Magic定量图谱成像与宫颈鳞癌病理的相关性研究

Correlation between Magic Quantitative Atlas Imaging and Pathology of Cervical Squamous Cell Carcinoma

目的探讨基于合成定量磁共振成像(Magic)定量图谱成像与宫颈鳞癌病理分化程度间的相关性。方法搜集37例经阴道镜或子宫颈活组织检查证实的宫颈鳞癌患者。37例患者均采用GE 3.0 T MRI行常规序列、Magic序列扫描及DWI序列,并在后处理软件测量合成定量参数值[T_(1)值、T_(2)值、质子密度(PD)值]及ADC值。以术后病理为“金标准”,分析结果包括鳞癌病理分级(低分化、中分化、高分化)、临床分期(Ⅰ~Ⅳ期)。应用SPSS 23.0软件进行统计分析,行正态性及方差齐性检验,用单因素方差分析比较宫颈鳞癌不同病理分级、不同临床分期各参数值的差异,P<0.05为差异有统计学意义。采用Spearman秩相关分析Magic定量参数值与子宫颈鳞癌病理结果之间的相关性。绘制受试者工作特征曲线(ROC)分别计算各参数在诊断宫颈鳞癌及临床分期的曲线下面积(AUC),评价各参数在诊断宫颈鳞癌的阈值及效能。结果37例患者纳入研究,年龄35~83岁,平均(51.9±11.3)岁。鳞癌中低分化12例、中分化11例、高分化14例;临床分期Ⅰ期13例、Ⅱ期8例、Ⅲ期9例、Ⅳ期7例。宫颈鳞癌不同病理分级间T1、T2和ADC值差异具有统计学意义(P值分别为0.000;0.015;0.045),PD值差异没有统计学意义(P=0.097)。宫颈鳞癌临床分期中T2值差异具有统计学意义(P值=0.023)。T_(1)、T_(2)、ADC值与鳞癌分级呈正相关;T2值与临床分期呈正相关(P<0.05)。T_(1)、T_(2)、ADC值诊断低分化鳞癌的AUC值分别为0.792(敏感度74.3%,特异度75.0%),0.808(敏感度73.3%,特异度87.5%),0.763(敏感度86.6%,特异度62.5%),其中T2值诊断效能最高。结论Magic序列合成定量参数与宫颈鳞癌病理分化程度间有一定的相关性,其中低分化宫颈鳞癌T_(1)、T_(2)值及ADC值低于中、高分化宫颈鳞癌。中晚期宫颈鳞癌T_(2)值高于早期宫颈鳞癌。

Objective To investigate the correlation between the Magic quantitative and the degree of pathological differentiation of cervical squamous cell carcinoma.Methods Thirty-seven patients with SCC confirmed by colposcopy or cervical biopsy were collected.All 37 patients underwent routine sequence,Magic and DWI sequence using GE 3.0T MRI.Quantitative parameter values(T_(1),T_(2),PD)and ADC were measured in post-processing software.The pathological results were analyzed,including the pathological grade(poorly differentiated,moderately differentiated,well differentiated)and clinical stage(Ⅰ-Ⅳstage)of squamous cell carcinoma.SPSS 23.0 software was used for statistical analysis,normality and homogeneity of variance tests were performed,and one-way analysis of variance was used to compare the differences of parameters in different pathological grades and clinical stages of SCC.P<0.05 was considered to be statistically significant.Spearman rank correlation was used to analyze the correlation between Magic quantitative parameter values and the pathological results of cervical squamous cell carcinoma.The receiver operating characteristic(ROC)curve was drawn to calculate the area under the curve of each parameter in the diagnosis of SCC and clinical stage,and the threshold and efficacy of each parameter in the diagnosis of SCC were evaluated.Results Thirty-seven patients were included in the study,35-83 years old,(51.9±11.3)years old.There were 12 cases of SCC with low differentiation,11 cases with moderate differentiation,and 14 cases with high differentiation;13 cases were in stageⅠ,8 cases in stageⅡ,9 cases in stageⅢ,and 7 cases in stageⅣ.There were statistically significant differences in T_(1),T_(2)and ADC values among different pathological grades of SCC(P=0.000;0.015;0.045,respectively),but there was no significant difference in PD values(P=0.097).There was a statistically significant difference in T_(2)value among the clinical stages of SCC(P=0.023).T1,T2,ADC values were positively correlated with the grade of SCC;T_(2)value was positively correlated with clinical stage,P<0.05.The AUC values of T_(1),T_(2)and ADC values for the diagnosis of poorly differentiated squamous cell carcinoma were 0.792(sensitivity 74.3%,specificity 75.0%),0.808(sensitivity 73.3%,specificity 87.5%),0.763(sensitivity 86.6%,specificity 62.5%),respectively.T2 value had the highest diagnostic efficiency.Conclusion There is a certain correlation between the synthetic quantitative parameters of Magic and the degree of pathological differentiation of SCC.The T1 and T2 values of poorly differentiated SCC are lower than those of moderately and well differentiated SCC.The T2 value of advanced stage SCC was higher than that of early stage SCC.