DCE-MRI联合临床及血管病理参数预测早期宫颈癌淋巴结转移的价值

DCE-MRI combined with clinical data and vascular pathological parameters to predict lymph node metastasis in early cervical cancer

目的:探讨动态对比增强磁共振成像(DCE-MRI)定量参数联合临床因素、微血管密度(MVD)、周细胞覆盖率(MPI)预测早期宫颈癌淋巴结转移(LNM)的价值。方法:回顾性搜集85例行DCE-MRI和病理免疫组化检查的早期宫颈癌患者,其中LNM阳性43例,LNM阴性42例。应用Extended Tofts Linear双室模型获取宫颈癌原发灶的DCE-MRI定量参数(Ktrans、Kep、Ve)。使用CD34和α-平滑肌肌动蛋白(α-SMA)进行免疫组织化学双染色分别量化宫颈癌MVD和MPI。比较LNM阳性组与阴性组间临床因素、DCE-MRI各定量参数、MVD、MPI的差异,并分析这些因素与LNM的关系。结果:LNM阳性组与阴性组间脉管癌栓(P=0.003)、2009 FIGO分期(P=0.019)差异具有统计学意义,两组间年龄(P=0.323)、肿瘤最大径(P=0.100)、病理类型(P=0.527)及分化程度(P=0.840)差异无统计学意义。LNM阳性组的Ktrans、Kep值显著高于阴性组,差异有统计学意义(P均<0.01);Ve在两组间差异无统计学意义。LNM阳性组的MPI明显低于阴性组(P<0.01),MVD在两组间差异无统计学意义。由Ktrans、MPI、脉管癌栓及2009 FIGO分期构成的联合预测模型的诊断效能(AUC为0.876)高于单独的DCE-MRI定量参数。结论:DCE-MRI定量参数联合临床因素及MPI在评估早期宫颈癌淋巴结转移方面具有一定价值。

Objective:To investigate the value of DCE-MRI quantitative parameters combined with clinical data,microvessel density(MVD)and microvessel pericyte coverage index(MPI)in predicting lymph node metastasis(LNM)of early cervical cancer.Methods:A total of 85 early cervical cancer cases underwent DCE-MRI and histopathological immunohistochemistry were retrospectively analyzed,including 43 cases in LNM positive group and 42 cases in LNM negative group.The Extended Tofts Linear two-compartment model was used to obtain DCE-MRI quantitative parameters(Ktrans,Kep,Ve)of primary cervical cancer;CD34 andα-smooth muscle actin(α-SMA)immunohistochemical staining were used to quantify MVD and MPI of cervical cancer,respectively.Clinical data,quantitative parameters of DCE-MRI,MVD and MPI between LNM positive and negative groups were compared,and the relationship among these factors with LNM were analyzed.Results:There were significant differences for vascular tumor thrombus(P=0.003)and 2009FIGO stage(P=0.019)between LNM positive and negative group.There were no significant differences for age(P=0.323),maximum tumor diameter(P=0.100),pathological type(P=0.527)and differentiation degree(P=0.840)between two groups.Ktrans and Kep in LNM positive group were significantly higher than those in negative group(all P<0.01).There was no significant difference for Ve between the two groups.The MPI of LNM positive group was significantly lower than that of negative group(P<0.01).There was no significant difference for MVD between two groups.The diagnostic performance of the combined prediction model composed of Ktrans,MPI,vascular tumor thrombi and 2009FIGO stage was higher than that of DCE-MRI parameters alone(AUC=0.876).Conclusion:There is certain predictive value for quantitative parameters of DCE-MRI combined clinical data with MPI in evaluating lymph node metastasis of early cervical cancer.