3.0 T动态对比增强MRI定量参数在鉴别FIGOⅡ期宫颈癌宫旁浸润中的应用价值

Value of Quantitative Parameters at Differential Diagnosis of Parametrial Invasion in Cervical Cancer of FIGO Ⅱ Staging Based on Dynamic Contrast-Enhanced 3.0 T MRI

目的探讨动态对比增强MRI（DCE-MRI）定量参数对FIGOⅡ期宫颈癌宫旁浸润（PI）的评估价值。方法搜集2010年1月至2017年3月间45例经病理证实的FIGOⅡ期宫颈癌患者,均行MRI平扫及DCE,测量双室Tofts模型下宫颈癌的DCE-MRI定量参数,包括容积转运常数（K^trans）、速率常数（Kep）、血管外细胞外间隙容积分数（Ve）。将45例患者分为有PI组和无PI组,使用独立样本t检验分析两组间年龄、肿瘤最大径、K^trans、Kep、Ve的差异;使用卡方检验分析两组间有无淋巴结转移、病理组织学类型的差异;使用Logistic回归分析方法对上述有差异的指标进行多因素分析。结果有PI和无PI组间K^trans（P=0.025）、Ve（P=0.017）、淋巴结转移（P〈0.001）、肿瘤最大径（P〈0.001）有统计学差异,K（ep）（P=0.916）、年龄（P=0.136）、病理组织学类型（P=0.187）无统计学差异;肿瘤最大径（P=0.030）、K^trans（P=0.038）是PI的独立风险因素。结论 DCE-MRI定量参数可初步评估FIGOⅡ期宫颈癌发生PI的可能性,可为FIGOⅡ期宫颈癌术前精准亚分期提供依据。

Objective To explore the value of quantitative parameters based on dynamic contrast-enhanced（ DCE）MRI for evaluating parametrial invasion（ PI） in cervical cancer（ CC） of FIGO Ⅱ. Methods 45 cases of FIGOⅡCC proven by pathology,who had underwent DCE T1W MRI at 3. 0 T MR,were gathered. The quantitative parameters（ K^trans,Kep,Ve） were obtained from enhancement tumors through Extended Tofts model,and 45 patients were divided into group of FIGOⅡCC with PI（ PI group） and group of FIGOⅡCC without PI group（ non-PI group）. By the means of independent sample t-test,differences of the various parameters,including age,K^trans,Kep,Ve,and maximum diameter of tumor,were compared between PI and non-PI groups. By the means of Chi-square test analysis,differences of lymph node metastasis（ LNM） and histopathology type were compared between the two groups and then Logistic regression analysis of PI was performed. Results Between PI and non-PI groups,statistical differences on K^trans（ P = 0. 025）,Ve（ P = 0. 017）,LNM and maximum diameter（ P〈0. 001） occurred. However,there were no statistical differences on Kep（ P = 0. 916）,age（ P =0. 136）,and histopathology type（ P = 0. 187）. Maximum diameter（ P = 0. 030） and K^trans（ P = 0. 038） were independent risk factors for PI. Conclusion Quantitative parameters based on DCE-MRI could evaluate the possibility of developing PI in FIGO Ⅱ CC preliminarily,which should be helpful for accurat preoperative sub-staging of FIGO Ⅱ CC.