扩散峰度成像直方图在诊断子宫内膜样腺癌临床及病理学特征的临床应用研究
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摘要
目的探讨扩峰度成像(DKI)直方图在鉴别子宫内膜样腺癌(EEC)临床及病理特征中的应用价值。方法回顾性分析65例经病理证实为EEC的患者资料,患者术前均行MRI检查,测量的数据包括DKI的表观扩散系数(D值)和表观峰度系数(K值),然后采用非高斯分布的双指数模型对数据进行分析。采用独立样本t检验或Mann Whitney U检验,对D值和K值直方图的参数与肿瘤组织学分级、肌层浸润深度进行相关性分析。并用受试者工作特征曲线(ROC)评估各个参数的诊断效能。结果肿瘤组织学分级越高、肌层浸润越深D_(10th)值相对较低,K_(90th)相对较高(P值均<0.05)。ROC的分析表明,D_(10th)和K峰度值具有更好的诊断价值。结论直方图分析DKI参数在鉴别EEC病理特征上有一定价值。
Objective To investigate the application of histogram analysis of diffusion kurtosis magnetic resonance imaging in discriminating pathologic features of endometrioid endometrial carcinoma(EEC). Methods A total of 65 patients pathologically confirmed to have EEC underwent preoperative diffusion-weighted magnetic resonance imaging(b value of 0,750,1500 s/mm~2) 3.0 T. The data was postprocessed with a bio-exponential diffusion kurtosis imaging(DKI) model for quantitation of apparent diffusion values(D) and apparent kurtosis coefficient values(K) for non-Gaussian distribution. The measurements were based on an entire-tumor analysis approach. Histogram parameters of D and K were compared between histological tumor grade,presence of deep myometrial invasion,and lymphovascular invasion subgroups using independent t test or Mann-Whitney U test. The diagnostic performance of the imaging parameters were assessed for discrimination of different pathologic features using receiver operating characteristic regression(ROC). Results Patients with high histologic tumor grade,deep myometrial invasion and positive lymphovascular invasion had significantly lower D values in 10 th percentile,higher K values in median and 90 th percentile than those of low grade tumors,superficial myometrial invasion and negative lymphovascular invasion(P<0.05 for all). ROC analysis revealed that 10 th percentile of D and kurtosis of K had better diagnostic performance in distinguishing high-grade tumor,deep myometrial invasion. Conclusion Distribution of DKI parameters characterized by histogram analysis may be useful in distinguishing poor pathologic features of endometrioid endometrial carcinoma.
Objective To investigate the application of histogram analysis of diffusion kurtosis magnetic resonance imaging in discriminating pathologic features of endometrioid endometrial carcinoma(EEC). Methods A total of 65 patients pathologically confirmed to have EEC underwent preoperative diffusion-weighted magnetic resonance imaging(b value of 0,750,1500 s/mm~2) 3.0 T. The data was postprocessed with a bio-exponential diffusion kurtosis imaging(DKI) model for quantitation of apparent diffusion values(D) and apparent kurtosis coefficient values(K) for non-Gaussian distribution. The measurements were based on an entire-tumor analysis approach. Histogram parameters of D and K were compared between histological tumor grade,presence of deep myometrial invasion,and lymphovascular invasion subgroups using independent t test or Mann-Whitney U test. The diagnostic performance of the imaging parameters were assessed for discrimination of different pathologic features using receiver operating characteristic regression(ROC). Results Patients with high histologic tumor grade,deep myometrial invasion and positive lymphovascular invasion had significantly lower D values in 10 th percentile,higher K values in median and 90 th percentile than those of low grade tumors,superficial myometrial invasion and negative lymphovascular invasion(P<0.05 for all). ROC analysis revealed that 10 th percentile of D and kurtosis of K had better diagnostic performance in distinguishing high-grade tumor,deep myometrial invasion. Conclusion Distribution of DKI parameters characterized by histogram analysis may be useful in distinguishing poor pathologic features of endometrioid endometrial carcinoma.
引文
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2 Salvesen HB,Haldorsen IS,Trovik J.Markers for individualised therapy in endometrial carcinoma[J].Lancet Oncol,2012,13:e353-361.
3 Koplay M,Dogan NU,Erdogan H,et al.Diagnostic efficacy of diffusion-weighted MRI for pre-operative assessment of myometrial and cervical invasion and pelvic lymph node metastasis in endometrial carcinoma[J].J Med Imaging Radiat Oncol,2014,58:538-546.
4 Yuan J,Yeung DK,Mok GS,et al.Non-Gaussian analysis of diffusion-weighted MR imaging in head and neck at 3T:a pilot study in patients with nasopharyngeal carcinoma[J].PLo S One,2014,e87024.
5 Kierans AS,Doshi AM,Dunst D,et al.Retrospective Assessment of Histogram-Based Diffusion Metrics for Differentiating Benign and Malignant Endometrial Lesions[J].J Comput Assist Tomogr,2016,40:723-729.
6 Gallego JC,Porta A,Pardo MC,et al.Evaluation of myometrial invasion in endometrial cancer:comparison of diffusion-weighted magnetic resonance and intraoperative frozen sections[J].Abdom Imaging,2014,39:1021-1026.
7 Inoue C,Fujii S,Kaneda,S,et al.Correlation of apparent diffusion coefficient value with prognostic parameters of endometrioid carcinoma[J].J Magn Reson Imaging,2015,41:213-219.
8 Schob S,Meyer HJ,Dieckow J,et al.Histogram Analysis of Diffusion Weighted Imaging at 3T is Useful for Prediction of Lymphatic Metastatic Spread,Proliferative Activity,and Cellularity in Thyroid Cancer[J].Int J Mol Sci,2017,18:821.
9 Hoang Dinh A,Melodelima C,Souchon R,et al.Quantitative Analysis of Prostate Multiparametric MR Images for Detection of Aggressive Prostate Cancer in the Peripheral Zone:A Multiple Imager Study[J].Radiology,2016,280:117-127.
10 Bakir VL,Bakir B,Sanli S,et a.Role of diffusion-weighted MRI in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus[J].Acta Radiol,2017,58:758-767.