摘要
目的 探讨全病变表观扩散系数(ADC)直方图参数鉴别子宫平滑肌肉瘤与富于细胞性平滑肌瘤的价值。方法 回顾性分析经手术病理证实的14例子宫平滑肌肉瘤病人与20例富于细胞性平滑肌瘤病人的术前MRI影像,所有病人术前均行常规MRI及扩散加权成像(DWI),分析比较2组病人的常规MRI特征。采用Firevoxel软件在DWI上逐层勾画兴趣区(ROI)并生成全病变ADC直方图,记录ADC最小值(ADCmin)、ADC平均值(ADCmean)、ADC最大值(ADCmax),不均匀性、偏度、峰度、熵,ADC第1、5、10、25、50、75、90百分位数(ADC1st、ADC5th、ADC10th、ADC25th、ADC50th、ADC75th、ADC90th)。采用Fisher确切概率检验比较2组间常规MRI特征的差异。采用独立样本t检验或Mann-Whitney U检验比较2组间ADC直方图参数的差异。采用受试者操作特征(ROC)曲线评估ADC直方图参数的诊断效能。结果 富于细胞性平滑肌瘤较子宫平滑肌肉瘤更多表现为边缘光滑,但更少出现T1WI高信号、T2WI高信号或低信号、DWI高信号或信号不均(均P<0.05)。子宫平滑肌肉瘤的不均匀性高于富于细胞性平滑肌瘤,而ADC1st、ADC5th、ADC10th和ADC25th小于富于细胞性平滑肌瘤(均P<0.05)。不均匀性鉴别两者的AUC值最高(0.782),当不均匀性取0.226作为最佳诊断阈值时鉴别两者的敏感度最高(78.57%),而特异度较低(80.0%)。结论 全病变ADC直方图分析有助于术前鉴别子宫平滑肌肉瘤与富于细胞性平滑肌瘤。
Objective To investigate the value of whole-lesion histogram analysis of MRI apparent diffusion coefficient(ADC) for differentiating uterine leiomyosarcomas and cellular leiomyomas. Methods The preoperative plain MRI data of 14 patients with uterine leiomyosarcomas and 20 patients with cellular leiomyomas confirmed by surgery and pathology were analyzed retrospectively. All patients accepted conventional MRI and diffusion weighted imaging(DWI) scan before surgery, conventional MRI features were analyzed and compared between the two groups. Firevoxel was used to generate histogram on ADC maps by delineating the region of interest slice by slice on DWI. The ADC histogram parameters were recorded, including ADC minimum(ADCmin), ADC mean(ADCmean), ADC maximum(ADCmax), inhomogeneity, skewness,kurtosis, entropy, ADC 1st, 5th, 10th, 25th, 50th, 75th, 90th percentile(ADC1st, ADC5th, ADC10th, ADC25th, ADC50th, ADC75th,ADC90th). Fisher exact test was used to compare the differences in conventional MRI features, and independent sample t-test or Mann Whitney U-test was used to compare the differences in ADC histogram parameters between the two groups.Receiver operating characteristic(ROC) curve was used to evaluate the diagnostic performance of ADC histogram metrics.Results More cellular leiomyomas demonstrated smooth margin than uterine leiomyosarcomas, but less cellular leiomyomas demonstrated hyper-intensity on T1WI, hyper-or hypo-intensity on T2WI, and hyper-intensity or hetero-intensity on DWI than uterine leiomyosarcomas(all P<0.05). For the ADC map, the heterogeneity of uterine leiomyosarcomas was higher than that of cellular leiomyomas(P<0.05), and the ADC1st,ADC5th,ADC10thand ADC25thof uterine leiomyosarcomas were lower than those of cellular leiomyomas(P<0.05). The area under curve(AUC) of heterogeneity in differentiating uterine leiomyosarcomas from cellular leiomyomas was the highest(0.782). With optimal threshold of 0.226, heterogeneity achieved the highest sensitivity of 78.57% and a lower specificity of 80.0%.
作者
李亚军
胡伟杰
吴超
LI Yajun;HU Weijie;WU Chao(Department of Medical Imaging,General Hospital of Tianjin Medical University,Tianjin 300052,China)
出处
《国际医学放射学杂志》
北大核心
2023年第1期95-99,共5页
International Journal of Medical Radiology
基金
天津市教委科研计划一般项目(2021KJ220)。
