扩散峰度成像与扩散加权成像在诊断宫颈鳞癌分级中的价值

目的对比分析扩散峰度成像(DKI)与扩散加权成像(DWI)诊断宫颈鳞癌分级的价值。方法回顾性纳入经术后病理证实的宫颈鳞癌病人42例,年龄39~69岁,平均(54.9±7.9)岁。以病理结果为金标准,分为高中分化组(27例)和低分化组(15例),分别测量2组肿瘤实质区平均扩散峰度(MK)值、平均扩散系数(MD)值及平均表观扩散系数(ADC)值、最小ADC值,采用独立样本t检验比较2组间各参数值的差异,采用受试者操作特征(ROC)曲线评价各参数值的诊断效能及最佳诊断阈值,并根据约登指数确定各参数相应的敏感度和特异度。结果2名观察者测得各参数的一致性均良好(均ICC>0.60,P<0.05)。低分化组的MK值高于高中分化组,而MD、平均ADC、最小ADC值均低于高中分化组(均P<0.05)。采用单一参数鉴别低分化与高中分化宫颈鳞癌时,MK为0.88时,AUC最大(0.877)、敏感度(92.6%)最高;MD为1.04×10^-3mm^2/s时,特异度(86.7%)最高。联合MK、MD和最小ADC值诊断时,AUC最大(0.937),敏感度最高(96.3%)。结论与传统DWI相比,DKI可更有效地鉴别低分化与高中分化宫颈鳞癌,联合应用DKI和DWI参数可有效提高诊断效能。

Value of diffusion kurtosis imaging and diffusion weighted imaging in evaluating histological grading of cervical squamous cell carcinoma

Objective To compare the value of diffusion kurtosis imaging(DKI)and diffusion weighted imaging(DWI)in evaluation of histological grading of cervical squamous cell carcinoma.Methods All of 42 patients(mean age,54.9±7.9 years;range,39-69 years)with cervical squamous cell carcinoma confirmed by pathological diagnosis were retrospectively enrolled.Using the pathological results as the gold standard,the patients were divided into the well/moderately differentiated squamous cell carcinoma(n=27)and the poorly differentiated squamous cell carcinoma(n=15).The mean kurtosis(MK),mean diffusion(MD),mean ADC and minimum ADC of the parenchymal regions were measured for the two groups.The differences in the measurements between the two groups were compared by using Student’s t-test.The diagnostic efficiency and optimal diagnostic threshold of each parameter value were evaluated by reciever operating characteristic(ROC)curve,and the corresponding sensitivity and specificity of each parameter were determined according to the Yoden index.Results The measurements exhibited good interobserver agreement(all ICC>0.60,P<0.05).The MK value was higher,but the MD,mean ADC,and minimum ADC values were lower in the poorly differentiated group than in the well/moderately differentiated group(all P<0.05).When the MK and MD were 0.88 and 1.04×10^-3 mm^2/s respectively,the MK achieved the largest AUC(0.877)and the highest sensitivity(92.6%),and the specificity of MD achieved the highest(86.7%)when a single parameter was used in the classification of the poorly differentiated cervical squamous cell carcinoma and the well/moderately differentiated squamous cell carcinoma.When combining MK,MD,and minimum ADC values,the AUC achieved the largest(0.937)and the highest sensitivity(96.3%).Conclusion Compared with traditional DWI,DKI can more effectively identify poorly differentiation and well/moderately differentiated squamous cell carcinoma,and the combination of DKI and DWI parameters can effectively improve diagnostic effectiveness.