IVIM-DWI联合DCE-MRI定量参数术前预测Ⅰ型与Ⅱ型子宫内膜癌的价值

Diagnostic Value of IVIM-DWI Combined with DCE-MRI Quantitative Parameters in Predicting TypeⅠand TypeⅡEndometrial Carcinoma Preoperative

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)联合动态对比增强磁共振成像(DCE-MRI)在术前预测Ⅰ型与Ⅱ型子宫内膜癌(EC)的诊断价值。方法回顾性分析50例经手术病理证实的Ⅰ型(n=31)与Ⅱ型(n=19)EC患者资料,所有患者在术前均行IVIM-DWI和DCE-MRI扫描。测量所有患者IVIM-DWI定量参数表观扩散系数(ADC)、真扩散系数(D)、假扩散系数(D^(*))、灌注分数(f)及DCE-MRI定量参数容积转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(V_(e))、血浆容积分数(V_(p))的值,并分析其在鉴别Ⅰ型与Ⅱ型EC中的价值。通过绘制受试者工作特征(ROC)曲线评估各参数的诊断效能,并采用Delong检验对曲线下面积(AUC)进行比较。结果Ⅰ型EC的ADC值和D值明显高于Ⅱ型EC,D^(*)、K^(trans)、V_(e)值明显低于Ⅱ型EC,且差异具有统计学意义(P<0.05)。ADC、D、D^(*)、K^(trans)和V_(e)值预测Ⅰ型与Ⅱ型EC的AUC分别为0.855、0.735、0.705、0.694和0.722。联合参数(ADC、D、D^(*)、K^(trans)和Ve联合)预测Ⅰ型与Ⅱ型EC的效能最高,AUC为0.924,优于D、D*、Ktrans和Ve单独预测效能(P<0.05),其敏感度和特异度分别为87.10%和94.74%。结论IVIM-DWI及DCE-MRI定量参数在术前预测Ⅰ型与Ⅱ型EC中具有良好的诊断价值,且联合应用可进一步提高预测效能。

Objective To evaluate the diagnostic value of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in predicting typeⅠand typeⅡendometrial carcinoma(EC)preoperative.Methods Fifty patients with typeⅠ(n=31)and typeⅡ(n=19)EC confirmed by operation and pathology were analyzed retrospectively.IVIM-DWI and DCE-MRI were scanned,and the value of quantitative including ADC,D,D^(*)and f of IVIM-DWI and Ktrans,K_(ep),V_(e),V_(p)of DCE-MRI was measured for all patients and analyzed for their value in differentiating typeⅠand typeⅡEC.The diagnostic efficacy of each parameters was evaluated by drawing the receiver operating characteristic(ROC)curve,and the area under the curve(AUC)was compared by Delong Test.Results The ADC value and D value of typeⅠEC were significantly higher than those of typeⅡEC,and the D*value,Ktransvalue and Ve value were significantly lower than those of typeⅡEC,and the differences were statistically significant(P<0.05).The AUC of ADC,D,D^(*),K_(trans)and Ve values in predicting typeⅠand typeⅡEC were 0.855,0.735,0.705,0.694 and 0.722,respectively.The combined parameters(ADC,D,D^(*),K_(trans)and V_(e))had the highest efficacy in predicting typeⅠand typeⅡEC,with AUC of 0.924,which was better than D,D^(*),Ktrans and V_(e)alone(P<0.05),and the sensitivity and specificity were 87.10%and 94.74%,respectively.Conclusion IVIM-DWI and DCE-MRI quantitative parameters has good diagnostic value in preoperative prediction of typeⅠand typeⅡEC,and the combined application can further improve the predictive efficiency.