分段读出平面回波成像与单次激发平面回波成像DWI序列ADC值在评估子宫内膜癌肌层浸润中的对比分析

Comparison between ADC value based on readout-segmented echo-planar imaging and single-shot echo-planar imaging in evaluating the myometrial invasion of endometrial carcinoma

目的:对比分析分段读出平面回波成像(RS-EPI)和单次激发平面回波成像(SS-EPI)的扩散加权成像(DWI)序列表观扩散系数(ADC)值在评估子宫内膜癌肌层浸润深度中的价值。方法:回顾性分析经手术病理证实的61例子宫内膜癌患者的磁共振成像(MRI)资料,其中无或浅肌层浸润(A组)41例、深肌层浸润(B组)20例。采用全瘤勾画记录T_(2)WI上肿瘤体积,并测量RS-EPI与SS-EPI DWI序列ADC图上肿瘤体积、最大ADC值(ADC_(max))、第90百分位数ADC值(ADC_(90th))、平均ADC值(ADC_(mean))、第10百分位数ADC值(ADC_(10th))和最小ADC值(ADC_(min)),对比各参数测量的一致性和准确性。分析不同ADC值在A、B两组间的差异,并采用受试者工作特征(ROC)曲线分析其诊断效能。结果:RS-EPI DWI序列ADC图测量各参数的一致性好于SS-EPI,两者与T_(2)WI测量的肿瘤体积差异无统计学意义(P>0.05)。SS-EPI的ADC_(max)和ADC_(90th)大于RS-EPI(P<0.05),而两者的其他参数无统计学差异(P>0.05)。SS-EPI的ADC_(10th)、ADC_(min)和RS-EPI的ADC 90th、ADC_(10th)、ADC_(min)在B组中均小于A组(P<0.05),而其他ADC值在两组间均无统计学差异(P>0.05)。RS-EPI的ADC_(min)在鉴别A、B两组时的诊断效能最高,曲线下面积(AUC)为0.850,最佳阈值为0.474×10^(-3)mm^(2)/s,敏感度75.00%,特异度90.24%。结论:相比SS-EPI,RS-EPI DWI序列ADC值的一致性和准确性更高,其ADC min在判断子宫内膜癌肌层浸润深度时效能较高。

Objective:To compare the value of apparent diffusion coefficient(ADC)value based on readout-segmented echo-planar imaging(RS-EPI)and single-shot echo-planar imaging(SS-EPI)in evaluating the myometrial invasion of endometrial carcinoma(EC).Methods:61 pathologically-proved EC patients were analyzed retrospectively,including 41 cases with no or superficial myometrial invasion(group A)and 20 with deep myometrial invasion(group B).The tumor volume on T_(2)WI was recorded by whole tumor delineation,and the tumor volume,maximum ADC value(ADC max),90th percentile ADC value(ADC 90th),mean ADC value(ADC_(mean)),10th percentile ADC value(ADC_(10th))and minimum ADC value(ADC min)were measured respectively on ADC map of RS-EPI and SS-EPI.The consistency and accuracy of all parameters were compared.In addition,the differences of each parameter between the two groups were analyzed,and receiver operating characteristic curve(ROC)analysis was used to assess the diagnostic efficacy of each parameter.Results:The consistency of parameters measured on the RS-EPI ADC_(map)was better than SS-EPI.There were no significant differences in tumor volume measurement between the two types of DWI and T_(2)WI(both P>0.05).The ADC_(max)and ADC_(90th)of SS-EPI were significantly higher than RS-EPI(both P<0.05),while other parameters showed no significant difference between SS-EPI and RS-EPI(all P>0.05).ADC_(10th),ADC min of SS-EPI and ADC 90th,ADC 10th,ADC_(min)of RS-EPI in group B were significantly lower than those in group A(all P<0.05),while other ADC values were no significant difference between the two groups(all P>0.05).ADC_(min)of RS-EPI showed the highest diagnostic efficiency in the differentiation of the two groups;the area under the curve(AUC)was 0.850,the best cut-off value was 0.474×10^(-3)mm^(2)/s,the sensitivity was 75.00%,and the specificity was 90.24%.Conclusion:The consistency and accuracy of ADC value based on RS-EPI were better than SS-EPI,and ADC min of RS-EPI showed the highest diagnostic efficiency in evaluating the myometrial invasion of EC.