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目的探讨扩散加权成像(DWI)及表观扩散系数(ADC)值定量分析对子宫内膜癌术前组织学分级的应用价值。方法回顾性分析105例经手术病理证实的子宫内膜癌患者术前MR资料,比较不同组织学分级间ADC值差异,分析ADC值与组织学分级的相关性,并通过受试者工作特征曲线(ROC)评估ADC对分级的诊断效能。结果不同观察者所测肿瘤的ADC值具有良好一致性,组内相关系数为0.901;子宫内膜癌组织学分级包括:G1 27例,G2 60例,G3 18例,三者的平均ADC值分别为(0.990±0.128)×10~(-3)mm~2/s、(0.915±0.122)×10~(-3)mm~2/s、(0.851±0.104)×10~(-3)mm~2/s,三者间差异具有统计学意义(P=0.001);ADC值与组织学分级呈负相关(r=-0.356,P<0.001);平均ADC值鉴别高低级别子宫内膜癌的ROC曲线下面积为0.693(P=0.003),95%置信区间为0.584~0.802,最佳诊断界值为0.910×10~(-3)mm~2/s,敏感度为74.1%,特异度为61.5%,阳性预测值为85.3%,阴性预测值为45.9%,准确度为71.4%。结论 ADC值定量分析能够在一定程度上反映子宫内膜癌的组织学分级特征,具备无创评估肿瘤组织学分级的潜力。
Objective To investigate the value of quantitative diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in preoperative histological grade of endometrial carcinoma. Methods The MR data of 105 patients with endometrial carcinoma proved by surgery and pathology were retrospectively analyzed. The differences of ADC value between different histological grades were compared. The correlation between ADC value and histological grade was analyzed. The receiver operating characteristic curve (ROC) to assess the diagnostic performance of ADC for grading. Results The ADC values of the tumors measured by different observers were in good agreement with a correlation coefficient of 0.901. The histological grade of endometrial carcinoma included 27 cases of G1, 60 cases of G2 and 18 cases of G3. The mean ADC values of the three groups were (0.990 ± 0.128) × 10 ~ (-3) mm ~ 2 / s, (0.915 ± 0.122) × 10 ~ (-3) mm ~ 2 / s and (0.851 ± 0.104) × 10 ~ (-3) mm ~ 2 / s, the difference was statistically significant (P = 0.001); the ADC value was negatively correlated with the histological grade (r = -0.356, P <0.001); the average ADC value was used to identify the high and low grade endometrial carcinoma The area under the ROC curve was 0.693 (P = 0.003), the 95% confidence interval was 0.584 ~ 0.802, the best diagnostic value was 0.910 × 10 -3 mm 2 / s, the sensitivity was 74.1% and the specificity was 61.5%, the positive predictive value was 85.3%, the negative predictive value was 45.9% and the accuracy was 71.4%. Conclusions Quantitative analysis of ADC values can reflect the histological grade of endometrial carcinoma to a certain degree and has the potential of noninvasive assessment of histological grade of tumors.