Thomassin-Naggara Isabelle, Bazot Marc, Daraï Emile, Callard Patrice, Thomassin Jeanne, Cuenod Charles A
Department of Radiology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75020 Paris, France.
Radiology. 2008 Jul;248(1):148-59. doi: 10.1148/radiol.2481071120. Epub 2008 May 5.
To retrospectively evaluate the diagnostic performance of dynamic contrast material-enhanced magnetic resonance (MR) imaging for the characterization of ovarian epithelial tumors, by using histologic findings as the reference standard, and to correlate dynamic contrast-enhanced MR imaging findings with angiogenesis biomarkers.
Ethics committee approval was obtained, with waiver of informed consent. Patients consented to having their data used for future retrospective research. Forty-one women (age range, 22-73 years) with 48 epithelial ovarian tumors underwent dynamic contrast-enhanced MR imaging before surgical excision. In case of bilateral tumors (n = 7), only the most complex tumor was analyzed. Thus, 41 tumors (12 benign, 13 borderline, and 16 invasive) were examined with dynamic contrast-enhanced MR imaging and immunohistochemical methods. Dynamic contrast-enhanced MR imaging parameters (enhancement amplitude [EA], time of half rising [T(max)], and maximal slope [MS]) were analyzed according to histopathologic findings, microvessel density, pericyte coverage index (PCI), and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Statistical analyses were performed by using Kruskal-Wallis, Fisher exact, and Spearman tests and receiver operating curve analysis.
EA was higher for invasive tumors than for benign (P < .001) and borderline (P < .05) tumors. T(max) was longer for benign tumors than for borderline (P < .05) and invasive (P < .01) tumors. MS was steeper for invasive tumors than for benign (P < .001) and borderline (P < .001) tumors. PCI was lower in invasive tumors than in borderline (P < .05) and benign (P < .05) tumors. Microvessels showed stronger immunohistochemical VEGFR-2 expression in invasive tumors than in benign or borderline tumors (P < .05). MS correlated with a lower PCI (r = -0.34, P = .04) and stronger VEGFR-2 expression by using both epithelial (r = 0.41, P < .01) and endothelial (r = 0.66, P < .001) cells.
The early enhancement patterns of ovarian epithelial tumors on dynamic contrast-enhanced MR images can help distinguish among benign, borderline, and invasive tumors and were found to correlate with tumoral angiogenic status.
以组织学结果为参考标准，回顾性评估动态对比剂增强磁共振（MR）成像对卵巢上皮性肿瘤特征的诊断性能，并将动态对比增强MR成像结果与血管生成生物标志物进行关联分析。
研究获得伦理委员会批准，豁免知情同意。患者同意其数据用于未来的回顾性研究。41例患有48个上皮性卵巢肿瘤的女性在手术切除前接受了动态对比增强MR成像检查。对于双侧肿瘤（n = 7），仅分析最复杂的肿瘤。因此，对41个肿瘤（12个良性、13个交界性和16个浸润性）进行了动态对比增强MR成像和免疫组织化学方法检查。根据组织病理学结果、微血管密度、周细胞覆盖指数（PCI）和血管内皮生长因子受体2（VEGFR-2）表达情况，分析动态对比增强MR成像参数（增强幅度[EA]、半上升时间[T(max)]和最大斜率[MS]）。采用Kruskal-Wallis检验、Fisher确切概率法和Spearman检验以及受试者操作特征曲线分析进行统计学分析。
浸润性肿瘤的EA高于良性肿瘤（P <.001）和交界性肿瘤（P <.05）。良性肿瘤的T(max)长于交界性肿瘤（P <.05）和浸润性肿瘤（P <.01）。浸润性肿瘤的MS比良性肿瘤（P <.001）和交界性肿瘤（P <.001）更陡。浸润性肿瘤的PCI低于交界性肿瘤（P <.05）和良性肿瘤（P <.05）。与良性或交界性肿瘤相比，浸润性肿瘤中的微血管显示出更强的免疫组织化学VEGFR-2表达（P <.05）。MS与较低的PCI相关（r = -0.34，P =.04），并且在使用上皮细胞（r = 0.41，P <.01）和内皮细胞（r = 0.66，P <.001）时与更强的VEGFR-2表达相关。
动态对比增强MR图像上卵巢上皮性肿瘤的早期强化模式有助于区分良性、交界性和浸润性肿瘤，并且发现与肿瘤血管生成状态相关。
