酰胺质子转移加权成像和多种模型弥散加权成像有助于术前对早期子宫内膜癌进行风险分层。
Amide Proton Transfer-Weighted Imaging and Multiple Models Diffusion-Weighted Imaging Facilitates Preoperative Risk Stratification of Early-Stage Endometrial Carcinoma.
机构信息
Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China.
Academy of Medical Sciences, Zhengzhou University, Zhengzhou, China.
出版信息
J Magn Reson Imaging. 2021 Oct;54(4):1200-1211. doi: 10.1002/jmri.27684. Epub 2021 May 15.
BACKGROUND
Endometrial carcinoma (EC) risk stratification is generally based on histological assessment. It would be beneficial to perform risk stratification noninvasively by MRI.
PURPOSE
To investigate the application of amide proton transfer-weighted imaging (APTWI), monoexponential, biexponential, and stretched exponential intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for the evaluation of risk stratification in early-stage EC.
STUDY TYPE
Prospective.
POPULATION
Eighty patients with early-stage EC (47 classified as low risk, 20 as medium risk, and 13 as high risk by histological grade and International Federation of Gynecology and Obstetrics stage).
FIELD STRENGTH/SEQUENCE: T1-weighted imaging, T2-weighted imaging, IVIM, APTWI, and DKI MRI at 3 T.
ASSESSMENT
The magnetization transfer ratio asymmetry (MTRasym [3.5 ppm]), apparent diffusion coefficient (ADC), diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), mean kurtosis (MK), and mean diffusivity (MD) were calculated and compared between low-risk and non-low-risk groups.
STATISTICAL TESTS
Individual sample t test, analysis of variance, and logistic regression. A P-value <0.05 was considered statistically significant.
RESULTS
The α, ADC, D, DDC, and MD were significantly higher and the f, MK, and MTRasym (3.5 ppm) were significantly lower in the low-risk group than in the non-low-risk group. The difference in D* between the two groups was not significant (P = 0.289). MTRasym (3.5 ppm), D, and MK were independent predictors of risk stratification. The combination of these three parameters was better able to identify low- and non-low-risk groups than each individual parameter.
DATA CONCLUSION
The IVIM, DKI, and APTWI parameters have potential as imaging markers for risk stratification in early-stage EC.
LEVEL OF EVIDENCE
2 TECHNICAL EFFICACY: Stage 3.
背景
子宫内膜癌（EC）的风险分层通常基于组织学评估。通过 MRI 进行非侵入性风险分层将是有益的。
目的
探讨酰胺质子转移加权成像（APTWI）、单指数、双指数和拉伸指数体素内不相干运动（IVIM）和扩散峰度成像（DKI）在评估早期 EC 风险分层中的应用。
研究类型
前瞻性。
人群
80 例早期 EC 患者（47 例组织学分级和国际妇产科联合会分期为低危，20 例中危，13 例高危）。
磁场强度/序列：3T 下的 T1 加权成像、T2 加权成像、IVIM、APTWI 和 DKI MRI。
评估
计算并比较低危组和非低危组之间的磁化转移率不对称性（MTRasym [3.5ppm]）、表观扩散系数（ADC）、扩散系数（D）、假性扩散系数（D*）、灌注分数（f）、分布扩散系数（DDC）、水分子扩散异质性指数（α）、平均峰度（MK）和平均扩散系数（MD）。
统计检验
个体样本 t 检验、方差分析和逻辑回归。P 值<0.05 被认为具有统计学意义。
结果
低危组的α、ADC、D、DDC 和 MD 显著升高，而 f、MK 和 MTRasym（3.5ppm）显著降低。两组间 D*差异无统计学意义（P=0.289）。MTRasym（3.5ppm）、D 和 MK 是风险分层的独立预测因子。这三个参数的组合比每个单独的参数更能识别低危和非低危组。
数据结论
IVIM、DKI 和 APTWI 参数有可能成为早期 EC 风险分层的影像学标志物。
证据水平
2 技术功效：3 级。
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