ADC差值法在子宫癌肉瘤与子宫内膜癌鉴别诊断中的应用

Utility of delta ADC value to differentiate uterine carcinosarcoma from endometrial carcinomas

目的 探讨表观扩散系数差值(delta apparent diffusion coefficient value,dADC)法在子宫癌肉瘤(uterine carcinosarcoma,UCS)中的诊断应用,以及评估联合dADC与时间-信号强度曲线(time-intensity curve,TIC)对鉴别诊断UCS和子宫内膜癌(endometrial carcinomas,EC)的效能。材料与方法 回顾性分析经病理证实且MRI资料完整的UCS患者病例28例及EC患者病例49例,测量两组病例中病灶的平均表观扩散系数(mean ADC,m ADC)、dADC,并绘制TIC判断其类型。对两组间的m ADC、dADC结果进行独立样本t检验,应用χ;检验比较两组TIC类型差异。绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价各参数单独及联合应用鉴别UCS与EC的效能。结果 UCS组dADC值[(2.04±0.77)×10;mm;/s]明显高于EC组[(0.78±0.48)×10;mm;/s],差异有统计学意义(P<0.01)。UCS的TIC曲线类型多为Ⅰ型(71.43%),而EC多表现为Ⅱ型(59.18%,P<0.01)。ROC曲线分析显示,dADC联合TIC鉴别诊断UCS与EC效能最高,曲线下面积为0.966,其敏感度、特异度、准确度分别为96.4%、95.9%、93.5%,明显高于各指标单独使用(P<0.05)。结论 dADC值对UCS诊断有一定价值,当dADC值大于1.112×10;mm;/s时诊断UCS可能性大,且应用dADC联合TIC可提高UCS与EC鉴别诊断的准确度,其诊断效能更高,可作为参考指标帮助临床选择合理方案。

Objective:To investigate the utility of delta apparent diffusion coefficient values (dADC) to diagnose uterine carcinosarcoma(UCS),and to evaluate the efficacy of combined dADC and time-intensity curve (TIC) in differentiating UCS from endometrial carcinomas (EC).Materials and Methods:DWI and DCE-MRI findings of 28 pathologically proven UCSs obtained on preoperative MRI were retrospectively evaluated.The DWI parameters including mean apparent diffusion coefficient value (m ADC),delta apparent diffusion coefficient value (dADC=maximum ADC-minimum ADC) and DCE-MRI parameter including time-intense curve (TIC) type were compared with those of 49 pathologically proven ECs.The efficiency of above parameters in differentiating UCSs from ECs was evaluated by receiver operating characteristic (ROC) curve.Results:dADC values in UCS group were higher than that in EC group with significant difference (P<0.01).UCSs were more frequently associated with typeⅠTIC,while ECs were associated with typeⅡ.ROC analysis revealed that with the combination of dADC and TIC,the diagnostic sensitivity,specificity and area under the curve were 96.4%,95.9%and 0.966 respectively with significant difference when compared with individual parameter (P<0.05).Conclusions:dADC was helpful in the diagnosis of UCS.Higher dADC values were associated with more possibility of diagnosing UCS.dADC combined with TIC was of great value in differentiating UCS from EC preoperatively and could be used to provide additional information in treatment planning.