Dynamic ⁃ contrast enhanced MRI combined diffusion ⁃ weighted image in differentiating malignant uterine mesenchymal tumours from leiomyomas with restricted diffusion on diffusion weighted imaging
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摘要:
目的:评估动态对比增强磁共振成像(dynamic-contrast enhanced magnetic resonance imaging,DCE-MRI)和表观弥散系数(apparent diffusion coefficient,ADC)在鉴别恶性潜能未定的平滑肌肿瘤(smooth muscle tumours of uncertain malignant poten- tial,STUMP)/恶性子宫间叶性肿瘤与在弥散加权成像(diffusion-weighted imaging,DWI)上表现为弥散受限的平滑肌瘤中的诊断效能。方法:连续收集2016年1月—2021年9月病理证实为子宫间叶性肿瘤患者68例,包括23例STUMP/恶性子宫间叶性肿瘤与45例弥散受限的平滑肌瘤,这些病灶在DWI(b=800 s/mm2 )上均显示为弥散受限。对病灶进行常规MR特征评估以及 ADC和DCE-MRI参数的直方图分析,受试者工作特征(receiver operating characteristic,ROC)曲线用于评估诊断性能。结果:STUMP/恶性子宫间叶性肿瘤囊变坏死的发生率高于非恶性组(34.8% vs. 8.9%,P=0.016)。STUMP/恶性组的ADC 中位数和Ve中位数显著低于非恶性组(P < 0.001,P=0.012),鉴别STUMP/恶性子宫间叶性肿瘤的ROC曲线下面积(area under the curve,AUC)分别为0.795和0.713,ADC 中位数+Ve 中位数联合可将AUC提高到0.850,ADC 中位数+Ve 中位数+有无囊变坏死联合得到更高AUC(0.883)。结论:ADC、DCE-MRI参数与常规MR特征联合可作为鉴别STUMP/恶性子宫间叶性肿瘤与弥散受限的平滑肌瘤的敏感指标。
Abstract:
Objective:To evaluate the diagnostic ability of dynamic-contrast enhanced magnetic resonance imaging(DCE-MRI)and apparent diffusion coefficient(ADC)in differentiating smooth muscle tumours of uncertain malignant potential(STUMP)or malignant uterine mesenchymal tumours from leiomyomas that manifests restricted diffusion on diffusion-weighted imaging(DWI). Methods:A total of 68 patients with pathologically confirmed uterine mesenchymal tumors that manifest restricted diffusion on DWI(b=800 s/mm2 ) were included between January 2016 and September 2021. We assessed conventional MR features of the lesions. Histogram analysis was performed based on ADC and DCE -MRI,and the derived quantitative parameters were compared between STUMP or malignant uterine mesenchymal tumours(n=23)and leiomyomas that manifest restricted diffusion on DWI(n=45). Receiver operating characteristic(ROC)curve was used for evaluating diagnostic performance. Results:The incidence of cystic necrosis in the STUMP or malignant group was higher than that in the non -malignant group(34.8% vs. 8.9%,P=0.016). ADCmedian and Ve median of the STUMP or malignant group were significantly lower than nonmalignant group(P < 0.001,P=0.012),with the highest area under the curve(AUC) for distinguishing STUMP or malignant uterine mesenchymal tumours reaching 0.795 and 0.713. ADCmedian+ Ve median improved AUC to 0.850. ADCmedian+Ve median+with or without cystic necrosis yield the highest AUC(0.883). Conclusion:The combination of ADC,DCE-MRI parameters and conventional MR features may serve as sensitive indicators for differentiating malignant uterine mesenchymal tumours from leiomyomas showing restricted diffusion on DWI.