■使用成像方法无创评估子宫内膜癌(EC)的增殖非常重要。这项前瞻性诊断研究了体素内不相干运动(IVIM)和动态对比增强磁共振成像(DCE-MRI)的双指数和拉伸指数模型在预测EC的Ki-67状态中的价值。
■总之,70例EC患者行盆腔MRI检查。扩散系数(D),伪扩散系数(D*),灌注分数(f),分布扩散系数(DDC),水分子扩散非均质性指数(α),体积转移常数(Ktrans),速率传递常数(Kep),比较了单位体积组织(Ve)的血管外细胞外间隙的体积。受试者工作特征(ROC)曲线下面积(AUC)用于量化诊断效能。多变量逻辑回归和bootstrap(1,000个样本)分析用于建立和评估,分别,预测Ki-67状态的最优模型。
■D,Ktrans,与低增殖组相比,高增殖组的Kep降低,而α升高(所有P值均<0.05)。D和Kep是EC中Ki-67状态的独立预测因子,这些参数的组合具有最佳的诊断功效(AUC=0.920;灵敏度85.71%;特异性89.29%),显著优于D组(AUC=0.753;Z=2.874;P=0.004),α(AUC=0.715;Z=3.505;P=0.001),Ktrans(AUC=0.808;Z=2.741;P=0.006),和Kep(AUC=0.832;Z=2.147;P=0.032)。验证模型显示出良好的准确性(AUC=0.882;95%置信区间0.861-0.897)和一致性(C统计量=0.902)。D,Kep,Ktrans,α显示为轻微负(r=-0.271),中等负值(r=-0.534),略负(r=-0.409),与Ki-67指数呈正相关(r=0.488),分别(所有P值<0.05)。
■IVIM-和DCE-MRI衍生参数,包括D,α,Ktrans,和Kep,与EC中的Ki-67状态相关,D和Kep的组合可以作为鉴定低和高增殖EC的优良成像标记。
UNASSIGNED: It is important to assess the proliferation of endometrial carcinoma (EC) noninvasively using imaging methods. This prospective diagnostic study investigated the value of biexponential and stretched exponential models of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the Ki-67 status of EC.
UNASSIGNED: In all, 70 patients with EC underwent pelvic MRI. The diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), distributed diffusion coefficient (DDC), water molecular diffusion heterogeneity index (α), volume transfer constant (Ktrans), rate transfer constant (Kep), and volume of extravascular extracellular space per unit volume of tissue (Ve) were compared. The area under the receiver operating characteristic (ROC) curve (AUC) was used to quantify diagnostic efficacy. Multivariate logistic regression and bootstrap (1,000 samples) analyses were used to establish and evaluate, respectively, the optimal model to predict Ki-67 status.
UNASSIGNED: D, Ktrans, and Kep were lower while α was higher in the high-proliferation group as compared with low-proliferation group (all P values<0.05). D and Kep were independent predictors of Ki-67 status in EC, and the combination of these parameters had optimal diagnostic efficacy (AUC =0.920; sensitivity 85.71%; specificity 89.29%), which was significantly better than that of D (AUC =0.753; Z=2.874; P=0.004), α (AUC =0.715; Z=3.505; P=0.001), Ktrans (AUC =0.808; Z=2.741; P=0.006), and Kep (AUC =0.832; Z=2.147; P=0.032) alone. The validation model showed good accuracy (AUC =0.882; 95% confidence interval 0.861-0.897) and consistency (C-statistic =0.902). D, Kep, Ktrans, and α showed a slightly negative (r=-0.271), moderately negative (r=-0.534), slightly negative (r=-0.409), and slightly positive (r=0.488) correlation with the Ki-67 index, respectively (all P values <0.05).
UNASSIGNED: IVIM- and DCE-MRI-derived parameters, including D, α, Ktrans, and Kep, were associated with Ki-67 status in EC, and the combination of D and Kep may serve as a superior imaging marker for the identification of low- and high-proliferation EC.