多模态扩散加权成像评估早期子宫内膜癌淋巴脉管间隙浸润的价值

The Diagnostic Value of Multi-Modal Diffusion MR Imaging in Differentiating Lymphatic Vascular Space Invasion of Early-Stage Endometrial Carcinoma

目的探讨多模态扩散加权成像(DWI)术前评估早期子宫内膜癌(EC)淋巴脉管间隙浸润(LVSI)的价值。方法前瞻性纳入62例早期EC患者,所有患者术前均行盆腔多b值DWI检查。采用单指数模型、体素内不相干运动(IVIM)及扩散峰度成像(DKI)对DWI数据进行后处理,计算病灶表观扩散系数(ADC)值、真实扩散系数(D)值、假性扩散系数(D^(*))值、灌注分数(f)值,非高斯分布平均扩散系数(MD)值及扩散峰度(MK)值。分析上述参数在LVSI阴性组与阳性组间的差异并比较各参数对LVSI阳性的诊断效能。结果 LVSI阳性组ADC值、D值、MD值小于LVSI阴性组,MK值大于阴性组,组间差异均有统计学意义(P<0.05),ADC值、D值、MD值、MK值诊断LVSI阳性的曲线下面积(AUC)值分别为0.690、0.711、0.705、0.708,ADC值、D值、MD值、MK值联合诊断的AUC值为0.741,参数单独及联合鉴别LVSI阳性的诊断效能组间差异无统计学意义(P均>0.05)。D;值、f值在LVSI阴性、阳性组间差异无统计学意义(P=0.420,0.887)。结论 DWI、IVIM及DKI对早期EC LVSI均具有一定诊断价值,多模态扩散加权成像有助于多方面反映肿瘤微观结构特征,提高诊断准确率。

Objective The aim of this study was to explore the diagnostic efficacy of DWI,IVIM and DKI in predicting lymphatic vascular space invasion of early-stage endometrial carcinoma. Methods We included sixty-two patients with early-stage endometrial carcinoma proved by operation and pathology in the Tianjin Medical University Cancer Institute and Hospital from June 2020 to February 2021 prospectively.All patients were examined by multi-b values DWI pelvic MRI before operations.Diffusion-weighted imaging data were post-processed using monoexponential, IVIM and DKI model to quantitate the apparent diffusion coefficient(ADC),true diffusion coefficient(D),pseudo-diffusion coefficient(Dstar),perfusion fraction(f),non-Gaussian distribution apparent diffusion coefficient(MD) and diffusion kurtosis(MK).The consistency and repeatability of the above parameters were analyzed.Independent sample t test or Mann-Whitney U test was performed to compare the differences of the above parameters between the negative group and the positive group of lymphatic vascular space invasion, and the received-operating characteristic curves(ROC) were used to analyze the differential diagnosis of individual and combined use of each parameter. Results The values of ADC,D and MD in the LVSI positive group were lower, and the MK values were higher than those in the LVSI negative group.The area under the ROC curves(AUCs) were 0.690(95%CI:0.560-0.802),0.711(95%CI:0.582-0.819),0.705(95%CI:0.575-0.814) and 0.708(95%CI:0.579-0.817),respectively.The AUC value of ADC,D,MD and MK combined diagnosis was 0.741(95%CI:0.614-0.844),all the P values were less than 0.05.There was no significant difference in the AUC for the prediction of the LVSI positive group by using those parameters.There were no significant differences in D;and f between the two groups(P>0.05). Conclusion DWI,IVIM and DKI diffusion weighted imaging have potential value in predicting lymphatic vascular space invasion of early-stage endometrial carcinoma, and the combined diagnosis is beneficial to learn the structural characteristics of the tumor tissues.