DCE-MRI全域直方图分析在子宫内膜癌鉴别诊断和浸润分级中的应用

Application of DCE-MRI full-field histogram analysis in the differential diagnosis and the infiltration grading of the endometrial cancer

目的:探究DCE-MRI全域直方图分析在子宫内膜癌(EC)鉴别诊断和浸润分级中的应用价值。方法:选取2019年9月-2022年3月本院收治的EC患者51例,采用1.5T MR核磁共振扫描仪检查,使用扩展的Tofts(ET)和分布参数(DP)模型分析DCE-MRI数据。使用Mann-Whitney检验比较高风险和低风险EC间的DCE参数,包括血流(F)、平均通过时间、血容量(Vp)、血管外细胞外体积(Ve)、渗透表面积积(PS)、提取分数、转移常数(Ktrans)和流出速率(Kep)。Bland-Altman分析比较参数一致性,Spearman检验评估参数相关性。通过受试者工作特征曲线(ROC)分析DCE参数的诊断性能,并与传统MRI评估比较。结果:51例患者中高危EC患者的Ktrans、Kep、F、Vp和PS显著降低(P<0.001),ET模式的Ktrans和DP模式的F的曲线下面积(AUC)分别为0.92和0.91。Bland-Altman分析表明,两个模型间Ve或Vp的一致性较低(P<0.001),而Spearman检验显示出很强的相关性(r=0.719、0.871)。Ktrans和F在预测EC风险类型准确性优于传统MRI评估。结论:两种不同模式的DCE-MRI全域直方图分析诊断EC效能均优于传统MRI,DCE-MRI在EC鉴别诊断和浸润分级中具有重要应用价值。

Objective:To investigate the value of DCE-MRI full-field histogram analysis in the differential diagnosis and the infiltration grading of the endometrial cancer(EC).Methods:51 patients with EC from September 2019 to March 2022 were selected in this study.These patients were examined by 1.5T MR Mri scanner.DCE MRI data were analyzed by extended Tofts(ET)and distributed parameter(DP)model.The DCE parameters values were compared between the patients with high-risk and with low-risk EC,including blood flow(F),mean transit time,blood volume(Vp),extravascular extracellular volume(Ve),osmotic surface area volume(PS),extraction fraction,transfer constant(Ktrans),and outflow rate(Kep)by Mann-whitney test.Bland-altman analysis was used to evaluate the consistency of these parameters.Spearman test was used to evaluate the correlation among these parameters each other.The diagnostic efficacy of DCE parameters values for EC of the patients was analyzed by receiver operating characteristic(ROC)curve,and which was compared with the values evaluated by traditional MRI.Results:The patients with high-risk EC exhibited significantly lower of the values of Ktrans,Kep,F,Vp,and PS(P<0.001).AUC of F derived by Ktrans and DP models of ET were 0.92 and 0.91.Bland-Altman analysis showed that the consistency of Ve or Vp between K transmodel and DP model was significantly lower(P<0.001).While Spearman test showed that a strong correlation(r=0.719,0.871)of Ve or Vp between Ktransmodel and DP model.Both Ktrans and F showed the higher accuracy in predicting the risk types of EC than that of the traditional MRI assessment.Conclusion:The diagnostic efficacy of the two different modes of DCE-MRI full-field histogram analysis was superior to that of the traditional MRI assessment,DCE-MRI has important application values in the differential diagnosis and the infiltration grading of EC.