间质转化型高级别浆液性卵巢癌的MRI形态学特征及表观扩散系数值的应用价值

Value of MRI morphological characteristics and apparent diffusion coefficient in diagnosing mesenchymal transition high-grade serous ovarian carcinoma

目的 探索MRI形态学特征及表观扩散系数(apparent diffusion coefficient,ADC)值在间质转化型高级别浆液性卵巢癌(high-grade serous ovarian cancer,HGSOC)中的诊断价值。方法 回顾性分析65例2014年1月至2020年1月于复旦大学附属中山医院经手术或穿刺病理证实的HGSOC患者且术前均行盆腔MRI扫描,包括弥散加权成像(diffusion weight imaging,DWI)。由病理科医师复阅所有病例的术后病理切片,并按镜下病理表现分为间质转化型及非间质转化型HGSOC。放射科医师评估病例的MRI形态学特征(病灶最大径、病灶成分构成、病灶毗邻肠管是否受侵、腹膜后淋巴结是否肿大及腹腔积液量)以及病灶的实性成分的全体积数和ADC值,并比较两组间各指标差异。受试者工作特征(receiver operating characteristic,ROC)曲线评价各参数鉴别诊断间质转化型与非间质转化型HGSOC的效能。结果 65例HGSOC病例中,间质转化型组28例,非间质转化型组37例。与非间质转化型HGSOC比较,间质转化型组病灶更多表现为以实性成分为主(P<0.05)。间质转化型组的病灶最大径和实性成分ADC值均小于非间质转化型组(均P<0.05),取病灶最大径≤54.50 mm与实性成分ADC值≤1.04×10^(-3)mm^(2)/s时,诊断间质转化型HGSOC的ROC曲线下面积(area under the curve, AUC)分别为0.715和0.685。病灶最大径及实性成分ADC值分别取临界值为52.00 mm和0.99×10^(-3)mm^(2)/s时,两者联合诊断的AUC为0.737,敏感度和特异度分别为71.4%和67.6%。两组间的实性成分全体积数、病灶毗邻肠管是否受侵犯、腹膜后淋巴结肿大及腹腔积液量比较,差异均无统计学意义(均P>0.05)。结论 常规MRI形态学特征联合ADC值有助于更好鉴别间质转化型与非间质转化型HGSOC,可为指导患者个体化治疗提供临床依据。

Objective To explore the value of MRI morphological characteristics and apparent diffusion coefficient(ADC)in diagnos-ing mesenchymal transition high-grade serous ovarian carcinoma(HGSOC).Methods A total of 65 patients with HGSOC pathologically proven via surgery or biopsy at Zhongshan Hospital of Fudan University from January 2014 to January 2020 were retrospectively analyzed.All patients underwent MRI examination before surgery including diffusion weight imaging(DWI).The postoperative pathological sections of all patients were reviewed and classified into mesenchymal transition and non-mesenchymal transition groups.The MRI morphological characteristics including the maximum diameter of the lesion,focal element,whether the adjacent intestinal tract was invaded,whether the retroperitoneal lymph node was enlarged and the volume of ascites,and the volume and ADC of solid components were compared between the two groups.Receiver operating characteristic(ROC)curves were used to evaluate their efficiency in the differential diagnosis of mesenchymal transition and non-mesenchymal transition HGSOC.Results Among 65 HGSOC patients,28 were mesenchymal transition cases and 37 were non-mesenchymal transition cases.Compared with the non-mesenchymal transition group,the mesenchymal transition group frequently demonstrated predominantly solid mass(P<0.05);the maximum diameter of the lesion and ADC of solid components in the mesenchymal transition group were lower than those in the non-mesenchymal transition group(both P<0.05).When the maximum diameter of the lesion was≤54.50 mm and the ADC of solid components was≤1.04×10^(-3)mm^(2)/s,the areas under the curves(AUCs)were 0.715 and 0.685,respectively.When the optimal cut off values of the maximum diameter of the lesion and the ADC of solid components were at 52.00 mm and 0.99×10^(-3)mm^(2)/s,respectively,the AUC for their combination was 0.737,with a sensitivity of 71.4%and a specificity of 67.6%.There were no statistical differences between the two groups in the volume of solid components,the invasion of adjacent intestinal tract,the enlargement of retroperitoneal lymph nodes and the volume of ascites.Conclusions MRI morphological characteristics combined with ADC can help distinguish mesenchymal transition HGSOC from non-mesenchymal transition subtype,and provide more information for individu-alized treatment of HGSOC.