磁共振表观弥散系数值联合增强最大强化率在鉴别卵巢交界性囊腺瘤与囊腺癌中的应用价值

Application of magnetic resonance apparent diffusion coefficient combined with maximum enhancement rate in differentiating ovarian borderline cystadenoma from cystadenocarcinoma

目的:探讨磁共振扩散加权成像的表观弥散系数(apparent diffusion coefficient,ADC)值和动态增强的最大强化率(maximum enhancement rate,ERmax)在鉴别卵巢交界性囊腺瘤和囊腺癌中的应用价值。方法:回顾性选取2018年1月—2023年4月间在盐城市第三人民医院就诊并经术后病理确诊的交界性囊腺瘤患者20例和囊腺癌患者25例。分析患者病灶发生位置、大小、形态、囊壁/囊隔厚度及病灶图像特征,测量病灶实性成分的ADC值和ERmax,并比较两组间差异。采用ROC曲线分析ADC值、ERmax及两者联合鉴别两组患者的效能。结果:交界性囊腺瘤组共21个病灶,囊腺癌组共28个病灶。两组病灶单/双侧、左/右侧别、单/多房表现差异均无统计学意义(P>0.05)。囊腺癌实性部分DWI明显高信号和增强明显强化的比例均高于交界性囊腺瘤(P<0.05)。囊腺癌囊壁/囊隔厚度、ERmax显著大于交界性囊腺瘤,ADC值显著小于交界性囊腺瘤(P<0.001)。ADC值和ERmax鉴别两组的最佳阈值分别为1.34×10^(-3)mm^(2)/s和57.32%。两者联合鉴别两组的曲线下面积、敏感性、特异性和约登指数分别为0.951、88.2%、93.1%和0.813,优于两者各自单独应用的鉴别效能。结论:分析MRI图像特征,联合ADC值和ERmax有利于卵巢交界性囊腺瘤与囊腺癌的鉴别,具有临床应用价值。

Objective To investigate the value of apparent diffusion coefficient(ADC)and maximum enhancement rate(ERmax)of dynamic enhancement in differentiating ovarian borderline cystadenoma from cystadenocarcinoma.Methods 20 cases of borderline cystadenoma and 25 cases of cystadenocarcinoma diagnosed by postoperative pathology in Yancheng Third People’s Hospital from January 2018 to April 2023 were retrospectively selected.Lesion location,size,morphology,cyst wall/septum thickness and lesion image characteristics were analyzed,ADC values and ERmax of the solid components of the lesion were measured,and differences between the two groups were compared.The ROC curve was used to analyze the efficacy of ADC value,ERmax,and combination of them in distinguishing the two groups of patients.Results There were 21 lesions in group of borderline cystadenoma and 28 lesions in group of cystadenocarcinoma.There were no significant differences in single/bilateral,left/right,single/multilocular manifestations between the two groups(P>0.05).The proportion of high signal on DWI and enhanced in solid part of cystadenoma was higher than that in borderline cystadenoma(P<0.05).The wall/septum thickness and ERmax of cystadenocarcinoma were significantly higher than those of borderline cystadenoma,and ADC values were significantly lower than those of borderline-3 cystadenoma(P<0.001).The optimal threshold values of ADC and ERmax were 1.34×10 mm^(2)/s and 57.32%respectively.The area under the curve,sensitivity,specificity and Yoden index of combination for identifying two groups were 0.951,88.2%,93.1%and 0.813,respectively,which were better than the discriminant efficacy of the two index separately.Conclusion Analysis of MRI image features,combined with ADC value and ERmax were beneficial to the differentiation of ovarian borderline cystadenoma from cystadenocarcinoma,which has clinical application value.