MRI动态增强定量灌注参数评价宫颈癌微循环及病理分级中的研究

目的探讨多期动态增强磁共振成像(DCE-MRI)定量灌注参数在宫颈癌微循环及病理分级中的价值。方法选取2017年1月~2018年12月在绍兴市人民医院就诊且手术病理证实为子宫颈癌21例(鳞癌17例,腺癌4例)及子宫肌瘤患者22例,术前行盆腔多期DCE-MRI检查,选择Extended Tofts和Exchange模型分别计算宫颈癌与子宫肌瘤、低分化与中高分化宫颈癌的定量灌注参数(Ktrans、K ep、V e、V p、PS、F p),对比分析组间差异及组内差异;在低分化与中高分化2组中,筛选出有统计学意义的参数,以病理为金标准绘制ROC曲线,评价不同参数的诊断效能。结果磁共振定量灌注参数K trans、K ep、V e、PS在宫颈癌组和子宫肌瘤组差异有统计学意义(P<0.05),低分化与中高分化宫颈癌K trans、PS、F p值差异有统计学意义(P<0.05)。绘制K trans、PS、F p值鉴别低分化组的ROC曲线,曲线下面积分别为0.867、0.867、0.867。结论DCE-MRI定量灌注参数可用于宫颈癌的诊断及病理分级,特别是K trans、PS、F p值在宫颈癌病理分化中具有较高的诊断效能,可作为宫颈癌病理分化的预测因子。

Application on Microcirculation and the pathological grading of Cervical Cancer with the quantitative perfusion parameters of dynamic contrast-enhanced MRI

Objective To explore the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)with extended tofts and exchange model in pathological grading of cervical carcinoma.Methods 21 patients with cervical carcinoma(17 cases of squamous carcinoma,4 of adenocarcinoma)and 22 with untrine leymonia confirmed by pathology who underwent preoperative DCE-MRI from January 2017 to December 2018 in shaoxing people's hospital were enrolled in this retrospective study.We prospectively measured and analyzed quantitative perfusion parameters transfer constant(K trans),efflux rate constant(K ep),extravascular extracellular space volume ratio(V e),blood plasma volume ratio(V p),using extended tofts and exchange model in 21 cervical cancer cases.Cervical carcinoma was divided into poorly differentiated,moderately differentiated and high differentiated according to pathology.Moderately and highly differentiated cervical cancer were classified as a group.We analyzed the differences between the two groups of the quantitative perfusion parameters of cervical carcinoma compared with the gold standard of pathological findings in order to draw the receiver operating characteristic(ROC)curve to evaluate the diagnostic efficacy of quantitative perfusion parameters of different models in the pathological grade of cervix carcinoma.Results The value of K trans,K ep,V e,PS had statistical significance(P<0.05)between cervical carcinoma and uertrine leymonia as well as between the poorly differentiated and moderately to highly differentiated cervical cancer groups.The value of K trans,PS,F p in poorly differentiated type were higher than the moderately differentiated and high differentiated type(P<0.01);with drawed ROC curves to identify the poorly differentiated,the area under ROC curve was 0.867 for K trans,0.867 for PS,0.867 for F p.Conclusion The quantitative perfusion parameters of DCE-MRI,especially the value of K trans,PS,F p have a greater diagnostic efficacy in the poorly differentiated cancer which will became a predictive factor of pathological grading in cervical carcinoma.