评价正电子发射断层显像(PET)-体素内不相干运动(IVIM)磁共振成像(MRI)对无淋巴结转移的宫颈癌患者淋巴血管间隙侵犯(LVSI)的预测价值。
本研究共纳入90例PET/MRI无淋巴结转移征象的宫颈癌患者。根据术后病理将肿瘤分为LVSI阳性(n=25)和LVSI阴性(n=65)组。PET衍生参数(SUVmax,Suvmean,代谢性肿瘤体积(MTV)和总病变糖酵解(TLG))和IVIM衍生参数(ADCmean,ADCmin,Dmean,Dmin,f,使用Studentt检验(非正态分布变量的Mann-WhitneyU检验)和受试者工作特征(ROC)曲线评估两组之间的D*和总肿瘤体积(GTV))。使用单变量和多变量逻辑回归模型研究预测LVSI的PET/MR参数的最佳组合,并通过ROC曲线进行评估。最佳截止阈值对应于Youden指数的最大值。使用1000个自举样本建立了控制模型,使用校准曲线和ROC曲线验证了性能。
PET衍生参数(SUVmax,Suvmean,MTV,TLG)和IVIMMRI衍生参数(Dmin,ADCmin,GTV)在有和没有LVSI的患者之间存在显着差异(P<0.05)。Logistic分析表明,TLG和Dmin的组合对LVSI诊断具有最强的预测价值(曲线下面积(AUC),0.861;灵敏度,80.00;特异性,86.15;P<0.001)。Dmin和TLG的最佳截止阈值分别为0.58×10-3mm2/s和66.68g/cm3。验证模型显示TLG和Dmin的组合具有最强的预测价值,其ROC曲线和校准曲线显示出良好的准确性(AUC,0.878)和一致性。
TLG和Dmin联合可能是预测无淋巴结转移的宫颈癌LVSI的最佳指标。
To evaluate the contributory value of positron emission tomography (PET)-intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the prediction of lymphovascular space invasion (LVSI) in patients with cervical cancer without lymphatic metastasis.
A total of 90 patients with cervical cancer without signs of lymph node metastasis on PET/MRI were enrolled in this study. The tumours were classified into LVSI-positive (n = 25) and LVSI-negative (n = 65) groups according to postoperative pathology. The PET-derived parameters (SUVmax, SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG)) and IVIM-derived parameters (ADCmean, ADCmin, Dmean, Dmin, f, D* and gross tumour volume (GTV)) between the two groups were evaluated using a Student\'s t test (Mann-Whitney U test for variables with a nonnormal distribution) and receiver operating characteristic (ROC) curves. The optimal combination of PET/MR parameters for predicting LVSI was investigated using univariate and multivariate logistic regression models and evaluated by ROC curves. The optimal cutoff threshold values corresponded to the maximal values of the Youden index. A control model was established using 1000 bootstrapped samples, for which the performance was validated using calibration curves and ROC curves.
PET-derived parameters (SUVmax, SUVmean, MTV, TLG) and IVIM MRI-derived parameters (Dmin, ADCmin, GTV) were significantly different between patients with and without LVSI (P < 0.05). Logistic analyses showed that a combination of TLG and Dmin had the strongest predictive value for LVSI diagnosis (area under the curve (AUC), 0.861; sensitivity, 80.00; specificity, 86.15; P < 0.001). The optimal cutoff threshold values for Dmin and TLG were 0.58 × 10-3 mm2/s and 66.68 g/cm3, respectively. The verification model showed the combination of TLG and Dmin had the strongest predictive value, and its ROC curve and calibration curve showed good accuracy (AUC, 0.878) and consistency.
The combination of TLG and Dmin may be the best indicator for predicting LVSI in cervical cancer without lymphatic metastasis.