Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, No.20, Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China.
Department of Oncologic Imaging, National Cancer Center, Singapore, 169610, Singapore.
Cancer Imaging. 2022 Mar 9;22(1):14. doi: 10.1186/s40644-022-00452-8.
To compare two tracer kinetic models in predicting of preoperative risk types in endometrial carcinoma (EC) using DCE-MRI.
A prospective study of patients with EC was conducted with institutional ethics approval and written informed consent. DCE-MRI data was analyzed using the extended Tofts (ET) and the distributed parameter (DP) models. DCE parameters blood flow (F), mean transit time, blood volume (Vp), extravascular extracellular volume (Ve), permeability surface area product (PS), extraction fraction, transfer constant (Ktrans), and efflux rate (Kep) between high- and low-risk EC were compared using the Mann-Whitney test. Bland-Altman analysis was utilized to compare parameter consistency and Spearman test to assess parameter correlation. Diagnostic performance of DCE parameters was analyzed by receiver-operating characteristic curve and compared with traditional MRI assessment.
Fifty-one patients comprised the study group. Patients with high-risk EC exhibited significantly lower Ktrans, Kep, F, Vp and PS (P < 0.001). ET-derived Ktrans and DP-derived F attained AUC of 0.92 and 0.91, respectively. Bland-Altman analysis showed that the consistency of Ve or Vp between the two models was low (P < 0.001) while Spearman test showed a strong correlation (r = 0.719, 0.871). Both Ktrans and F showed higher accuracy in predicting EC risk types than traditional MRI assessment.
Kinetic parameters derived from DCE-MRI revealed a more hypovascular microenvironment for high risk EC than to low- risk ones, providing potential imaging biomarkers in preoperative risk assessment that might improve individualized surgical planning and management of EC.
比较两种示踪剂动力学模型在使用 DCE-MRI 预测子宫内膜癌（EC）术前风险类型中的应用。
本研究经机构伦理审查委员会批准，并获得患者书面知情同意，前瞻性纳入 EC 患者。采用扩展 Tofts（ET）和分布参数（DP）模型分析 DCE-MRI 数据。使用 Mann-Whitney 检验比较高、低危 EC 之间的 DCE 参数（F、平均通过时间、血容量（Vp）、血管外细胞外容积（Ve）、渗透率表面积乘积（PS）、提取分数、转移常数（Ktrans）和流出率（Kep）。Bland-Altman 分析用于比较参数一致性，Spearman 检验用于评估参数相关性。通过接收者操作特征曲线分析 DCE 参数的诊断性能，并与传统 MRI 评估进行比较。
本研究共纳入 51 例患者。高危 EC 患者的 Ktrans、Kep、F、Vp 和 PS 明显降低（P<0.001）。ET 衍生的 Ktrans 和 DP 衍生的 F 的 AUC 分别为 0.92 和 0.91。Bland-Altman 分析表明两种模型之间 Ve 或 Vp 的一致性较差（P<0.001），Spearman 检验表明相关性较强（r=0.719，0.871）。与传统 MRI 评估相比，Ktrans 和 F 对预测 EC 风险类型的准确性更高。
DCE-MRI 衍生的动力学参数显示高危 EC 具有更低的血管生成微环境，为术前风险评估提供了潜在的影像学生物标志物，可能改善 EC 的个体化手术规划和管理。
