合成MRI定量参数评估宫颈鳞癌淋巴脉管间隙浸润的初步研究

A preliminary study of quantitative parameters derived from synthetic MRI for predicting the lymphovascular space invasion status in cervical squamous cell carcinoma

目的探究合成MRI的定量参数[纵向弛豫时间(longitudinal relaxation time,T1)、横向弛豫时间(transverse relaxation time,T2)、质子密度(proton density,PD)]在预测宫颈鳞癌淋巴脉管间隙浸润(lymphovascular space invasion,LVSI)状态中的价值。材料与方法前瞻性招募2020年5月至2022年11月首次因疑似宫颈癌于山西医科大学第二医院就诊的患者。患者术前行盆腔常规MRI平扫、合成MRI矢状位扫描,测定肿瘤实质区的T1、T2、PD值。根据LVSI状态,将受试者分为LVSI阳性及阴性组,采用独立样本t检验或U检验,比较两组间T1,T2和PD值的差异。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估各参数独立及联合分析在预测宫颈鳞癌LVSI状态的诊断效能。结果本研究共纳入80名经手术病理证实的宫颈鳞癌患者,其中LVSI阳性51例,LVSI阴性29例。宫颈鳞癌LVSI阳性组的T1值[(1191.60±101.17)ms vs.(1316.58±107.42)ms]和T2值[(80.72±5.62)ms vs.(89.79±7.43)ms]低于LVSI阴性组,差异有统计学意义(P<0.001)。T1、T2值诊断宫颈鳞癌患者LVSI状态的ROC曲线下面积(area under the curve,AUC)分别为0.798、0.850。T1和T2值联合诊断的AUC值为0.881。DeLong检验结果显示,T1和T2联合诊断与T1、T2值独立诊断的AUC值差异无统计学意义(P>0.05)。结论合成MRI定量参数有助于术前评估宫颈鳞癌的LVSI状态,为临床医生制订治疗方案提供参考。

Objective:To investigate the feasibility of synthetic MRI[longitudinal relaxation time(T1),transverse relaxation time(T2),and proton density(PD)]for the prediction of the lymphovascular space invasion(LVSI)status in cervical squamous cell carcinoma(CSCC).Materials and methods:Patients who first went to the Second Hospital of Shanxi Medical University for suspected cervical cancer from May 2020 to November 2022 were prospectively collected.All patients underwent preoperative routine MRI scan,sagittal synthetic MRI to obtain the T1,T2,and PD values of the tumor.According to the LVSI status confirmed by postoperative pathological diagnosis,the subjects were divided into positive and negative LVSI groups.Use independent sample t-test or U-test to compare T1,T2 and PD values between the two groups.The receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic efficacy of each parameter in predicting the LVSI status of CSCC.Results:A total of 80 patients with operatively pathology confirmed CSCC were included in the study,including positive LVSI(n=51)and negative LVSI(n=29).There were significant differences in T1 value[(1191.60±101.17)ms vs.(1316.58±107.42)ms]and T2 value[(80.72±5.62)ms vs.(89.79±7.43)ms],all P<0.001.In term of distinguishing LVSI positive from LVSI negative,the area under the curve(AUC)for T1 and T2 values were 0.798 and 0.850,respectively.A combination of T1 and T2 values showed a higher diagnostic performance(AUC=0.881),although there was no significant difference between T1,T2 and the AUC value of the combined parameter model(P>0.05)by DeLong test.Conclusion:The quantitative parameters from synthetic MRI have potential for evaluating the LVSI status of CSCC and to help to optimize therapeutic strategies.