动态增强磁共振成像不同药代动力学模型预测子宫肌瘤高强度聚焦超声消融效果的比较
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摘要
目的探讨动态增强磁共振成像(DCE-MRI)定量分析中,不同药代动力学模型预测高强度聚焦超声(HIFU)治疗子宫肌瘤消融的效果。资料与方法收集2015年8月-2017年8月重庆医科大学附属第一医院收治的56例子宫肌瘤患者的临床资料。所有患者行HIFU术前均行DCE-MRI检查。分别用ETL和RR模型计算获得定量参数后,按术后消融效果分为高消融率组和低消融率组。分析各参数值与消融率的相关性以及各组参数的差异,并采用受试工作特征曲线进行评价。结果 ETL模型中容量转移常数(K~(trans))、速率常数(K_(ep))、血管外细胞外容积分数(V_e)、血浆容积分数(V_p)和RR模型中RR K~(trans)、RR K_(ep)、RR V_p均与消融率呈负相关(R~2=0.116～0.285,P<0.05)。低消融率组K~(trans)与RR K~(trans)、K_(ep)与RR K_(ep)、V_e、RR V_p值均小于高消融率组,差异均有统计学意义(P<0.05)。两组V_p差异无统计学意义(P>0.05)。K~(trans)、K_(ep)、V_e与RR K~(trans)、RR K_(ep)、RR V_p最佳预测值分别为1.0349、1.0625、0.7000与2.9380、1.0619、0.6606。ROC曲线下面积分别为0.781、0.725、0.722与0.728、0.824、0.790。结论 ETL模型和RR模型定量分析均可有效预测HIFU治疗子宫肌瘤的消融率,RR模型中RR K_(ep)的预测效能最佳。
Purpose To investigate the effect of different pharmacokinetic models in the prediction of high intensity focused ultrasound(HIFU)on the ablation rate of uterine fibroids in dynamic quantitative magnetic resonance imaging(DCE-MRI)quantitative analysis.Materials and Methods Fifty-six patients with uterine fibroids admitted to the First Affiliated Hospital of Chongqing Medical University from August 2015 to August 2017 were enrolled in this study.All these patients underwent DCE-MRI before HIFU,and were divided into high ablation rate group and low ablation rate group according to the postoperative ablation rate after the ETL and RR models were used to calculate the quantitative parameters.The correlation among each parameter value and ablation rate,the differences among the parameters of each group were analyzed and evaluated by the receiver operating characteristic curve.Results K~(trans)、K_(ep)、V_e、V_(p )of the ETL and RR K~(trans),RR K_(ep),RR V_p of the RR model were negatively correlated with ablation rate(R~2=0.116-0.285,P<0.05).The values of K~(trans) and RR K~(trans),K_(ep) and RR K_(ep),V_e、RR V_p in the low ablation rate group were all lower than those in the high ablation rate group with statistically significant difference(P<0.05).There was no statistically significant difference in the values of Vp between the above two groups(P>0.05).The best predicted values of K~(trans),K_(ep),V_e and RR K~(trans),RR K_(ep),RR V_p were 1.0349,1.0625,0.7000and 2.9380,1.0619,0.6606,and the area under the corresponding ROC curve were 0.781,0.725,0.722 and 0.728,0.824,0.790,respectively.Conclusion Both of the quantitative analysis of the ETL model and RR model can effectively predict the ablation rate of HIFU in the treatment of uterine fibroids.RR Kep of the RR model has the best prediction performance.
Purpose To investigate the effect of different pharmacokinetic models in the prediction of high intensity focused ultrasound(HIFU)on the ablation rate of uterine fibroids in dynamic quantitative magnetic resonance imaging(DCE-MRI)quantitative analysis.Materials and Methods Fifty-six patients with uterine fibroids admitted to the First Affiliated Hospital of Chongqing Medical University from August 2015 to August 2017 were enrolled in this study.All these patients underwent DCE-MRI before HIFU,and were divided into high ablation rate group and low ablation rate group according to the postoperative ablation rate after the ETL and RR models were used to calculate the quantitative parameters.The correlation among each parameter value and ablation rate,the differences among the parameters of each group were analyzed and evaluated by the receiver operating characteristic curve.Results K~(trans)、K_(ep)、V_e、V_(p )of the ETL and RR K~(trans),RR K_(ep),RR V_p of the RR model were negatively correlated with ablation rate(R~2=0.116-0.285,P<0.05).The values of K~(trans) and RR K~(trans),K_(ep) and RR K_(ep),V_e、RR V_p in the low ablation rate group were all lower than those in the high ablation rate group with statistically significant difference(P<0.05).There was no statistically significant difference in the values of Vp between the above two groups(P>0.05).The best predicted values of K~(trans),K_(ep),V_e and RR K~(trans),RR K_(ep),RR V_p were 1.0349,1.0625,0.7000and 2.9380,1.0619,0.6606,and the area under the corresponding ROC curve were 0.781,0.725,0.722 and 0.728,0.824,0.790,respectively.Conclusion Both of the quantitative analysis of the ETL model and RR model can effectively predict the ablation rate of HIFU in the treatment of uterine fibroids.RR Kep of the RR model has the best prediction performance.
引文
[1]Froeling V,Meckelburg K,Schreiter N,et al.Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids:Long-term results.Eur J Radiol,2013,82(12):2265-2269.
[2]Mikami K,Murakami T,Okada A,et al.Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids:early clinical experience.Radiat Med,2008,26(4):198-205.
[3]Cheng HL,Wang C,Tian J.Correlation between uterine fibroids with various magnetic resonance imaging features and therapeutic effects of high-intensity focused ultrasound ablation.Pak J Med Sci,2015,31(4):869-873.
[4]Zhao WP,Chen JY,Zhang L,et al.Feasibility of ultrasoundguided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging.Eur J Radiol,2013,82(1):e43-e49.
[5]Kim YS,Lim HK,Kim JH,et al.Dynamic contrast-enhanced magnetic resonance imaging predicts immediate therapeutic response of magnetic resonance-guided high-intensity focused ultrasound ablation of symptomatic uterine fibroids.Invest Radiol,2011,46(10):639-647.
[6]周星,黄刚,张庆,等.动态增强MRI及扩散加权成像对宫颈癌病理特征及临床分期的应用.中国医学影像学杂志,2016,24(11):855-860.
[7]Li X,Welch EB,Arlinghaus LR,et al.A novel AIF tracking method and comparison of DCE-MRI parameters using individual and population-based AIFs in human breast cancer.Phys Med Biol,2011,56(17):5753-5769.
[8]Bergamino M,Bonzano L,Levrero F,et al.A review of technical aspects of T1-weighted dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in human brain tumors.Phys Med,2014,30(6):635-643.
[9]Wei C,Fang X,Wang CB,et al.The predictive value of quantitative DCE metrics for immediate therapeutic response of high-intensity focused ultrasound ablation(HIFU)of symptomatic uterine fibroids.Abdom Radiol,2018,43(8):2169-2175.
[10]刘柳恒,吕富荣,肖智博,等.动态增强MRI定量参数与高强度聚焦超声消融子宫肌瘤疗效的相关性研究.临床放射学杂志,2017,36(7):1024-1028.
[11]赵飞飞,吕富荣,肖智博,等.动态增强MRI Reference region模型在子宫肌瘤中的初步应用.中国医学影像技术,2015,31(12):1861-1865.
[12]Orsini LF,Salardi S,Pilu G,et al.Pelvic organs in premenarcheal girls:real-time ultrasonography.Radiology,1984,153(1):731-732.
[13]Park MJ,Kim YS,Rhim H,et al.Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused us therapy.J Vasc Interv Radiol,2014,25(2):231-239.
[14]Yankeelov TE,Gore JC.Dynamic contrast enhanced magnetic resonance imaging in oncology:theory,data acquisition,analysis,and examples.Curr Med Imaging Rev,2009,3(2):91-107.
[15]Jansen J,Sch?der H,Lee NY,et al.Noninvasive assessment of tumor microenvironment using dynamic contrast enhanced MRI and(18)F-fluoromisonidazole PET imaging in neck nodal metastases.Int J Radiat Oncol Biol Phys,2010,77(5):1403-1410.
[16]Evelhoch J,Garwood M,Vigneron D,et al.Expanding the use of Magnetic Resonance in the assessment of tumor response to therapy:workshop report.Cancer Res,2005,65(16):7041-7044.
[17]Amamath J,Sangeeta T,Mehta SB.Role of quantitative pharmacokinetic parameter(transfer contrast:ktrans)in the characterization of breast lesions on MRI.Indian J Radiol Imaging,2013,23(1):19-25.
[18]Jackson A,O'connor JP,Parker GJ.Imaging tumor vascular heterogeneity and angiogenesis using dynamic contrastenhanced magnetic resonance imaging.Clin Cancer Res,2007,13(12):3449-3459.
[19]Yun TJ,Park CK,Kim TM,et al.Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy:differentiation of true progression from pseudoprogression with quantitative dynamic contrastenhanced MR imaging.Radiology,2015,274(3):830-840.
[20]徐曦,张冬,黄家喜,等.体素内不相干运动成像及动态增强MRI在前列腺癌诊断及分级中的应用.中国医学影像学杂志,2018,26(10):772-776,780.
[21]王苏波,赵振华,胡红杰,等.动态对比增强磁共振药代动力学模型在鉴别富细胞型子宫平滑肌瘤中的应用.浙江大学学报(医学版),2017,46(5):498-504.
[22]Mills SJ,Soh C,Rose CJ,et al.Candidate biomarkers of extravascular extracellular space:a direct comparison of apparent diffusion coefficient and dynamic contrastenhanced MR imaging-derived measurement of the volume of the extravascular extracellular space in glioblastoma multiforme.Am J Neuroradiol,2010,31(3):549-553.
[2]Mikami K,Murakami T,Okada A,et al.Magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids:early clinical experience.Radiat Med,2008,26(4):198-205.
[3]Cheng HL,Wang C,Tian J.Correlation between uterine fibroids with various magnetic resonance imaging features and therapeutic effects of high-intensity focused ultrasound ablation.Pak J Med Sci,2015,31(4):869-873.
[4]Zhao WP,Chen JY,Zhang L,et al.Feasibility of ultrasoundguided high intensity focused ultrasound ablating uterine fibroids with hyperintense on T2-weighted MR imaging.Eur J Radiol,2013,82(1):e43-e49.
[5]Kim YS,Lim HK,Kim JH,et al.Dynamic contrast-enhanced magnetic resonance imaging predicts immediate therapeutic response of magnetic resonance-guided high-intensity focused ultrasound ablation of symptomatic uterine fibroids.Invest Radiol,2011,46(10):639-647.
[6]周星,黄刚,张庆,等.动态增强MRI及扩散加权成像对宫颈癌病理特征及临床分期的应用.中国医学影像学杂志,2016,24(11):855-860.
[7]Li X,Welch EB,Arlinghaus LR,et al.A novel AIF tracking method and comparison of DCE-MRI parameters using individual and population-based AIFs in human breast cancer.Phys Med Biol,2011,56(17):5753-5769.
[8]Bergamino M,Bonzano L,Levrero F,et al.A review of technical aspects of T1-weighted dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in human brain tumors.Phys Med,2014,30(6):635-643.
[9]Wei C,Fang X,Wang CB,et al.The predictive value of quantitative DCE metrics for immediate therapeutic response of high-intensity focused ultrasound ablation(HIFU)of symptomatic uterine fibroids.Abdom Radiol,2018,43(8):2169-2175.
[10]刘柳恒,吕富荣,肖智博,等.动态增强MRI定量参数与高强度聚焦超声消融子宫肌瘤疗效的相关性研究.临床放射学杂志,2017,36(7):1024-1028.
[11]赵飞飞,吕富荣,肖智博,等.动态增强MRI Reference region模型在子宫肌瘤中的初步应用.中国医学影像技术,2015,31(12):1861-1865.
[12]Orsini LF,Salardi S,Pilu G,et al.Pelvic organs in premenarcheal girls:real-time ultrasonography.Radiology,1984,153(1):731-732.
[13]Park MJ,Kim YS,Rhim H,et al.Safety and therapeutic efficacy of complete or near-complete ablation of symptomatic uterine fibroid tumors by MR imaging-guided high-intensity focused us therapy.J Vasc Interv Radiol,2014,25(2):231-239.
[14]Yankeelov TE,Gore JC.Dynamic contrast enhanced magnetic resonance imaging in oncology:theory,data acquisition,analysis,and examples.Curr Med Imaging Rev,2009,3(2):91-107.
[15]Jansen J,Sch?der H,Lee NY,et al.Noninvasive assessment of tumor microenvironment using dynamic contrast enhanced MRI and(18)F-fluoromisonidazole PET imaging in neck nodal metastases.Int J Radiat Oncol Biol Phys,2010,77(5):1403-1410.
[16]Evelhoch J,Garwood M,Vigneron D,et al.Expanding the use of Magnetic Resonance in the assessment of tumor response to therapy:workshop report.Cancer Res,2005,65(16):7041-7044.
[17]Amamath J,Sangeeta T,Mehta SB.Role of quantitative pharmacokinetic parameter(transfer contrast:ktrans)in the characterization of breast lesions on MRI.Indian J Radiol Imaging,2013,23(1):19-25.
[18]Jackson A,O'connor JP,Parker GJ.Imaging tumor vascular heterogeneity and angiogenesis using dynamic contrastenhanced magnetic resonance imaging.Clin Cancer Res,2007,13(12):3449-3459.
[19]Yun TJ,Park CK,Kim TM,et al.Glioblastoma treated with concurrent radiation therapy and temozolomide chemotherapy:differentiation of true progression from pseudoprogression with quantitative dynamic contrastenhanced MR imaging.Radiology,2015,274(3):830-840.
[20]徐曦,张冬,黄家喜,等.体素内不相干运动成像及动态增强MRI在前列腺癌诊断及分级中的应用.中国医学影像学杂志,2018,26(10):772-776,780.
[21]王苏波,赵振华,胡红杰,等.动态对比增强磁共振药代动力学模型在鉴别富细胞型子宫平滑肌瘤中的应用.浙江大学学报(医学版),2017,46(5):498-504.
[22]Mills SJ,Soh C,Rose CJ,et al.Candidate biomarkers of extravascular extracellular space:a direct comparison of apparent diffusion coefficient and dynamic contrastenhanced MR imaging-derived measurement of the volume of the extravascular extracellular space in glioblastoma multiforme.Am J Neuroradiol,2010,31(3):549-553.