CAJ | 학술논문

目的探讨MR DWI ADC值直方图诊断ⅠB期宫颈癌的价值。方法前瞻性收集经宫颈涂片组织检查诊断为宫颈癌，且未接受过治疗的73例患者作为宫颈癌组，依照国际妇产科联盟（FIGO）分期系统进行分期；收集经妇科体检、超声或CT检查临床诊断为子宫肌瘤拟行子宫切除术，且宫颈涂片组织病理检查结果为良性的43例患者作为对照组。2组患者术前均行常规盆腔MRI平扫、DWI及动态增强扫描，采用后处理软件生成ADC值直方图。观察2组患者的直方图特征，记录直方图参数，包括ADC平均值（ADCmean）、ADC中位数（ADCmedian）、ADC第25百分位数（ADC_25th）、ADC第75百分位数（ADC_75th）、偏度值及峰度值。采用两样本t检验（方差齐）和Mann-Whitney检验（方差不齐）比较两组患者的直方图参数值，并采用ROC分析直方图各ADC值鉴别宫颈癌组和对照组的诊断效能。结果宫颈癌组中35例为FIGOⅠB期；对照组中5例手术病理结果为子宫颈上皮内瘤变3级被剔除，共38例纳入研究。宫颈癌组的ADC值直方图以正偏度分布为主，对照组的ADC值直方图以负偏度分布为主。ⅠB期宫颈癌组ADCmean、ADCmedian、ADC_25th、ADC_75th、偏度值和峰度值分别为（1.10±0.21）×10-3mm2/s、（1.05±0.21）×10-3mm2/s、（0.90±0.19）×10-3mm2/s、（1.26±0.23）×10-3mm2/s、0.83（中位数）和1.25（中位数），对照组上述参数为（1.62±0.25）×10-3mm2/s、（1.64±0.24）×10-3mm2/s、（1.42±0.24）×10-3 mm2/s、（1.84±0.27）×10-3 mm2/s、－0.11（中位数）和0.29（中位数），差异均有统计学意义（t值分别为－9.693、－11.117、－10.255、－9.988，Z值分别为－6.360、－4.445，P均<0.01）。ADCmedian诊断ⅠB期宫颈癌的准确性最高，ROC下面积为0.97，最佳截断点值为1.21×10-3mm2/s，诊断的敏感度和特异度分别为95.6%和89.3%。结论 MR DWI ADC值直方图诊断ⅠB期宫颈癌具有较大价值，可以准确区分ⅠB期宫颈癌和正常宫颈或宫颈良性病变。目的探討MR DWI ADC值直方圖診斷ⅠB期宮頸癌的價值。方法前瞻性收集經宮頸塗片組織檢查診斷為宮頸癌，且未接受過治療的73例患者作為宮頸癌組，依照國際婦產科聯盟（FIGO）分期繫統進行分期；收集經婦科體檢、超聲或CT檢查臨床診斷為子宮肌瘤擬行子宮切除術，且宮頸塗片組織病理檢查結果為良性的43例患者作為對照組。2組患者術前均行常規盆腔MRI平掃、DWI及動態增彊掃描，採用後處理軟件生成ADC值直方圖。觀察2組患者的直方圖特徵，記錄直方圖參數，包括ADC平均值（ADCmean）、ADC中位數（ADCmedian）、ADC第25百分位數（ADC_25th）、ADC第75百分位數（ADC_75th）、偏度值及峰度值。採用兩樣本t檢驗（方差齊）和Mann-Whitney檢驗（方差不齊）比較兩組患者的直方圖參數值，併採用ROC分析直方圖各ADC值鑒彆宮頸癌組和對照組的診斷效能。結果宮頸癌組中35例為FIGOⅠB期；對照組中5例手術病理結果為子宮頸上皮內瘤變3級被剔除，共38例納入研究。宮頸癌組的ADC值直方圖以正偏度分佈為主，對照組的ADC值直方圖以負偏度分佈為主。ⅠB期宮頸癌組ADCmean、ADCmedian、ADC_25th、ADC_75th、偏度值和峰度值分彆為（1.10±0.21）×10-3mm2/s、（1.05±0.21）×10-3mm2/s、（0.90±0.19）×10-3mm2/s、（1.26±0.23）×10-3mm2/s、0.83（中位數）和1.25（中位數），對照組上述參數為（1.62±0.25）×10-3mm2/s、（1.64±0.24）×10-3mm2/s、（1.42±0.24）×10-3 mm2/s、（1.84±0.27）×10-3 mm2/s、－0.11（中位數）和0.29（中位數），差異均有統計學意義（t值分彆為－9.693、－11.117、－10.255、－9.988，Z值分彆為－6.360、－4.445，P均<0.01）。ADCmedian診斷ⅠB期宮頸癌的準確性最高，ROC下麵積為0.97，最佳截斷點值為1.21×10-3mm2/s，診斷的敏感度和特異度分彆為95.6%和89.3%。結論 MR DWI ADC值直方圖診斷ⅠB期宮頸癌具有較大價值，可以準確區分ⅠB期宮頸癌和正常宮頸或宮頸良性病變。
목적탐토MR DWI ADC치직방도진단ⅠB기궁경암적개치。방법전첨성수집경궁경도편조직검사진단위궁경암，차미접수과치료적73례환자작위궁경암조，의조국제부산과련맹（FIGO）분기계통진행분기；수집경부과체검、초성혹CT검사림상진단위자궁기류의행자궁절제술，차궁경도편조직병리검사결과위량성적43례환자작위대조조。2조환자술전균행상규분강MRI평소、DWI급동태증강소묘，채용후처리연건생성ADC치직방도。관찰2조환자적직방도특정，기록직방도삼수，포괄ADC평균치（ADCmean）、ADC중위수（ADCmedian）、ADC제25백분위수（ADC_25th）、ADC제75백분위수（ADC_75th）、편도치급봉도치。채용량양본t검험（방차제）화Mann-Whitney검험（방차불제）비교량조환자적직방도삼수치，병채용ROC분석직방도각ADC치감별궁경암조화대조조적진단효능。결과궁경암조중35례위FIGOⅠB기；대조조중5례수술병리결과위자궁경상피내류변3급피척제，공38례납입연구。궁경암조적ADC치직방도이정편도분포위주，대조조적ADC치직방도이부편도분포위주。ⅠB기궁경암조ADCmean、ADCmedian、ADC_25th、ADC_75th、편도치화봉도치분별위（1.10±0.21）×10-3mm2/s、（1.05±0.21）×10-3mm2/s、（0.90±0.19）×10-3mm2/s、（1.26±0.23）×10-3mm2/s、0.83（중위수）화1.25（중위수），대조조상술삼수위（1.62±0.25）×10-3mm2/s、（1.64±0.24）×10-3mm2/s、（1.42±0.24）×10-3 mm2/s、（1.84±0.27）×10-3 mm2/s、－0.11（중위수）화0.29（중위수），차이균유통계학의의（t치분별위－9.693、－11.117、－10.255、－9.988，Z치분별위－6.360、－4.445，P균<0.01）。ADCmedian진단ⅠB기궁경암적준학성최고，ROC하면적위0.97，최가절단점치위1.21×10-3mm2/s，진단적민감도화특이도분별위95.6%화89.3%。결론 MR DWI ADC치직방도진단ⅠB기궁경암구유교대개치，가이준학구분ⅠB기궁경암화정상궁경혹궁경량성병변。
Objective To investigate the diagnostic value of ADC histogram obtained from MR DW imaging for stage ⅠB cervical cancer. Methods Seventy three patients diagnosed by cervical smear screening as cervical cancer without priortreatment were included prospectively in the patient group, and staged according to the international federation of gynecology and obstetrics (FIGO) staging system. Forty three patients with uterine leiomyoma detected by gynecologic examination, ultrasonography or CT and with negative result of cervical smear screening who were scheduled for hysterectomy were included prospectively in the control group. The patients of both groups underwent routine pelvic MR sequences, dynamic contrast enhanced imaging and DWI before hysterectomy. ADC histograms of the entire tumor and cervix volume were generated by post-processing software. Features of ADC histogram for the 2 groups were observed. Histogram parameters such as mean ADC (ADCmean), median ADC (ADCmedian), the 25th percentile of ADC (ADC_25th), the 75th percentile of ADC (ADC_75th), skewness and kurtosis were recorded. Student's t test or Mann-Whitney U test depending on homogeneity of variance was employed for the comparison of <br> those parameters. ROC analysis was employed for assessing the diagnostic performance of ADC histogram in distinguishing the 2 groups. Results Thirty five patients in the patient group were staged as FIGO IB. Five patients in the control group ended up with pathologic findings of cervical intraepithelial neoplasia grade 3. Therefore 38 patients in the control group were investigated. ADC histograms of the patient group were mostly skewed positively, while the curves were largely skewed negatively. ADCmean, ADCmedian, ADC_25th, ADC_75th, skewness and kurtosis for the IB stage patient group were (1.10±0.21)×10-3mm2/s, (1.05±0.21)× 10-3 mm2/s, (0.90 ± 0.19) × 10-3mm2/s, (1.26 ± 0.23) × 10-3mm2/s, 0.83 (median) and 1.25 (median) respectively. ADCmean, ADCmedian, ADC_25th, ADC_75th, skewness and kurtosis for the control group were (1.62 ± 0.25)×10-3mm2/s, (1.64±0.24)×10-3mm2/s, (1.42±0.24)×10-3mm2/s, (1.84±0.27)×10-3mm2/s,-0.11(median) and 0.29 (median) respectively. All parameters showed statistically different (t values were -9.693,- 11.117, -10.255, and -9.988 for ADCmean, ADCmedian, ADC_25th and ADC_75th respectively;Z values were -6.360 and -4.445 for skewness and kurtosis respectively; P< 0.01). ROC analysis indicated that ADCmedian had the highest diagnostic accuracy for differentiating the 2 groups, with the area under the curve being 0.97, a cutoff value of 1.21×10-3mm2/s, and a sensitivity of 95.6%and a specificity of 89.3%. Conclusion ADC histogram of DWI may be valuable for diagnosing stage IB cervical cancer by distinguishing stage IB cervical cancer from normal cervix or cervical benign lesions.