定量动态增强MRI在鉴别交界性与恶性上皮性卵巢肿瘤中的价值
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摘要
目的探讨动态增强磁共振成像(DCE-MRI)半定量参数在卵巢交界性上皮性肿瘤(BEOT)与恶性上皮性卵巢癌(EOC)鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的60例EOC和24例BEOT患者行常规MRI及多期动态对比增强扫描。经后处理获得半定量参数,包括达峰时间(TTP)、最大浓度(Cmax)、对比浓度-时间曲线下面积(AUC)和最大线性斜率(MS)。采用Mann-Whitney U秩和检验比较两组间各参数之间的差异,并通过受试者工作特征(ROC)曲线评价上述各参数的鉴别诊断效能。结果 TTP在BEOT中高于EOC(3.851 vs 3.166),Cmax、AUC、MS均在BEOT中低于EOC(0.151 vs 0.171,0.473 vs 0.561,0.217 vs 0.304),且差异均具有统计学意义(P<0.05),其中MS的ROC曲线下面积最大(0.80),当阈值为0.25时,其敏感性和特异性分别为70.83%和77.22%。AUC敏感性最高为86.11%,TTP特异性最高为83.33%。结论 DCE-MRI 4个半定量参数均有助于EOC和BEOT的鉴别诊断,其中MS值是诊断效能最高的指标。
Objective To investigate the value of quantitative dynamic contrast enhanced-MR imaging(DCE-MR) for differentiating borderline and malignant epithelial ovarian tumors. Methods Sixty patients with epithelial ovarian carcinomas(EOC) and twenty four patients with borderline epithelial ovarian tumors(BEOT) confirmed by surgery or histopathology underwent conventional and DCE-MRI scans,were analyzed retrospectively. Four semi-quantitative DCE-MRI parameters,including the time to peak(TTP),maximum concentration(Cmax),area under the concentration time curves(AUC)and maximal slope(MS),were evaluated and compared between BEOT and EOC. The four DCE-MRI parameters were compared using Mann-Whitney U Test. Receiver operating characteristic(ROC) curve was used to determine the diagnostic efficiency of four parameters. Results The value of TTP in BEOT was higher than in EOC(3.851 vs 3.166),but the value of Cmax,AUC,MS in BEOT was lower than those in EOC(0.151 vs 0.171,0.473 vs 0.561,0.217 vs 0.304),and there was significant statistical difference in TTP,Cmax,AUC and MS values between the BEOT and EOC(P<0.05).The largest areas under ROC curve was the MS(0.80).Taking MS=0.25 as cutoff value,the sensitivity and specificity were 70.83% and 77.22%,the highest sensitivity and specificity were the AUC(86.11%) and TTP(83.33%),respectively. Conclusion DCE-MRI can be useful for differentiating BEOT from EOC,and the MS value is the best indicator.
Objective To investigate the value of quantitative dynamic contrast enhanced-MR imaging(DCE-MR) for differentiating borderline and malignant epithelial ovarian tumors. Methods Sixty patients with epithelial ovarian carcinomas(EOC) and twenty four patients with borderline epithelial ovarian tumors(BEOT) confirmed by surgery or histopathology underwent conventional and DCE-MRI scans,were analyzed retrospectively. Four semi-quantitative DCE-MRI parameters,including the time to peak(TTP),maximum concentration(Cmax),area under the concentration time curves(AUC)and maximal slope(MS),were evaluated and compared between BEOT and EOC. The four DCE-MRI parameters were compared using Mann-Whitney U Test. Receiver operating characteristic(ROC) curve was used to determine the diagnostic efficiency of four parameters. Results The value of TTP in BEOT was higher than in EOC(3.851 vs 3.166),but the value of Cmax,AUC,MS in BEOT was lower than those in EOC(0.151 vs 0.171,0.473 vs 0.561,0.217 vs 0.304),and there was significant statistical difference in TTP,Cmax,AUC and MS values between the BEOT and EOC(P<0.05).The largest areas under ROC curve was the MS(0.80).Taking MS=0.25 as cutoff value,the sensitivity and specificity were 70.83% and 77.22%,the highest sensitivity and specificity were the AUC(86.11%) and TTP(83.33%),respectively. Conclusion DCE-MRI can be useful for differentiating BEOT from EOC,and the MS value is the best indicator.
引文
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15 Mansour SM,Saraya S,El-faissal Y.Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumours:when to say malignancy?[J].Br J Radiol 2015,88:20150099.
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17 Choi YS,Lee HJ,Ahn SS,et al.Primary central nervous system lymphoma and atypical glioblastoma:differentiation using the initial area under the curve derived from dynamic contrast-enhanced MR and the apparent diffusion coefficient[J].Eur Radiol,2017,27:1344-1351.
18 Liu X,Cheng D,Wang W.MRI in differentiation of benign and malignant tongue tumors[J].Front Biosci(Landmark Ed),2015,20:614-620.
19 Yin J,Yang J,Han L,et al.Quantitative discrimination between invasive ductal carcinomas and benign lesions based on semi-automatic analysis of time intensity curves from breast dynamic contrast enhanced MRI[J].J Exp Clin Cancer Res,2015,34:24.
2 Morotti M,Menada MV,Gillott DJ,et al.The preoperative diagnosis of borderline ovarian tumors:a review of current literature[J].Arch Gynecol Obstet,2012,285:1103-1112.
3 Park JY,Kim DY,Kim JH,et al.Surgical management of borderline ovarian tumors:The role of fertility-sparing surgery[J].Gynecol Oncol,2009,113:75-82.
4 Fischerova D,Zikan M,Dundr P,et al.Diagnosis,treatment,and follow-up of borderline ovarian tumors[J].The Oncologist,2012,17:1515-1533.
5 Li HM,Zhao SH,Qiang JW,et al.Diffusion kurtosis imaging for differentiating borderline from malignant epithelial ovarian tumors:Acorrelation with Ki-67 expression[J].J Magn Reson Imaging,2017,46:1499-1506.
6 Li HM,Qiang JW,Ma FH,et al.The value of dynamic contrast-enhanced MRI in characterizing Complex ovarian tumors[J].J Ovarian Res,2017,10:4.
7李海明.动态增强MRI在卵巢肿瘤中的研究进展[J].放射学实践,2013,28:987-989.
8朱振宁,魏娜,严妮子.HE4联合CA125在卵巢癌早期诊断中的应用价值[J].现代肿瘤医学,2014,22:623-624.
9 Goh V,Halligan S,Gharpuray A,et al.Quantitative assessment of colorectal cancer tumor vascular parameters by using perfusion CT:influence of tumor region of interest[J].Radiology,2008,247:726-732.
10 Chalian H,Tochetto SM,Tore HG,et al.Hepatic tumors:region-ofinterest versus volumetric analysis for quantification of attenuation at CT[J].Radiology,2012,262:853-861.
11 Lambregts DM,Beets GL,Maas M,et al.Tumour ADC measurements in rectal cancer:effect of ROI methods on ADC values and interobserver variability[J].Eur Radiol,2011,21:2567-2574.
12 Hayes C,Padhani AR,Leach MO.Assessing changes in tumour vascular function using dynamic contrast-enhanced magnetic resonance imaging[J].NMR Biomed,2002,15:154-163.
13强金伟.磁共振功能成像在卵巢肿瘤中的临床应用研究[J].肿瘤影像学,2016,25:11-15.
14申洋,周延,何为,等.基于IVIM模型的扩散加权成像和动态增强核磁共振在卵巢肿瘤良恶性鉴别中的应用价值[J].临床放射学杂志,2016,35:410-414.
15 Mansour SM,Saraya S,El-faissal Y.Semi-quantitative contrast-enhanced MR analysis of indeterminate ovarian tumours:when to say malignancy?[J].Br J Radiol 2015,88:20150099.
16 Thomassin-Naggara I,Bazot M,Dara E,et al.Epithelial ovarian tumors:value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis[J].Radiology,2008,248:148-159.
17 Choi YS,Lee HJ,Ahn SS,et al.Primary central nervous system lymphoma and atypical glioblastoma:differentiation using the initial area under the curve derived from dynamic contrast-enhanced MR and the apparent diffusion coefficient[J].Eur Radiol,2017,27:1344-1351.
18 Liu X,Cheng D,Wang W.MRI in differentiation of benign and malignant tongue tumors[J].Front Biosci(Landmark Ed),2015,20:614-620.
19 Yin J,Yang J,Han L,et al.Quantitative discrimination between invasive ductal carcinomas and benign lesions based on semi-automatic analysis of time intensity curves from breast dynamic contrast enhanced MRI[J].J Exp Clin Cancer Res,2015,34:24.