目的 对比小视野扩散加权成像(field of view optimized and constrained undistorted single-shot diffusion-weighted imaging,FOCUS DWI),探讨基于复合灵敏度编码的小视野 扩 散加权成像(field of view optimized and constrained undistorted multiplexed sensitivity encoding diffusion-weighted imaging,FOCUS-MUSE DWI)在宫颈癌临床诊断中的应用价值.材料与方法前瞻性纳入2023年2月至2023年9月来院就诊并经脱落细胞学检查病理证实的55例宫颈癌患者作为患者组,另收集33名经磁共振检查未见明显异常且宫颈刮片阴性的健康志愿者作为健康组.所有患者及志愿者均接受常规MRI、FOCUS-MUSE DWI和FOCUS DWI扫描.由两名具有15年以上腹部诊断经验的副主任医师采用双盲法分别对患者组DWI图像中的磁敏感伪影、几何变形、解剖细节及整体图像质量进行主观评价,并对图像的信噪比(signal to noise ratio,SNR)及对比噪声比(contrast to noise ratio,CNR)进行客观评估.同时测量患者组和健康组的表观扩散系数(apparent diffusion coefficient,ADC),比较两种DWI序列的平均ADC值差异,以及患者组内不同国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期的ADC值差异及相关性,进一步比较患者组与健康组的ADC值差异.结果 两名医师对患者组两种DWI图像的主观评分及客观测量结果具有良好一致性[Kappa值为0.824～0.942,组内相关系数(intra-class correlation coefficient,ICC)为0.792～0.971].与FOCUS DWI相比,FOCUS-MUSE DWI的主观评分更高、SNR相对较低,差异均有统计学意义(P＜0.001),但CNR在两者间差异无统计学意义(P=0.893).两种DWI序列的平均ADC值差异无统计学意义(P=0.195),但患者组内FIGO(ⅠB～ⅡA)期与(ⅡB～Ⅳ)期的ADC值差异有统计学意义(P＜0.001),且ADC值均与FIGO分期呈负相关(FOCUS-MUSE DWI:r=-0.667,P＜0.001;FOCUS DWI:r=-0.613,P＜0.001).测得患者组两种DWI的ADC值低于健康组(P＜0.001).结论 相较于FOCUS DWI,FOCUS-MUSE DWI能有效减少磁敏感伪影和图像变形,获得更高的图像质量及更清晰的病灶细节显示,可更好地辅助临床医师对病灶进行评估.同时,通过测量ADC值也可用于评估宫颈癌的FIGO分期并区分其与正常组织.
Clinical value of reduced field-of-view diffusion-weighted imaging based on composite sensitivity coding in cervical cancer
Objective:Compared to field of view optimized and constrained undistorted single-shot diffusion-weighted imaging(FOCUS DWI),we aim to explore the clinical diagnostic value for field of view optimized and constrained undistorted multiplexed sensitivity encoding diffusion-weighted imaging(FOCUS-MUSE DWI)in assessing cervical cancer.Materials and Methods:In this prospective study,55 cervical cancer patients confirmed by cytopathology between Febrary 2023 and September 2023 were included in the patient group,while 33 healthy volunteers with normal cervical MRI findings and negative cervical pathology were recruited in the control group.All participants underwent routine MRI,FOCUS-MUSE DWI,and FOCUS DWI scans.Two radiologists with over 15 years of experience in abdominal diagnosis independently evaluated DWI images in the patient group in a blinded fashion,subjective rating magnetic susceptibility artifacts,geometric distortion,anatomical detail,and overall image quality and objective calculating signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR).Apparent diffusion coefficient(ADC)values were also measured in both the patient and control groups.Differences in mean ADC values between two DWI sequences,and between groups and within groups across various International Federation of Gynecology and Obstetrics(FIGO)stages.Results:The subjective ratings and objective measurements for the two DWI sequences in the patient group showed good inter-rater consistency[Kappa=0.824-0.942 and intraclass correlation coefficient(ICC)=0.792-0.971,accordingly].FOCUS-MUSE DWI had significantly higher subjective scores and lower SNR than FOCUS DWI(P＜0.001);however,CNR differences between sequences were not statistically significant(P=0.893).No significant differences in mean ADC values were found between the two DWI sequences(P=0.195),while significant differences were observed within the patient group(FIGO ⅠB～ⅡA stage vs.FIGO ⅡB～Ⅳ stage),where ADC values were negatively correlated with FIGO stage(FOCUS-MUSE DWI:r=-0.667,P＜0.001;FOCUS DWI:r=-0.613,P＜0.001).Both DWI sequences yielded lower ADC values in the patient group compared to the control group(P＜0.001).Conclusions:Compared to FOCUS DWI,FOCUS-MUSE DWI effectively reduces magnetic susceptibility artifacts and image distortion,resulting in higher image quality and clearer lesion details,which can better assist clinicians in lesion evaluation.Furthermore,ADC measurements servers an auxiliary tool in assessing FIGO staging in cervical cancer and in differentiating it from normal tissues.
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