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浙江大学学报(医学版)  2021, Vol. 50 Issue (1): 97-105    DOI: 10.3724/zdxbyxb-2021-0036
原著     
动态对比增强磁共振成像定量灌注直方图参数对子宫肌瘤病理分型的诊断价值
王苏波1(),赵振华2,*(),章俞2,杨立铭2,黄亚男2,阮雅文2,王诚2
1. 绍兴市中医院放射科,浙江 绍兴312000
2. 绍兴市人民医院放射科,浙江 绍兴 312000
Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify different pathological types of uterine leiomyoma
WANG Subo1(),ZHAO Zhenhua2,*(),ZHANG Yu2,YANG Liming2,HUANG Yanan2,RUAN Yawen2,WANG Cheng2
1. Department of Radiology,Shaoxing Hospital of Traditional Medicine,Shaoxing 312000,Zhejiang Province,China;
2. Department of Radiology,Shaoxing People’s Hospital,Shaoxing 312000,Zhejiang Province,China
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摘要:

目的:探讨动态对比增强磁共振成像(DCE-MRI)定量灌注直方图参数在子宫肌瘤病理分型诊断中的价值及其与Ki-67蛋白表达的相关性。 方法:回顾性分析2015年10月至2017年9月在绍兴市人民医院经手术后病理检查证实为子宫肌瘤35例患者(普通型15例,富细胞型8例,退变型12例)的资料。所有患者术前行盆腔DCE-MRI检查,计算各定量灌注参数包括容量转运常数(K trans)、速率常数 (K ep)、 血管外细胞外间隙容积分数(V e)、血管间隙容积分数(V p)的直方图参数(中位数、平均值、偏度、峰度、能量、熵),并采用受试者操作特征(ROC)曲线评估不同参数在鉴别子宫肌瘤病理分型中的效能。免疫组织化学方法测定子宫肌瘤Ki-67蛋白表达,比较不同病理类型Ki-67蛋白表达的差异,并采用Pearson和Spearman相关性分析法分析直方图参数与Ki-67蛋白表达的相关性。 结果:富细胞型组K trans、K ep、V e、V p的中位数和平均值均大于退变型组和普通型组( P<0.05或 P<0.01);V e的偏度、K ep的偏度和峰度均小于普通型组(均 P<0.05);K trans的熵高于退变型组和普通型组(均 P<0.05);V p的熵高于普通型组( P<0.01)。K trans的中位数、平均值和偏度,K ep的中位数和平均值,V e的中位数和平均值,V p的中位数、平均值、能量和熵均与Ki-67表达水平相关(均 P<0.05)。ROC 曲线分析结果显示,当K trans中位数阈值为0.994/min时,其诊断富细胞型子宫肌瘤的敏感度为100.0%,特异度为77.8%,ROC曲线下面积为0.949;当K trans平均值阈值为1.170/min时,其诊断富细胞型子宫肌瘤的敏感度为100.0%,特异度为77.8%,ROC曲线下面积为0.958;K trans的熵,K ep的中位数和平均值,V p的中位数、平均值和熵诊断富细胞型子宫肌瘤的ROC曲线下面积也较高(0.755~0.907)。 结论:DCE-MRI定量灌注直方图参数对不同病理类型子宫肌瘤尤其是富细胞型子宫肌瘤具有较高的诊断价值。

关键词: 子宫肌瘤病理分型动态增强磁共振成像Ki-67诊断    
Abstract:

Objective:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression. Methods: Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People’s Hospital from October 2015 to September 2017 were analyzed retrospectively,including 15 cases of ordinary type,8 cases of cellular type and 12 cases of degenerative type. All patients were examined by pelvic DCE-MRI before operation,and the histogram parameters (median,mean,skewness,kurtosis,energy,entropy) of various quantitative perfusion parameters,including volume transport constant (K trans),rate constant (K ep),extravascular extracellular space distribute volume per unit tissue volume (V e),blood plasma volume per unit volume of tissue (V p) were calculated,and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve. The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical method,and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis. Results: The median and mean values of K trans,K ep,V e and V p in the cellular group were higher than those in the degenerative group and the ordinary group( P<0.05 or P<0.01),while the skewness of V e,the skewness and kurtosis of K ep in the cellular group were lower than those in the ordinary group (all P<0.05). The entropy of K trans in the cellular group was higher than that in the degenerative group and the ordinary group (all P < 0.05). The entropy of V p in the cellular group was higher than that in the ordinary group ( P<0.01). The median,mean,skewness of K trans,median and mean of K ep,median and mean of V e,median,mean,energy and entropy of V p were correlated with Ki-67 expression(all P<0.05). The results of ROC curve analysis showed that the median threshold of K trans was 0.994/min,the sensitivity and specificity for the diagnosis of cellular uterine leiomyoma were 100.0% and 77.8% respectively,and the area under the ROC curve was 0.949. When the mean threshold of K trans was 1.170/min,the sensitivity and specificity for diagnosing cellular uterine leiomyoma were 100.0% and 77.8% respectively,and the area under the ROC curve was 0.958. The area under the ROC curve of K trans (entropy),K ep (median,mean),V p (median,mean,entropy) in the diagnosis of cellular uterine leiomyoma were 0.755–0.907. Conclusion:DCE-MRI quantitative perfusion histogram parameters have high diagnostic value in differentiating pathological types of uterine leiomyoma,especially for cellular uterine leiomyoma.

Key words: Uterus myoma    Pathological types    Dynamic contrast-enhanced of magnetic resonance imaging    Ki-67    Diagnosis
收稿日期: 2020-05-13 出版日期: 2021-05-16
CLC:  R73  
基金资助: 浙江省公益性技术应用研究(2014C33151); 浙江省医药卫生科技计划(2014KYA215); 浙江省自然科学基金(LY16H180006); 绍兴市公益性技术应用研究(2018C30086,2018C30119,2020A13045)
通讯作者: 赵振华     E-mail: 19019095@qq.com;zhao2075@163.com
作者简介: 王苏波,副主任技师,主要从事放射诊断研究; E-mail:19019095@qq.com; https://orcid.org/0000-0003-2183-2730
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引用本文:

王苏波,赵振华,章俞,杨立铭,黄亚男,阮雅文,王诚. 动态对比增强磁共振成像定量灌注直方图参数对子宫肌瘤病理分型的诊断价值[J]. 浙江大学学报(医学版), 2021, 50(1): 97-105.

WANG Subo,ZHAO Zhenhua,ZHANG Yu,YANG Liming,HUANG Yanan,RUAN Yawen,WANG Cheng. Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify different pathological types of uterine leiomyoma. J Zhejiang Univ (Med Sci), 2021, 50(1): 97-105.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0036        http://www.zjujournals.com/med/CN/Y2021/V50/I1/97

病理类型

例数

年龄(岁)

肿瘤体积(cm 3

体质量(kg)

体重指数(kg/m 2

普通型

15

43.5±5.0

124±55

62±9

21±9

富细胞型

8

40.8±4.7

100±95

57±9

14±12

退变型

12

47.7±3.3

153±139

61±8

18±11

F

6.300

0.700

0.833

1.081

P

<0.01

>0.05

>0.05

>0.05

表 1  三种不同病理类型子宫肌瘤患者的一般特征比较

病理类型

n

K trans

中位数(min)

平均值(min)

偏度

峰度

能量

普通型

15

0.779(0.380,0.979)

0.718±0.350

1.150±1.004

1.694(1.092,6.753)

0.012(0.010,0.016)

6.617 ±0.476

富细胞型

8

1.469(1.128,2.244) **##

1.710 ±0.532 **##

0.289 ± 0.950

–0.207(–0.694,1.790)

0.117(0.101,0.164)

7.420±0.433 *#

退变型

12

0.676(0.159,1.092)

0.720±0.451

1.265±0.894

1.363(0.318,3.364)

0.010(0.007,0.021)

6.668±0.939

F/ H

13.960

16.333.

2.856.

7.500

8.641

4.258

P

<0.01

<0.01

>0.05

>0.05

>0.05

<0.05

病理类型

n

K ep

中位数(/min)

平均值(/min)

偏度

峰度

能量

普通型

15

0.984(0.619,1.074)

1.040(0.623,1.127)

2.400±2.195

7.148(1.371,22.285)

0.019(0.012,0.039)

5.850±0.863

富细胞型

8

1.727(1.128,2.922) **##

1.819(1.245,2.556) **##

0.415±0.777 *

0.715(–0.048,2.052) *

0.010(0.008,0.032)

6.706±0.980

退变型

12

0.913(0.633,1.332)

1.065(0.765,1.446)

1.415±1.267

1.362(0.185,12.050)

0.013(0.009,0.025)

6.445±0.777

F/ H

13.668

13.102

3.804

8.988

3.751

3.040

P

<0.01

<0.01

<0.05

>0.05

>0.05

>0.05

病理类型

n

V e

中位数

平均值

偏度

峰度

能量

普通型

15

0.836±0.233

0.811±0.210

–1.392(–5.167,–0.113)

3.242(-0.360,31.560)

0.007(0.006,0.012)

6.924±1.081

富细胞型

8

0.925±0.209 *#

0.908±0.200 *#

–3.532(–14.732,–2.437) *

14.787(6.370,249.257)

0.011(0.008,0.019)

6.166±1.776

退变型

12

0.651±0.337

0.666±0.254

0.010(–1.028,0.681)

–0.442(–1.168,3.576)

0.008(0.006,0.011)

7.085±0.605

F/ H

2.820

3.008

3.338

2.015

1.126

1.667

P

>0.05

>0.05

<0.05

>0.05

>0.05

>0.05

病理类型

n

V p

中位数

平均值

偏度

峰度

能量

普通型

15

0.002(0.001,0.221 )

0.053(0.005,0.290)

3.459±3.594

2.798(0.217,63.201)

0.364±0.355

4.182±2.656

富细胞型

8

0.326(0.077,0.840) **##

0.354(0.162,0.725) **##

1.149 ± 5.880

0.193(–0.765,44.816)

0.173±0.318

5.825±2.397 **

退变型

12

0.001(0.000,0.002)

0.010(0.003,0.117)

5.560±4.477

19.012(0.894,91.687)

0.544±0.287

2.739±1.994

F/ H

7.383

7.449

2.346

3.120

3.170

0.055

P

<0.01

<0.01

>0.05

>0.05

>0.05

<0.05

表 2  35例不同病理类型子宫肌瘤患者DCE-MRI定量灌注直方图参数比较

直方图参数

r

直方图参数

r

K trans

V e

?

中位数

0.562 **

中位数

0.338 *

平均值

0.566 **

平均值

0.356 *

偏度

–0.387 *

偏度

–0.272

峰度

–0.153

峰度

0.214

能量

–0.121

能量

0.175

0.268

–0.176

K ep

V p

?

中位数

0.502 **

中位数

0.377 *

平均值

0.471 **

平均值

0.397 *

偏度

–0.161

偏度

–0.285

峰度

–0.101

峰度

–0.103

能量

0.054

能量

–0.336 *

0.116

0.362 *

表 3  35例子宫肌瘤患者DCE-MRI定量灌注直方图参数与Ki-67表达的相关性分析结果
图 1  三种不同病理亚型子宫肌瘤患者在Extended Tofts模型的DCE-MRI定量灌注K彩图及直方图 transA、D:普通型子宫肌瘤,K直方图可见偏度稍左偏;B、E:富细胞型子宫肌瘤,K直方图可见偏度明显右偏;C、F:退变型子宫肌瘤,方图可见偏度明显左偏. DCE-MRI:动态对比增强磁共振成像;K:容量转运常数.
图 2  DCE-MRI定量灌注直方图参数诊断富细胞型子宫肌瘤的受试者操作特征曲线 DCE-MRI:动态对比增强磁共振成像;K:容量转运常数; K:速率常数;V:血管外细胞外间隙容积分数;V:血管间隙容积分数.

直方图参数

曲线下面积

阈值

约登指数

敏感度(%)

特异度(%)

K trans中位数

0.949

0.994/min

0.778

100.0

77.8

K trans平均值

0.958

1.170/min

0.778

100.0

77.8

K trans

0.843

7.189

0.417

75.0

81.5

K ep中位数

0.907

1.233/min

0.639

75.0

88.9

K ep平均值

0.898

1.212/min

0.690

87.5

81.5

K ep偏度

0.236

0.707

–0.163

50.0

33.7

V e偏度

0.245

–3.292

–0.204

50.0

29.6

V p中位数

0.819

0.058

0.616

87.5

74.1

V p平均值

0.796

1.443

0.616

87.5

74.1

V p

0.755

5.479

0.616

87.5

74.1

表 4  DCE-MRI定量灌注直方图参数诊断富细胞型子宫肌瘤的效能
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