合成MRI在O-RADS MRI 3~5分卵巢附件肿物良恶性鉴别中的价值

Value of synthetic MRI in differential diagnosis of benign and malignant ovarian adnexal lesions with O-RADS MRI score 3-5

目的探索合成MRI(synthetic MRI,syMRI)对卵巢-附件影像报告和数据系统(Ovarian-Adnexal Reporting and Data System,O-RADS)MRI 3~5分的卵巢附件占位良恶性鉴别的效能。材料与方法回顾性分析在2021年8月至2023年6月期间于我院就诊的100例盆腔占位患者病例及影像资料,共计附件肿块126例,所有占位的O-RADS MRI评分均为3~5分。以手术病理或至少1年的随访结果为诊断标准。所有患者均在3.0 T MRI扫描仪上进行盆腔MRI扫描,包括syMRI及扩散加权成像(diffusion-weighted imaging,DWI)序列。在附件区病灶的实性成分的最大层面勾画感兴趣区,以获得syMRI定量参数[T1、质子密度(proton density,PD)、T2^(*)、R2^(*)]及表观扩散系数(apparent diffusion coefficient,ADC)值。采用独立样本t检验或Mann-Whitney U检验比较各参数的差异,通过logistic回归分析建立syMRI及syMRI+ADC诊断模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线比较各参数及模型的诊断效能,DeLong检验比较各模型ROC曲线下面积(area under the curve,AUC)的差异。结果入组100例患者共126个病灶,其中良性55例,恶性71例。T1、T2^(*)、R2^(*)及ADC值在两组间差异有统计学意义(P<0.05),其鉴别卵巢附件良恶性病变的AUC分别为0.739[95%置信区间(confidence interval,CI):0.652~0.826]、0.780(95%CI:0.698~0.862)、0.783(95%CI:0.699~0.866)及0.674(95%CI:0.576~0.772)。syMRI及syMRI+ADC模型的AUC分别为0.860(95%CI:0.791~0.929)及0.879(95%CI:0.818~0.940),二者之间差异无统计学意义,均高于ADC值(P<0.05)。结论syMRI在鉴别O-RADS MRI 3~5分卵巢附件病变的良恶性中具有很好的效能。

Objective:To investigate the diagnostic efficacy of synthetic MRI(syMRI)in differentiation of benign and malignant ovarian adnexal lesions with Ovarian-Adnexal Reporting and Data System(O-RADS)MRI score 3-5.Materials and Methods:Totally 100 patients with 126 ovarian adnexal lesions scored 3-5 according to O-RADS MRI in our hospital from August 2021 to June 2023 were retrospectively enrolled.The diagnosis was confirmed via pathological examination or one-year follow-up.All patients underwent pelvic syMRI and diffusion-weighted imaging(DWI)on a 3.0 T MR scanner.Regions of interest(ROIs)were placed on the largest slice of the solid part of adnexal lesion and avoid the cystic or necrotic areas.Quantitative parameters of syMRI[T1,proton density(PD),T2^(*),R2^(*)]and apparent diffusion coefficient(ADC)values were calculated.Independent samples t test and Mann-Whitney U test were utilized to compare the differences of quantitative parameters between benign and malignant lesions.Two models,the syMRI model and the syMRI+ADC model,were constructed using logistic regression analysis.Receiver operating characteristic(ROC)analysis was used to evaluate the diagnostic efficacy of the individual quantitative parameters and diagnostic models.DeLong test was employed to compare the difference of area under the curve(AUC).Results:Among 126 ovarian adnexal lesions,55 lesions were benign,and 71 lesions were malignant.T1,T2^(*),R2^(*),and ADC showed significant difference between groups(all P<0.05)and the AUCs of these parameters in differentiating benign and malignant adnexal lesions were 0.739[95%confidence interval(CI):0.652-0.826],0.780(95%CI:0.698-0.862),0.783(95%CI:0.699-0.866),and 0.674(95%CI:0.576-0.772),respectively.The AUCs of syMRI and syMRI+ADC models were 0.860(95%CI:0.791-0.929)and 0.879(95%CI:0.818-0.940),respectively.The AUCs of the two models showed no statistical difference,and both of them were higher than that of ADC(all P<0.05).Conclusions:The syMRI proved to be valuable in differential diagnosis of benign and malignant ovarian adnexal lesions with O-RADS MRI score 3-5.