IVIM-DWI参数及纹理特征术前鉴别宫颈癌亚型的价值

Explore the Value of IVIM-DWI Parameters and Texture Features in the Preoperative Evaluation of Different Histological Types of Cervical Carcinoma

目的探讨利用体素内不相干运动扩散加权成像(IVIM-DWI)及纹理分析(TA)术前鉴别不同亚型宫颈癌的价值。方法回顾性分析60例经病理结果证实的宫颈癌患者,其中宫颈鳞癌(SCC)38例、宫颈腺癌(AC)16例、宫颈小细胞癌(SCCC)6例。所有患者术前均行MRI检查,并行10个b值DWI扫描。在轴位T2WI图像上手动勾画宫颈癌全病灶,获得其纹理特征,包括平均值、标准差、峰度、偏度、熵和一致性。绘制受试者工作特征曲线(ROC),并计算曲线下面积(AUC)。结果IVIM-DWI分析中,标准表观扩散系数(ADCstandard)、真实扩散系数(D)值可以鉴别SCC与SCCC(P<0.001,AUC=0.867;P=0.001,AUC=0.920),D、假性扩散系数(D*)值鉴别SCC与AC时差异有统计学意义(P=0.024,AUC=0.774;P=0.023,AUC=0.753),而灌注分数(f)值鉴别AC与SCCC时差异有统计学意义(P=0.034,AUC=0.850)。纹理特征分析时,熵值鉴别AC与SCCC、峰度鉴别SCC与AC及偏度鉴别SCC与SCCC时差异具有统计学意义(P<0.001,AUC=0.875;P=0.027,AUC=0.910;P=0.020,AUC=0.766)。结论IVIM-DWI参数或纹理特征术前鉴别宫颈癌三种不同组织学亚型有一定价值,为宫颈癌个性化治疗提供客观的影像学依据。

Objective To investigate the value of IVIM-DWIand texture analysis(TA)in the differential diagnosis of different histological types of cervical carcinoma.Methods A retrospective analysis of 60 cases with cervical carcinoma was peformed,including 38 cases of SCC,16 cases of AC,and 6 cases of SCCC.All patients underwent MRI examination before surgery,and underwent MultiB 10 b DWI(IVIM-DWI)scanning.The whole lesion of MRI T2 WI image was sketched manually,and its texture features were calculated,including mean value,standard deviation,kurtosis,skewness,entropy and uniformity.The receiveroperating characteristic curve(ROC)was drawn,and the area under the curve(AUC)was calculated.Results In the study of IVIM-DWI,the difference of ADCstand、D value between SCC?and SCCC was statistically significant(P<0.001,AUC=0.867;P=0.001,AUC=0.920),the difference of D、D*value between SCC and AC was statistically significant(P=0.024,AUC=0.774;P=0.023,AUC=0.753),and f value had statistical significance in differentiating AC from SCCC(P=0.034,AUC=0.850).In the study of TA,the difference in entropy between AC and SCCC、kurtosis between SCC and AC、skewness between SCC and SCCC were statistically significant(P<0.001,AUC=0.875;P=0.027,AUC=0.910;P=0.020,AUC=0.766).Conclusion IVIM-DWI or TA features are of limited value in preoperative evaluation of three histological subtypes of cervical carcinoma,providing objective imaging basis for individualized treatment of cervical cancer.