MRI 和弥散加权成像在诊断宫颈癌患者正常大小盆腔淋巴结转移中的价值。
Value of MRI and diffusion-weighted imaging in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer.
机构信息
Graduate School, Dalian Medical University, Dalian, China.
Department of Radiology, Cancer Hospital of China Medical University, Liaoning cancer hospital & institute Shenyang, Liaoning, China.
出版信息
Br J Radiol. 2022 Sep 1;95(1138):20200203. doi: 10.1259/bjr.20200203. Epub 2022 Aug 4.
OBJECTIVES
To investigate the value of conventional MRI and diffusion-weighted imaging (DWI) in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer.
METHODS
102 patients with cervical cancer who underwent MRI and DWI scan were included. 137 lymph nodes were analyzed, including 44 metastatic lymph nodes (MLNs) and 93 non-metastatic lymph nodes (non-MLNs). The morphology and apparent diffusion coefficient (ADC) value of lymph nodes were measured including short-axis diameter (D), long-axis diameter (D), ratio of short-to-long-axis diameter (D), fatty hilum, asymmetry, ADC, ADC and ADC. The Mann-Whitney U-test, independent sample t-test and Chi-square test were employed to compare the differences of all criteria between MLNs and non-MLNs. Logistic regression and decision tree were used to develop the combined diagnostic model. ROC analyses were used to evaluate the diagnostic performance.
RESULTS
The D and D of MLNs were significantly higher than those of non-MLNs ( < 0.05), the ADC, ADC and ADC of MLNs were significantly lower than those of non-MLNs ( < 0.05). Presence of fatty hilum and asymmetric lymph nodes between MLNs and non-MLNs were significantly different (＜0.05). Combined measurement of ADC, D and D had the highest AUC 0.937 with 90.9% sensitivity and 87.1% specificity. The accuracy of decision tree was 88.3%.
CONCLUSION
MRI with DWI had potential in diagnosing normal-sized pelvic lymph nodes metastases in patients with cervical cancer. The combined evaluation of D, D and ADC of lymph nodes and decision tree of the combined measure showed better diagnostic performances than sole criteria.
ADVANCES IN KNOWLEDGE
The short-axis diameter, ratio of short-to-long-axis diameter and ADC of lymph nodes have moderate value in the diagnosis of the metastases of the normal-sized lymph nodes for the patient with cervical cancer as the sole indices. The combined evaluation of D, D and ADC is much more valuable in the detection of metastatic lymph nodes.
目的
探讨常规 MRI 和弥散加权成像（DWI）在诊断宫颈癌患者正常大小盆腔淋巴结转移中的价值。
方法
纳入 102 例行 MRI 和 DWI 扫描的宫颈癌患者，共分析 137 枚淋巴结，包括 44 枚转移性淋巴结（MLNs）和 93 枚非转移性淋巴结（non-MLNs）。测量淋巴结的形态和表观弥散系数（ADC）值，包括短轴直径（D）、长轴直径（D）、短轴与长轴直径比（D）、脂肪门、不对称、ADC、ADC 和 ADC。采用 Mann-Whitney U 检验、独立样本 t 检验和卡方检验比较 MLNs 和 non-MLNs 之间各指标的差异。采用 Logistic 回归和决策树建立联合诊断模型。ROC 分析评估诊断效能。
结果
MLNs 的 D 和 D 明显大于 non-MLNs（<0.05），MLNs 的 ADC、ADC 和 ADC 明显小于 non-MLNs（<0.05）。MLNs 和 non-MLNs 之间脂肪门和淋巴结不对称的存在有显著差异（<0.05）。ADC、D 和 D 的联合测量具有最高的 AUC 0.937，灵敏度为 90.9%，特异性为 87.1%。决策树的准确率为 88.3%。
结论
MRI 联合 DWI 对宫颈癌患者正常大小盆腔淋巴结转移具有一定的诊断价值。淋巴结 D、D 和 ADC 的联合评估及联合测量的决策树比单一指标具有更好的诊断性能。
知识进展
作为单一指标，淋巴结的短轴直径、短轴与长轴直径比和 ADC 对诊断宫颈癌患者正常大小淋巴结转移具有中等价值。D、D 和 ADC 的联合评估对检测转移性淋巴结更有价值。
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