726,0.666,0.706,0.686 and 0.777 for Ktrans,Kep,Ve,ADC-slow,ADCfast,f,DDC andαin detecting endometrial lesions provided the largest Youden index.A cutoff value of 0.45,0.86,0.51,0.47,12.69,0.37,1.02 and 0.66 for Ktrans,Kep,Ve,ADC-slow,ADC-fast,f,DDC andαresulted in an AUC,sensitivity,specificity,positive predictive value and negative predictive value of 0.894(95%CI:0.812~0.975),84.8%,93.9%,93.4%and 86.2%,suggesting that the combined test had better diagnostic efficacy than that of separate test(P<0.05).Conclusion The combined application of abdominal DCE-MRI and IVIM can improve the diagnostic accuracy of endometrial lesions and is of great clinical value.