宫颈鳞癌DCE-MRI动态增强灌注参数测量的可重复性以及与病理、临床特征的相关性

摘要

目的:探讨宫颈鳞癌动态增强磁共振成像(dynamic contrast-enhanced MRI,DCE-MRI)灌注参数测量的可重复性及与病理和临床特征的相关性.方法:52例经病理学证实的宫颈鳞癌患者进行DCE-MRI检查,由两位医师测量血管动态增强灌注参数,包括容积转运常数(Ktrans)、速率常数(Kep)和血管外细胞外容积分数(Ve).将患者按照病理分化程度分为低分化组和中高分化组,按照治疗方式分为手术组和放化疗组.计算两位医师测量结果的组内相关系数(intraclass correlation coefficient,ICC).采用Mann-Whitney U检验分别比较不同分化组和不同治疗组的动态增强灌注参数的差异.分析动态增强灌注参数与宫颈鳞癌病理学和临床特征的相关性.结果:宫颈鳞癌Ktrans、Kep和Ve的ICC值分别为0.750、0.696和0.405.低分化组Ktrans、Kep分别为(0.610 ±0.129)/min、(0.801±0.181)/min,高于中高分化组Ktrans和Kep值(0.489±0.129)/min、(0.675±0.194)/min,差异具有统计学意义(P＜0.05);Ve之间差异不具有统计学意义(P＞0.05).手术组病灶Kttrans、Kep分别为(0.454±0.101)/min、(0.641±0.177)/min,低于放化疗组Ktrans、Kep分别为(0.545±0.145)/min、(0.739 ±0.202)/min,差异具有统计学意义(P＜0.05);Ve之间差异不具有统计学意义(P＞0.05).宫颈鳞癌动态增强灌注参数与病灶大小不具有相关性(P＞0.05);动态灌注参数Ktrans、Kep与其分化程度呈负相关(r值分别为-0.605、-0.500,P＜0.05);动态增强灌注参数Ve与宫鳞癌分化程度不具有相关性.宫颈鳞癌的Ktrans、Kep、Ve值与FIGO分期不具有相关性.结论:动态增强灌注参数在宫鳞癌诊断中具有较好的稳定性;动态定量灌注参数在低分化组、中高分化组之间及手术组与放化疗组间有明显差别,与分化程度相关,但与病灶大小、临床分期无明显相关性.%Objective:To investigate the DCE-MRI pharmacokinetic parameters'measurement reproducibility and the correlation with the pathological clinical features in cervical squamous cell carcinomas.Methods:The data of 52 patients diagnosed as squamous cell carcinomas underwent DCE-MRI scan preoperatively.Then the pharmacokinetic parameters were measured by two diagnosis to obtain two groups of Ktrans,Kep and Ve.Divide the patients into low differentiation and middle-high differentiation group,either surgery and radiation and chemotherapy.Calculate the ICC (intraclass correlation coefficient) of the two doctors'diagnostic results.Pharmacokinetic parameters were compared to judge whether there were significant differences between the low and high differentiation groups,either groups of operation and chemoradiotherapy respectively by Mann-Whitney U test.Analysis the relevance between pharmacokinetic parameters and pathology and clinical characteristics of cervical cancer respectively.Results:The ICC values of the two groups were 0.750,0.696,0.405.They all ＞ 0.4 separately.Ktrans,Kep of poorly differentiated group respectively were (0.610 ± 0.129)/min,(0.801 ± 0.181)/min which were higher than middle and high differentiation group of which Ktrans,Kep were (0.489 ± 0.129)/min,(0.675 ± 0.194)/min respectively that had statistical significance.So did chemoradiotherapy and operation group.The size of cervical lesions were (43 720.442 ± 3.239) mm3,and there was no clear correlation with pharmacokinetic parameters.Dynamic quantitative parameters Ktrans and Kep negatively correlated to the degree of differentiation of cervical cancer separately(r:-0.605,-0.500,P ＜ 0.05).And Ve with degree of differentiation of cervical cancer had no clear correlation.Perfusion parameters had no correlation with FIGO staging.Conclusion:The DCE-MRI penetration quantitative parameters in the quantitative analysis of cervical cancer had good stability in the application of cervical cancer diagnosis.There were obvious difference between the low and medium-high differentiation group also in operation and chemoradiotherapy group.Pharmacokinetic parameters are related to the degree of differentiation,but there is no obvious correlation with the lesion size and the clinical stages.