MR扩散加权成像ADC值与子宫内膜癌病理分化程度的相关性研究

The correlation between the MR diffusion weighted imaging ADC values and pathologic differentiation grade of endometrial carcinoma

目的探讨MR扩散加权成像ADC值与子宫内膜癌病理分化程度的相关性。方法回顾性分析83例经病理证实且未行辅助治疗而直接手术治疗的子宫内膜癌病人的DWI影像资料,按照病理分化程度将其分为高分化组(36例)、中分化组(28例)、低分化组(19例),分别测量各组病灶ADC值,对3组数据进行单因素方差分析,并进一步进行组间两两比较。采用Spearman相关分析子宫内膜癌ADC值与病理分化程度的相关性。应用ROC曲线,获得区分中、低分化癌灶与高分化癌灶的最佳ADC界值,并计算诊断的敏感度、特异度和准确度。结果高分化组、中分化组及低分化组子宫内膜癌的ADC值分别为(1. 02±0. 11)×10^(-3)mm^2/s、(0. 91±0. 07)×10^(-3)mm^2/s、(0. 84±0. 06)×10^(-3)mm^2/s,差异具有统计学意义(P <0. 05),组间进一步两两比较,其差异均具有统计学意义(P <0. 05)。ADC值与子宫内膜癌病理分化程度呈正相关(r_s=0. 69,P <0. 05)。ADC值鉴别子宫内膜癌中、低分化组与高分化组的ROC曲线下面积为0. 861,最佳界值为0. 94×10^(-3)mm^2/s,其敏感度为83. 0%,特异度为77. 8%,准确度为80. 7%。结论 MR扩散加权成像ADC值与子宫内膜癌病理分化程度呈正相关,有助于评估癌灶的恶性程度。

Objective To investigate the correlation between the apparent diffusion coefficient( ADC) values and pathologic differentiation grade of endometrial carcinoma. Methods A retrospective analysis of MR DWI finding in 83 patients with pathologically diagnosed endometrial carcinoma. They were divided into three groups based on grade of differentiation: well differentiated( 36 patients),moderately differentiated( 28 patients) and poorly differentiated group( 19 patients). The ADC values were measured separately,The ADC values of the three groups were analyzed by one-way ANOVA method,and results were compared between each other among the groups. Spearman correlative analysis test was used to evaluate correlation between the ADC values and pathologic differentiation grade of endometrial carcinoma. ROC curve was used to obtain the best ADC boundary value for differentiating the poorly and moderately carcinoma from the well carcinoma,and then calculated the sensitivity,specificity and accuracy. Results ADC values of the well,moderately and poorly differentiated endometrial carcinoma were( 1. 02 ± 0. 11) × 10-3 mm2/s、( 0. 91 ± 0. 07) × 10-3 mm2/s、( 0. 84 ± 0. 06) × 10-3 mm2/s respectively,the difference was statistically significant( P < 0. 05). The statistically significant differences in ADC values existed between each other among all groups( P < 0. 05). There was a positive correlation between ADC values and the pathologic differentiation grade( rs= 0. 69,P < 0. 05). ROC curve analysis showed that the ADC value for the best critical point of diagnosis for poorly and moderately differentiated endometrial carcinoma was 0. 94 × 10-3 mm2/s. The AUC was 0. 861 and the sensitivity was 83. 0%,specificity was 77. 8%,accuracy was 80. 7%. Conclusion The ADC value of DWI bear a positive correlation with pathologic differentiation grade of endometrial carcinoma,which could help in predicting the malignancy of the carcinoma.