上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (2): 224-.doi: 10.3969/j.issn.1674-8115.2020.02.013

• 论著·临床研究 • 上一篇    下一篇

体素不相干运动与动态对比增强磁共振成像在评估早期宫颈癌淋巴脉管浸润状态中的应用

米红兰1，程杰军1，殷 霞2，朱 莉1，林 聪1，路 青1   

  1. 1. 上海交通大学医学院附属仁济医院放射科，上海 200127；2. 上海交通大学医学院附属仁济医院妇产科，上海 200127
  • 出版日期:2020-02-28 发布日期:2020-03-20
  • 通讯作者: 路 青，电子信箱：drluqingsjtu@163.com。
  • 作者简介:米红兰 （1991—），女，住院医师，硕士生；电子信箱：mihonglan@sjtu.edu.cn。
  • 基金资助:
    上海市浦江人才计划（15PJ1405200）；上海交通大学医学院教学项目（888.002.5039.02）。

Clinical value of IVIM MRI and DCE MRI in assessment of lymphovascular space invasion status in early cervical cancer

MI Hong-lan, CHENG Jie-jun, YIN Xia, ZHU Li, LIN Cong, LU Qing   

  1. 1. Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 2. Department of Gynecology and Obstetrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2020-02-28 Published:2020-03-20
  • Supported by:
    Shanghai Pujiang Plan (15PJ1405200); Teaching Program of Shanghai Jiao Tong University School of Medicine (888.002.5039.02).

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摘要： 目的·探讨体素不相干运动（intravoxel incoherent motion，IVIM）与动态对比增强（dynamic contrast enhancement，DCE）磁共振成像（magnetic resonance imaging，MRI）术前评估早期宫颈癌淋巴脉管浸润(lymphovascular space invasion，LVSI)状态的临床价值。方法·收集早期宫颈癌患者56例，均在术前行IVIM与DCE MRI检查，分别测量癌灶最大径、肌层浸润深度（比例）以及MRI定量参数(IVIM: f、D、D*；DCE: Ktrans、Kep、Ve)。根据术后病理结果，将病例分为LVSI阳性组与LVSI阴性组，并记录患者年龄、FIGO分期、病理类型和分化程度。比较2组患者基本资料和 MRI参数的差异，Logistic回归分析早期宫颈癌发生LVSI的关联因素，受试者操作特征曲线分析这些关联因素用于评估LVSI情况的诊断效能。结果·LVSI阳性组与LVSI阴性组间患者年龄、FIGO分期、病理类型、肿瘤分化程度、肿瘤最大径比较，差异无统计学意义；LVSI阳性组癌灶肌层浸润深度（比例）显著高于LVSI阴性组（P0.000），而Ktrans值、D*值显著低于LVSI阴性组（P0.003，P0.004）；D值、f值、Kep值、Ve值在2组间比较，差异无统计学意义；Logistic回归分析显示肌层浸润深度（比例）和Ktrans值与早期宫颈癌发生LVSI独立相关；两者独立诊断LVSI状态的曲线下面积（area under the curve，AUC）与准确度分别为0.760与75.1%、0.723与71.4%；联合诊断的AUC为0.839，准确度为76.8%；纳入D*值后三者诊断的AUC为 0.874，准确度为87.5%。结论·宫颈癌肌层浸润深度(比例)、Ktrans值有助于术前评估早期宫颈癌LVSI状态，两者进一步联合D*值可提高其诊断效能。

关键词: 宫颈癌, 淋巴脉管浸润, 体素不相干运动, 动态对比增强

Abstract:

Objective · To investigate the clinical value of intravoxel incoherent motion (IVIM) MRI and dynamic contrast enhancement (DCE) MRI in assessment of lymphovascular space invasion (LVSI) in early cervical cancer patients preoperatively. Methods · Fifty-six patients with early cervical cancer were collected, all of whom underwent preoperative IVIM and DCE MRI. The tumor maximum diameter, the depth ratio of cervical infiltration and the IVIM (f, D and D*) and DCE (Ktrans, Kep and Ve) MRI quantitative parameters were measured, respectively. According to postoperative pathological results, patients were divided into LVSI positive group and LVSI negative group. Patients age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathological type and differentiation degree were also recorded. The difference of basic characteristics and MRI parameters of the two groups was compared. Logistic regression was used to analyze the risk factors of LVSI in early cervical cancer, and the receiver operator characteristic curve (ROC curve) was applied to assess the diagnostic efficacy of these risk factors of LVSI. Results · There were no significant differences in patients age, FIGO stage, pathological type, differentiation degree and tumor maximum diameter between LVSI positive group and LVSI negative group. The depth ratio of cervical infiltration in LVSI positive group was significantly higher than that in LVSI negative group (P0.000), while D* value and Ktrans value in LVSI positive group were significantly lower than those in LVSI negative group (P0.003, P0.004). D value, f value, Kep value and Ve value showed no significant difference between the two groups. Logistic regression analysis showed that the depth ratio of cervical infiltration and Ktrans value were independently correlated with LVSI. The area under the curve AUC and the accuracy of independent diagnosis of LVSI state were 0.760 and 75.1%, 0.723 and 71.4%, respectively. The AUC of combined diagnosis was 0.839 and the accuracy was 76.8%. After the inclusion of D* value, the AUC of the three diagnosis was 0.874, with the accuracy of 87.5%. Conclusion · The depth ratio of cervical infiltration and Ktrans value are helpful for preoperative evaluation of LVSI status in early cervical cancer, and they can improve the diagnostic efficacy when combined with D* value.

Key words: cervical carcinoma, lymphovascular space invasion (LVSI), intravoxel incoherent motion (IVIM), dynamic contrast enhancement (DCE)