Page 44 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第5期
·626 · Journal of Nanjing Medical University（Natural Sciences） 2023年5月

·肿瘤专题研究·

动态对比增强磁共振结合表观弥散系数鉴别恶性子宫间叶性

肿瘤与弥散受限的子宫肌瘤

蒋晓婷 ，宋佳成 ，张爱宁 ，罗成燕 ，陈 婷 ，刘希胜 1*
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1 南京医科大学第一附属医院放射科，妇科，江苏 南京 210029
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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/mm）上均显示为弥散受限。对病灶进行常规MR特征评估以及
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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。
［关键词］ 动态对比增强磁共振成像；弥散加权成像；表观弥散系数；恶性子宫间叶性肿瘤；平滑肌瘤
［中图分类号］ R445.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）05⁃626⁃08
doi：10.7655/NYDXBNS20230506

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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JIANG Xiaoting ，SONG Jiacheng ，ZHANG Aining ，LUO Changyan ，CHENG Ying ，LIU Xisheng 1*
1 Department of Radiology，Department of Gynaecology，the First Affiliated Hospital of Nanjing Medical University，
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Nanjing 210029，China
［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/mm）
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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⁃

［基金项目］ 国家自然科学基金（82071919）
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通信作者（Corresponding author），E⁃mail：liuxisheng2013@163.com