基于术前DWI和半定量DCE-MRI评估早期子宫内膜癌风险分层的价值分析

Study on the value of evaluating the risk stratification of early endometrial cancer based on preoperative DWI and semiquantitative dynamic contrast-enhanced MRI

目的探讨基于术前DWI和半定量动态增强磁共振成像(DCE-MRI)评估早期子宫内膜癌(EC)风险分层的价值。方法选取57例经病理证实为ⅠA或ⅠB期的早期EC患者,根据欧洲肿瘤医学学会(ESMO)临床实践指南将患者分为低、中、高风险组。所有患者术前均进行盆腔DWI和DCE-MRI检查。测量所有患者ADC值和半定量DCE-MRI参数。比较各组别之间不同ADC值和半定量DCE-MRI参数的差异,基于差异有统计学意义(P<0.05)的指标构建单参数、单模态和双模态MRI评估低风险和非低风险早期EC分类器,并绘制受试者工作特征曲线(ROC)图。结果早期EC低风险组ADC最小值(ADCmin)、ADC平均值(ADCmean)和相对ADC值(rADC)均显著高于非低风险组,差异有统计学意义(P<0.05),而早期EC低风险组正性增强积分(PEI)和最大上升斜率(MSI)均显著低于非低风险组,差异有统计学意义(P<0.05)。ROC分析显示评估低风险和非低风险早期EC单参数、单模态MRI最优分类器是基于MSI和PEI+MSI参数构建,AUC值分别为0.887和0.908;联合ADCmean、ADCmin、rADC、PEI和MSI构建的评估低风险和非低风险早期EC双模态MRI分类器AUC为0.966。结论基于不同ADC值和定量DCE-MRI参数构建的单参数、单模态和双模态MRI分类器可以作为术前评估早期EC风险分层的无创性工具。

Objective To explore the value of preoperative DWI and semi-quantitative dynamic contrast enhancement magnetic resonance imaging(DCE-MRI)to assess the risk stratification of early endometrial cancer(EC).Methods A total of 57 patients with early stage EC were confirmed by pathology in our hospital with stage IA or IB.According to the clinical practice guidelines of the European Society for Oncology(ESMO),these patients were divided into low,medium,and high risk groups.All patients underwent pelvic DWI and DCE-MRI examination before operation.The ADC values and semi-quantitative DCE-MRI parameters of all patients were measured.The difference of different ADC values and semi-quantitative DCE-MRI parameters between different groups were compared.Based on the parameters with statistical difference(P<0.05),the classifiers of single-parameter,unimodal,and bimodal MRI of evaluating low-risk and non-low-risk early EC were constructed and the receiver operating characteristic curve(ROC)pictures were delineated.Results The ADC minimum value(ADCmin),ADC mean value(ADCmean)and relative ADC value(rADC)of the early EC low-risk group were significantly higher than those of the non-low-risk group(all P values<0.05),while the positive enhancement integral(PEI)and maximum ascending slope(MSI)of the early EC low-risk group were significantly lower than those of the non-low-risk group(both P values<0.05).ROC analysis showed that the best single-parameter and single-modal MRI classifiers for evaluating low-risk and non-low-risk early EC were constructed based on MSI and PEI+MSI parameters,with AUCs of 0.887 and 0.908,respectively.The AUC of the bimodal MRI classifier constructed by combining ADCmean,ADCmin,rADC,PEI and MSI to assess low-risk and non-low-risk early EC was 0.966.Conclusion The single-parameter,single-modal and bi-modal MRI classifiers constructed based on different ADC values and quantitative DCE-MRI parameters can be used as a noninvasive tool for preoperative assessment of early EC risk stratification.