酰胺质子转移成像与动态对比增强MRI评估宫颈癌神经侵犯的价值OA北大核心CSTPCD

Objective:To explore the value of amide proton transfer weighted (APTw) combined with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) sequence in evaluating perineural invasion (PNI) of cervical cancer. Materials and Methods:A retrospective analysis was conducted on 36 patients who underwent pelvic 3.0 T MRI examination (including APTw and DCE-MRI sequences) and were confirmed to have cervical cancer by surgical pathology. Among them,there were 12 cases in the PNI group and 24 cases in the non-PNI (NPNI) group. Two observers measured the APT value and DCE-MRI quantitative parameter values of the lesion,including volume transfer constant (Ktrans),exchange rate between EES and blood plasma (Kep),extravascular volume fraction (Ve),and capillary plasma volume (Vp). The mean of the measurements was then taken for statistical analysis. Using intra-class correlation coefficient (ICC) to test the consistency of the measurement results of two observers for each parameter value;Kolmogorov-Smirov test was used to determine whether the data conforms to a normal distribution. Two independent sample t-tests or Mann-Whitney U-tests were used to compare the differences in parameter values between the two groups. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the parameters with differences,and the corresponding area under the curve (AUC),threshold,sensitivity,and specificity were obtained. Calculate the joint diagnostic efficacy of differential parameters using binary logistic regression,and compare the AUC of each parameter and the joint parameter using DeLong test. Use Spearman correlation to detect the correlation between APT values and differential DCE-MRI parameters. Results:The APT values,Ktrans values,Kep values,Ve values,and Vp values measured by the two observers showed good consistency,with ICC values greater than 0.75. The difference in APT and Vp values between the two groups was statistically significant (P<0.05),while the difference in Ktrans,Kep,and Ve was not statistically significant (P>0.05). The APT value (2.89％±0.72％) and Vp value[7.80×10-3 (6.80×10-3,1.14×10-2)]of the PNI group were both higher than those of the NPNI group[APT value 2.31％±0.71％;Vp value 4.19×10-3 (2.04×10-3,7.35×10-3)]. The AUC for evaluating the APT value and Vp value of cervical cancer PNI were 0.717 and 0.785,respectively;the thresholds are 2.7％ and 6.46×10-3,respectively,and the sensitivity and specificity are 66.7％ and 75.0％,83.3％ and 75.0％,respectively. The AUC of APT value combined with Vp value is 0.792;there was no statistically significant difference (P>0.05) between the APT value,Vp value,and the AUC of the combined evaluation of PNI. There is no correlation between APT value and Vp value (r=0.219,P=0.198). Conclusions:The quantitative parameters of APTw sequence and DCE-MRI can effectively predict cervical cancer PNI,which has certain clinical application value.