基于DCE-MRI建立高分化子宫内膜腺癌肌层浸润的诊断模型研究

Study on the Diagnosis Model of Myometrial Invasion of Well-Differentiated Endometrial Adenocarcinoma Based on DCE-MRI

目的探讨动态增强磁共振成像(Dynamic Contrast Enhanced Magnetic Resonance Imaging,DCE-MRI)定量参数评估高分化子宫内膜腺癌肌层浸润的诊断价值。方法回顾性分析2017年6月至2020年12月在我院就诊的88例子宫内膜腺癌患者的临床资料,根据病理检查的肌层浸润结果分为无肌层浸润36例、浅肌层浸润28例和深肌层浸润24例。比较三组患者的扩散加权成像表观扩散系数(Apparent Diffusion Coefficient,ADC)值和DCE-MRI定量参数(K^(trans)、K_(ep)、V_(e));采用Logistic回归方程建立上述参数联合模型以评估其预测子宫内膜腺癌肌层浸润的诊断价值。结果深肌层浸润组患者ADC值低于无肌层浸润组及浅肌层浸润组(P<0.05),但无肌层浸润组与浅肌层浸润组ADC值无明显差异(P>0.05);三组患者DCE-MRI参数(K^(trans)、K_(ep)、V_(e))之间差异均存在统计学意义(P<0.05),均为深肌层浸润组参数值最高,无肌层浸润组参数值最低。K^(trans)+K_(ep)+V_(e)联合诊断的灵敏度显著高于单项检测的灵敏度(P<0.05),ROC曲线下面积显著高于ADC值和DCE-MRI参数各单项检测(P<0.05),诊断效能最佳。结论基于DCE-MRI定量参数建立的联合模型更有助于评估子宫内膜腺癌的肌层浸润情况。

Objective To explore the diagnostic value of the quantitative parameters of dynamic contrast-enhanced(DCE)MRI on highly differentiated endometrial adenocarcinoma of muscle layer infiltration.Methods Retrospective analysis of the clinical data of 88 patients with endometrial adenocarcinoma admitted to our hospital from June 2017 to December 2020.According to postoperative pathological examination,36 cases were non-muscle layer infiltration,28 with superficial muscle layer infiltration and 24 with deep muscle layer infiltration.The DWI apparent diffusion coefficient(ADC)values and DCE-MRI quantitative parameters (K^(trans)、K_(ep)、V_(e)) were compared between the 3 groups;the logistic regression equation was used to establish the combined model of the above parameters to evaluate its diagnostic value in predicting myometrial invasion of endometrial adenocarcinoma.Results The ADC value of patients in the deep muscle layer infiltration group was lower than that of the non-muscular layer and superficial muscle layer infiltration group(P<0.05),but there was no significant difference in ADC value between the non-muscular layer infiltration group and superficial muscle layer infiltration group(P>0.05);there were significant differences in DCE-MRI parameters (K^(trans)、K_(ep)、V_(e)) between the three groups(P<0.05).The deep muscle layer infiltration group had the highest parameter value,and the non-muscular layer infiltration group had the lowest parameter value.The combined diagnosis sensitivity of K^(trans)+K_(ep)+V_(e) was significantly higher than that of single detection(P<0.05).The area under the ROC curve was significantly higher than that of the ADC value and DCE-MRI parameters(P<0.05),and the diagnostic efficiency was the best.Conclusion The combined model based on quantitative parameters of DCE-MRI is more helpful for evaluating the infiltration of membranous adenocarcinoma.