T_(2)WI高信号子宫肌瘤信号强度比值和纹理分析预测聚焦超声消融疗效

Application of signal intensity ratio and texture analysis in predicting the efficacy of focused ultrasound ablation for T2WI high signal hysteromyoma

目的探讨T_(2)WI信号强度比值(SIR)联合扩散加权成像表观扩散系数(ADC)直方图纹理参数在预测T_(2)WI高信号子宫肌瘤聚焦超声消融疗效中的应用价值。方法选择2012年3月至2016年10月接受高强度聚焦超声(HIFU)消融治疗的患者,55例共有T_(2)WI高信号子宫肌瘤59个,根据体积消融率(消融率≥70%、消融率≤50%)分组,27例患者28个肌瘤入组高消融组,24例患者27个肌瘤入组低消融组。采用独立样本t检验比较两组T_(2)WI-SIR和ADC直方图纹理参数,使用受试者工作特征曲线下面积(AUC)评价各参数在预测T_(2)WI高信号子宫肌瘤聚焦超声消融疗效中的诊断效能。结果高消融组的T_(2)WI-SIR低于低消融组(P<0.05),AUC为0.886,最佳临界值为2.16,敏感度为88.9%,特异度为75%;ADC直方图纹理参数中ADC_(均值)、ADC_(方差)、ADC_(90%)、ADC_(99%)的AUC分别为0.632、0.640、0.651、0.647,最佳临界值分别为696.529、545569.085、1621.5、2839.5,敏感度分别为29.6%、92.6%、88.9%、92.6%,特异度分别为96.4%、50%、46.4%、31.3%。T_(2)WI-SIR联合ADC90%和ADC_(均值)的AUC值分别为0.914和0.906,敏感度均为92.6%,特异度均为78.6%。结论T_(2)WI-SIR和ADC直方图纹理参数可成为T_(2)WI高信号肌瘤术前预判疗效因子,T_(2)WI-SIR联合ADC直方图纹理参数可加强预测效能,为后期临床选择可治性T_(2)WI高信号肌瘤及术前评估疗效提供影像学依据。

Objective To investigate the application value of T_(2)WI signal intensity ratio(T_(2)WI-SIR combined with diffusion weighted imaging apparent diffusion coefficient(ADC)histogram texture parameters in predicting the efficacy of high intensity focused ultrasound(HIFU)ablation for T_(2)WI high signal hysteromyoma.Methods A total of 55 patients with T_(2)WI high signal hysteromyoma(59 lesions in total),who received HIFU ablation between March 2012 and October 2016,were collected.According to the volume ablation rate(ablation rate≥70%,ablation rate≤50%),the patients were divided into high ablation group(n=27,28 lesions)and low ablation group(n=24,27 lesions).Independent sample t-test was used to compare T_(2)WI-SIR and ADC histogram texture parameters between the two groups.The area under receiver operating characteristic curve(AUC)was used to evaluated the diagnostic efficacy of various parameters in predicting the effect of HIFU ablation for T_(2)WI high signal hysteromyoma.Results T_(2)WI-SIR in high ablation group was lower than that in low ablation group(P<0.05).The AUC value was 0.886,the best critical value was 2.16,the sensitivity was 88.9%,and the specificity was 75%.Among the texture parameters of ADC histogram the AUC values of the ADC mean,ADC variance,ADC90%and ADC99%were 0.632,0.640,0.651 and 0.647 respectively,the best critical values were 696.529,545569.085,1621.5 and 2839.5 respectively,the sensitivities were 29.6%,92.6%,88.9%and 92.6%respectively,and the specificity were 96.4%,50%,46.4%and 31.3%respectively.The AUC values of T_(2)WI-SIR combined with ADC_(90%)and ADC_(mean)were 0.914 and 0.906,respectively,the sensitivity and specificity were 92.6%and 78.6%respectively.Conclusion T_(2)WI-SIR and ADC histogram texture parameters can be used as preoperative prognostic factors for predicting the curative efficacy of HIFU ablation for T_(2)WI high signal hysteromyoma,and combination use of T_(2)WI-SIR and ADC histogram texture parameters can enhance the prediction efficiency,providing imaging reference for later clinical selection of treatable T_(2)WI high signal hysteromyoma and for making preoperative evaluation of curative effect.(J Intervent Radiol,2022,31:1081-1084)