磁共振DKI、DWI及DCE成像在宫颈肿瘤性病变诊断中的价值

Diagnostic value of by use of magnetic resonance DKI,DWI and DCE imaging in cervical naopiastic lesions

目的探讨磁共振功能成像DKI、DWI与DCE-MRI分析宫颈癌与正常宫颈组的影像学表现以及对比分析三种MRI技术对宫颈癌术前诊断的准确性,同时比较DKI成像参数在宫颈癌与宫颈肌瘤组的诊断价值。方法选取确诊宫颈癌的患者37例,宫颈肌瘤15例,正常宫颈患者33例。宫颈癌脉管癌栓阳性与脉管癌栓阴性分别为20例、17例。利用西门子3.0T超导型MR扫描仪,测得DKI定量参数FA、D⊥、MD、D//、MK、K⊥、K//;计算DCE定量参数:对比容积转移常量(Ktrans)、渗漏空间(Ve)和速度常量(Kep);测得DWI序列的ADC值。同时测得肌瘤组的DKI参数,对比其与宫颈癌组的差异。两组间比较利用独立样本t检验;利用ROC曲线评价三种成像对宫颈癌的诊断价值。结果MK、Ktrans、ADC值在正常宫颈组与宫颈癌组差异有统计学意义;MK在宫颈癌脉管癌栓阳性与脉管癌栓阴性患者之间差异有明显统计学意义;ADC、Ktrans和MK评价宫颈癌的曲线下面积分别为:0.72、0.75、0.82。统计得到宫颈癌组与宫颈肌瘤组的DKI参数K//、MK与K⊥差异有明显统计学意义。结论DKI成像可反映宫颈癌组织微环境的复杂程度,在诊断宫颈癌中优于DCE-MRI及DWI技术;MK参数可以预判宫颈癌的病理特征,如脉管内是否有癌栓浸润,DKI序列在宫颈癌的诊断中有重要的意义,其中MK等参数可用于鉴别诊断宫颈癌与宫颈肌瘤。

Objective By use of DKI,DWI and DCE-MRI,to explore the manifestation of the cervical cancer and to assess the value of these three technologies in diagnosing cervical cancer before operation.Methods 37 cases diagnosed with cervical cancer were collected and 15 cases with undenatured myoma were collected.33 cases of normal cervical patients were collected.There were 20 cases in the positive group and 17 cases in the negative group.Using siemens 3.0 T superconductive magnetic resonance imaging scanner,the quantitative parameters of DKI were measured,such as fractional anisotropy(FA),radial diffusivity(D⊥),mean diffusivity(MD),axial diffusivity(D//),mean kurtosis(MK),radial kurtosis(K⊥)and axial kurtosis(K//).The DCE quantitative parameters were calculated comparative volume transfer constant(Ktrans),leakage space(Ve)and velocity constant(Kep);The value(apparent diffusion coefficient,ADC)of DWI sequence was measured.At the same time,uterine fibroids group DKI parameters were measured and compared difference of DKI parameter between cervical cancer group and uterine fibroids.The data of two groups were compared by independent-samples t test analysis.The diagnostic value of the parameters in cervical cancer through the under ROC curve area.Results The values of MK,Ktrans and ADC in normal cervix group were significantly different from those in cervical cancer group was assessed.There was significant difference in MK between the positive group and the negative group.ROC curve was for applied analysis of ADC,Ktrans and MK cervical cancer.The area under the curve was 0.72,0.75,0.82 respectively.DKI parameters in two groups had significantly statistical differences.Conclusion DKI can reflect the complexity of the tissue microenvironment.The parameters of DKI are superior to DCE-MRI and DWI in the diagnosis of cervical cancer.MK can predict the pathological features of cervical cancer,such as tumor thrombus infiltration in the vessels.DKI parameters play an important role in the diagnosis of cervical cancer,MK and other parameters play an important role in the diagnosis of cervical cancer and uterine fibroids.