摘要
目的 探讨基于笛卡尔排序差分抽样(DISCO)的超快速动态对比增强MRI(DCE-MRI)技术在宫颈癌病理分型鳞癌和腺癌鉴别诊断中的价值.方法 选取经手术病理确诊的 66 例宫颈癌患者资料进行回顾性分析,其中宫颈鳞癌(CSCC)56 例为CSCC组,宫颈腺癌(CAC)10 例为CAC组.患者均行基于DISCO的DCE-MRI检查并测量其相关参数,定量参数包括容积转移常数(Ktrans)、反向容积转移常数(Kep)和每单位体积组织的血管外细胞外间隙容积(Ve),半定量参数包括初始增强曲线下面积(IAUGC)、最大增强斜率(MaxSlope)、对比增强比率(CER)、团注到达时间(BAT).以病理结果为金标准,对基于DISCO的DCE-MRI的定量参数及半定量参数进行对比及统计学分析,差异有统计学意义的参数行ROC曲线分析评价其诊断效能.结果 宫颈鳞癌及腺癌的基于DISCO的DCE-MRI的Ktrans、Kep、Ve、MaxSlope值间比较差异均有统计学意义(均 P<0.05),其 ROC曲线 AUC分别为 0.837、0.935、0.942、0.726;诊断界值分别为 0.473、0.702、0.716、0.020;灵敏度分别为 80.00%、100%、90.00%、100%;特异度分别为 73.21%、78.57%、92.86%、46.43%.而IAUGC、CER、BAT值间的差异无统计学意义(均P>0.05).结论 基于DISCO的DCE-MRI技术对宫颈鳞癌及腺癌的鉴别诊断具有重要意义,Kep值、Ve值诊断效能较高,Ktrans值、MaxSlope值诊断效能中等,且Kep、MaxSlope的灵敏度极高,Ve同时具有较高的灵敏度及特异度,可以为宫颈癌病理分型提供参考价值.
Abstract
Objective To explore the worth of Cartesian sorting differential sampling(DISCO)-based ultra-fast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)technology in the differential diagnosis of cervical cancer by patho-logical classification.Methods Clinical data from 66 patients including 56 cases of squamous cell carcinoma and 10 cases of adenocarcinoma who had cervical cancer that had been pathologically proven were retrospectively analyzed.All patients under-went DCE-MRI based on DISCO,and their related parameters were measured.The quantitative parameters included Kep、Ktrans and Ve.The semi-quantitative parameters included IAUGC,CER,MaxSlope,and BAT.To assess the quantitative and semi-quantitative parameters of DISCO-based DCE-MRI,a comparison study was carried out.The diagnostic efficacy of the pathologi-cal findings was evaluated by applying them as the gold standard,and the parameters that showed statistical significance were used to create the ROC curves.Results The Ktrans,Kep,Ve,and MaxSlope values of DCE-MRI based on DISCO were revealed significant differences(all P＜0.05)between cervical adenocarcinoma(CAC)and cervical squamous cell carcinoma(CSCC).And their AUCs of ROI curves were 0.837,0.935,0.942,and 0.726,respectively.The relative diagnostic levels were 0.473,0.702,0.716,and 0.020,respectively.The associated sensitivity values were 80.00%,100%,90.00%,and 100%,respec-tively.The specificities were 73.21%,78.57%,92.86%,and 46.43%,respectively.The differences were not statistically signifi-cant among IAUGC,CER,and BAT values(all P＞0.05).Conclusions The DCE-MRI technology based on DISCO is of great significance for the differential diagnosis between CSCC and CAC.The diagnostic efficiency of Kep value and Ve value is high,while the diagnostic efficiency of Ktrans value and MaxSlope value is moderate.Moreover,the sensitivity of Kep and MaxSlope is extremely high,and Ve has both high sensitivity and specificity,which can be used as a foundation for evaluating the preopera-tive pathological classification of cervical cancer.
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