功能MRI评价子宫肌瘤病理分型及其与免疫组织化学相关性的初步研究

A Preliminary Research of Functional MRI on Uterine Leiomyoma Pathological Classification and Correlation with Immunohistochemical Indexes

目的探讨动态增强磁共振成像（DCE-MRI）定量灌注参数联合表观扩散系数（ADC）参数在鉴别子宫肌瘤病理分型中的应用价值,并分析其与微血管密度（MVD）、血管内皮生长因子（VEGF）免疫组织化学指标的相关性。方法前瞻性搜集2015年9月至2016年8月行子宫肌瘤切除术的65例患者资料,根据病理结果分为普通型（30例）、富细胞型（13例）、变性型（22例）,术前均行DCE-MRI增强扫描及Extenged tofts双室模型拟合计算出容量转运常数（K^（trans））、返流速率常数（K_（ep））、血管外细胞外间隙容积分数（V_e）、血浆容积分数（V_p）及ADC值,并评价不同参数的诊断效能;免疫组织化学方法测定组织标本的MVD、VEGF的表达;比较分析定量灌注参数与免疫组织化学分数间的相关性。结果三组子宫肌瘤的定量灌注指标间存在差异,富细胞型肌瘤K^（trans）、K_（ep）、V_p值高于普通型、变性型肌瘤（P〈0.05）,变性型肌瘤ADC值高于富细胞型、普通型肌瘤（P=0.01）;绘制K^（trans）、K_（ep）、V_e、V_p值鉴别富细胞型肌瘤的受试者工作特征（ROC）曲线,曲线下面积分别为0.918、0.827、0.622、0.761,ADC值鉴别退变型肌瘤的曲线下面积为0.816;子宫肌瘤K^（trans）、K_（ep）、V_p与MVD呈正相关（r=0.793,P〈0.001;r=0.528,P=0.02;r=0.445,P=0.014）,定量灌注指标与VEGF之间无相关性。结论 K^（trans）、K_（ep）、V_p、ADC值有助于不同病理分型子宫肌瘤间的鉴别诊断,定量灌注参数与MVD表达间存在显著相关性,定量灌注参数可以无创性评价子宫肌瘤的微血管生成。

Objective To investigate the application value of dynamic contrast-enhanced magnetic resonance imaging（ DCE-MRI） quantitative perfusion parameters combined with ADC parameters in identifying the pathological classification of uterine fibroids,and to analyze its correlation with immunohistochemical indexes including microvascular density（ MVD）and vascular endothelial growth factor（ VEGF）. Methods 65 cases of patients with hysteromyoma resection were collected prospectively between September 2015 and August 2016 and were divided into the normal type（ 30 cases）,cellular type（ 13 cases） and degenerate type（ 22 cases）. The patients underwent DCE-MRI scan preoperatively,and Extended tofts model was used to calculate the volume transfer constant（ K^（trans））,reflux rate constant（ K_（ep））,volume fraction of extravascular extracellular clearance（ V_e） and plasma volume fraction（ V_p） and ADC values,and to evaluate efficacy of different parameters; Immunohistochemical methods were used to determine the expressions of MVD and VEGF in tissue specimens,and compare and analyze the correlations between quantitative perfusion parameters and immunohistochemical scores. Results There were differences among three groups of uterine fibroids in quantitative perfusion indexes,K^（trans）,K_（ep） and V_pof cellular uterine fibroids were higher than those of the normal and cellular type（ P 0. 05）,and ADC value of the degenerate type uterine fibroids was higher than that of the cellular and normal type（ P = 0. 01）. K^（trans）,K_（ep）,V_e and V_pwere drawn to identify the ROC curve of cellular type,and the areas under the curve were 0. 918,0. 827,0. 622 and 0. 761,respectively,and ADC value identified the degenerate-type AUC for 0. 816; K^（trans）,K_（ep） and V_eof uterine fibroids were positively correlated with microvascular density（ MVD）（ r = 0. 793,P 0. 001; r = 0. 528,P = 0. 002; r = 0. 445,P = 0. 014）,and there was no correlation between quantitative perfusion index and VEGF. Conclusion K^（trans）,K_（ep）,V_p,and ADC values can help in the differential diagnosis between uterine fibroids of different pathological types. There is a significant correlation between quantitative perfusion parameters and MVD expression,and quantitative perfusion parameters can noninvasively evaluate the angiogenesis of uterine fibroids.