宫颈癌表观弥散系数与临床病理相关性分析

目的:分析核磁共振成像（MRI）弥漫加权成像(DWI)表观弥漫系数（ADC）的平均值（ADCmean）、最小值(ADCmin)和最大值（ADCmax）与宫颈癌临床病理特征的相关性，探讨其作为生物预测因子在临床应用中的价值。方法:112例Ib1-IVb期宫颈癌患者，11例腺癌，101例鳞癌。采用GE Discovery 3.0T MR，b值＝0，800 s/mm2行常规盆腔MRI及DWI扫描。由一名有经验的影像医师手工勾画感兴趣区（ROI），自动生成ADCmean、ADCmin和ADCmax。临床病理特征包括FIGO分期、MRI测得的肿瘤最大径及浸润深度、鳞癌细胞相关抗原（SCC-Ag）、肿瘤分化、病理类型、MRI诊断的盆腔淋巴结转移。结果:不同FIGO分期间ADCmean及ADCmin差异有统计学意义，随着分期的增加数值降低［I期、II期和III/IVb 期ADCmean分别为（0.975±0.105）×10-3 mm2/s，（0.943±0.105）×10-3 mm2/s，（0.894±0.115）×10-3 mm2/s，P=0.020］；ADCmax分期间差异未达到统计学意义。影像学检测盆腔淋巴结阳性的ADCmean及ADCmax均明显低于淋巴结阴性组［ADCmean分别为（0.883±0.125）×10-3 mm2/s，（0.951±0.111）×10-3 mm2/s，P=0.006］；但ADCmin无差异。鳞癌ADCmean［(0.889±0.115）×10-3 mm2/s］低于腺癌［(0.934±0.131）×10-3 mm2/s］，但差异未达到统计学意义（P=0.287)，ADCmin及ADCmax也无差异；ADCmean低分化肿瘤明显低于中/高分化，分别为（0.915±0.124）×10-3 mm2/s和（0.943±0.123）×10-3 mm2/s，P=0.002，ADCmin和ADCmax两组间差异无统计学意义。相关分析显示SCC-Ag及肿瘤浸润深度与ADCmean呈负相关（r分别为-0.241、-0.212，P值分别为0.013、0.025），ADCmin及ADCmax与以上因素均不相关。肿瘤直径与ADC各值均不相关。结论:宫颈癌ADCmean在各种临床病理因素间存在较明显的差异，有作为生物预测因子的潜能；而ADCmin和ADCmax仅在个别因素间有差异，可作为预测因子的潜能较低。

The correlation between apparent diffusion coefficient and clinicopathologic features in cervical carcinoma

Objective:To study the parameters of apparent diffusion coefficient(ADC) calculated from diffusion-weighted imaging(DWI) including ADCmean，ADCmin and ADCmax in cervical cancer patients and evaluate their correlations with different clinicopathologic features in order to establish their role as predictive biomarkers.Methods:One hundred twelve patients with FIGO Ib1-IVb cervical carcinoma were scanned at 3.0TMRI including DWI sequence before treatment，and b-values was 0，800 s/mm2.Of those，101 patients were squamous cell carcinoma and 11 were adenocarcinoma.A regions of interest（ROI） in the widest diameter of cervical tumor while excluding areas of necrosis was manually drawn on ADC maps by an expert observer，and the values of ADCmean，ADCmin and ADCmax were extracted automatically for each ROI.The clinicopathologic features include FIGO stage，histologic type，tumor grade，diameterof tumor，depth of invasion，squamous carcinoma cell antigen (SCC-Ag) and pelvic lymph node status.Results:There were significant difference among the FIGO stages for ADCmean and ADCmin but not for ADCmax.For stage I，II and III/IVb the ADCmean were (0.975±0.105)×10-3 mm2/s，(0.943±0.105)×10-3 mm2/s and (0.894±0.115)×10-3 mm2/s，respectively，P=0.020，ADCmean and ADCmax were significant lower in the lymph node positive patients than in the negative patients ［ADCmean were (0.883±0.125)×10-3 mm2/s and (0.951±0.111)×10-3 mm2/s，respectively，P=0.006］，but there was no different in ADCmin.There was no statistically significant difference between the ADCmean of squamous cell carcinoma［(0.889±0.115）×10-3 mm2/s］ and of adenocarcinoma［（0.934±0.131）×10-3 mm2/s,P=0.287］.The ADCmean of well/moderately differentiated［（0.943±0.123）×10-3 mm2/s］ was higher than that of the poorly differentiated ［(0.915±0.124）×10-3 mm2/s，P=0.002］.The ADCmean correlated negatively with SCC-Ag and depth of invision（r=-0.241 and -0.212，respectively，P=0.013 and 0.025），ADCmin and ADCmax had no significant correlation with any clinicopathological features.Conclusion:ADCmean had the ability to be a predictive biomarker to be further studied，but ADCmin and ADCmax need to used prudently.