食管鳞状细胞癌动态增强MRI定量参数与病理分级的相关性研究

Correlation between Dynamic Contrast Enhanced MRI Quantitative Parameters and Pathological Grade of Esophageal Squamous Cell Carcinoma

目的探讨食管鳞状细胞癌(ESCC)动态增强磁共振成像(DCE-MRI)定量参数与病理分级的相关性。方法搜集2015年3月至2017年12月在本院住院,经病理确诊为ESCC,经临床评估直接手术治疗,术前一周行DCE-MRI检查的85例患者资料。所有患者行MRI平扫及动态增强扫描,通过软件计算DCE-MRI定量参数,包含容积转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积分数(V_(e)),术后标本行病理分级,分为高分化组、中低分化组两组。对两名医师测量的DCE-MRI定量参数进行一致性分析,计算组内相关系数(ICC),比较两组间差异有无统计学意义,对各定量参数值行正态性检验,定量资料用独立样本t检验。采用Spearman秩相关分析评价DCE-MRI各参数值与ESCC病理分级的相关性。绘制受试者工作特征曲线(ROC),评价各参数的诊断价值。结果85例患者中,高分化组15例,中低分化组70例。对两名磁共振医师DCE-MRI定量参数测量的所有数据行一致性检验,ICC为0.939(P<0.05),一致性较好。对于诊断高分化鳞状细胞癌的诊断效能比较,K^(trans)平均值、K^(trans)-P25、K^(trans)-P50、K^(trans)-P75、K^(trans)-P90、K_(ep)平均值、K_(ep)-P50、K_(ep)-P75、K_(ep)-P90、Ve-P50、Ve-P75、Ve-P90,诊断高分化ESCC的曲线下面积(AUC)为0.778、0.740、0.763、0.757、0.783、0.743、0.730、0.753、0.719、0.703、0.776。其中K^(trans)-P90的诊断效能最佳,诊断阈值为0.783 min-1,敏感度为85.7%,特异度为73.3%。K^(trans)-P90与病理分级呈正相关(r=0.391,P=0.000)。结论DCE-MRI定量参数与ESCC的病理分级存在相关性,对食管癌的病理分级具有一定的预测性。

Objective To investigate the correlation between dynamic contrast enhanced(DCE)MRI quantitative parameters and pathological grade of esophageal squamous cell carcinoma(ESCC).Methods Data of 85 patients who were hospitalized in the XXX Hospital from March 2015 to December 2017 were collected,all of them were diagnosed with ESCC by pathological biopsy,were planning to receive surgery without neoadjuvant chemotherapy,and performed DCE-MR scanning one week before surgery.All patients underwent MR plain scan and dynamic enhancement examination,quantitative parameters of DCE-MRI,including volume transfer constant(K^(trans)),exchange rate constant(K_(ep))and extravascular extracellular volume fraction(V_(e))were calculated.Postoperative specimens were pathologically graded and divided into highly differentiated,moderatelyand poorly differentiated groups.The DCE-MRI quantitative parameters measured by two physicians were analyzed for consistency,and the intra group correlation efficient(ICC)was calculated.Normality test was performed for each quantitative parameter value,quantitative data was tested by independent sample t test.Spearman rank correlation analysis was used to evaluate the correlation between DCE MRI parameters and pathological grade of ESCC.Draw receiver operating characteristic(ROC)curveto evaluate the diagnostic value of each parameter.Results Among the 85 subjects,15 were well-differentiated squamous cell carcinoma and70 were moderately and poorlydifferentiated squamous cell carcinoma.The consistency of all data measured by DCE-MRI quantitative parameters of two radiologists were tested,and the consistency was good.The intra group correlation coefficient(ICC)was 0.939(P<0.05).For comparison of the diagnostic efficacy for the diagnosis of well-differentiated squamous cell carcinoma,the K^(trans)mean,K^(trans)-P25,K^(trans)-P50,K^(trans)-P75,K^(trans)-P90,K_(ep)mean,K_(ep)-P50,K_(ep)-P75,K_(ep)-P90,Ve-P50,Ve-P75,Ve-P90,the area of ROC for diagnosis of highly differentiated squamous cell carcinoma were 0.778,0.740,0.763,0.757,0.783,0.743,0.730,0.753,0.719,0.703,0.776,respectively.Among them,K^(trans)-P90 showed the best diagnostic efficiency,the diagnostic threshold was 0.783 min-1,with the sensitivity of 85.7%and the specificity of 73.3%.K^(trans)-P90 was positively correlated with pathological grade(r=0.391,P=0.000).Conclusion The quantitative parameters of DCE-MRI are correlated with the pathological grading of ESCC,and have a certain predict ability for the pathological grading of ESCC.