扩散峰度成像与宫颈癌病理学特征相关性的初步探索

摘要

目的：评价对比磁共振扩散加权成像(DWI)与扩散峰度成像(DKI)在鉴别宫颈癌病理类型及分化程度的价值。材料与方法搜集39例经病理确诊的宫颈癌患者，包括鳞癌组(31例)与腺癌组(8例)，鳞癌组分为高、中、低分化组(分别为7、19、5例)。所有患者行常规、DWI和DKI序列扫描，对比ADC、MK及MD值在鳞癌、腺癌与高、中、低分化宫颈鳞癌内的差别，经ROC曲线评价对比ADC、MK及MD值鉴别宫颈鳞癌、腺癌与高、中、低分化鳞癌的能力。结果(1) ADC值与MD值鳞癌均低于腺癌， MK值鳞癌高于腺癌，差异均具有统计学意义(P＜0.001)。MK鉴别宫颈鳞癌与腺癌的ROC曲线下面积AUC (0.968)最大，其次为MD (0.940)、ADC (0.915)。(2) ADC、MK、MD值在低中高分化鳞癌中差异均具有统计学意义(P＜0.05)。在低、中与中、高分化鳞癌的鉴别中，MK具有最佳鉴别诊断效能，ROC曲线下面积AUC (0.905，P=0.003；0.940，P＜0.001)，其次是MD (AUC=0.884，P=0.009；AUC=0.887，P=0.002)、ADC (AUC=0.853，P=0.012；AUC=0.842，P=0.003)。结论在宫颈鳞癌与腺癌、高中低分化鳞癌的鉴别上， DKI优于DWI。%AbstractObjective:To evaluate and contrast diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in differentiating cervical cancer pathological type and degree of differentiation.Materials and Methods:Collecting 39 patients with cervical cancer diagnosed by pathological examination, 31 were cervical squamous cell cancer (7 high, 19 medium and 5 low differentiation cervical squamous cell cancer), and the remaining 8 patients were cervical adenocarcinoma. Everyone underwent cervical magnetic resonance imaging (MRI) examination, the sequences included conventional, DWI and DKI. Compared mean value of ADC (apparent diffusion coefficient), MK (mean kurtosis) and MD (mean diffusion) of cervical squamous cell cancer, cervical adenocarcinoma and high, medium and low differentiation cervical squamous cell cancer. Evaluate the discriminability of ADC, MK and MD in cervical squamous cell cancer, cervical adenocarcinoma and high, medium and low differentiation cervical squamous cell cancer by receiver operating characteristics (ROC) curves.Results:(1) The mean values of ADC, MD were lower in cervical squamous cell carcinoma contrast to adenocarcinoma (P<0.001), but the mean values of MK in cervical squamous cell carcinoma were higher contrast to adenocarcinoma (P<0.001). When differentiating cervical squamous cell carcinoma from cervical adenocarcinoma, mean value of MK possessed a biggest AUC (0.968), followed MD (0.940) and ADC (0.915). (2) When differentiating poorly from medium , medium from high differentiated squamous cell carcinoma, the mean value of MK had best ability with largest AUC (0.905,P=0.003. 0.940,P<0.001), followed MD (AUC=0.884,P=0.009. AUC=0.887,P=0.002) and ADC (AUC=0.853,P=0.012. AUC=0.842,P=0.003).Conclusions:DKI is better than DWI on discriminating cervical squamous cell carcinoma, cervical adenocarcinoma and high, medium and low differentiated subtypes of cervical squamous carcinoma.