Correlations Between Quantitative Parameters Of Dynamic Contrast Enhanced Magnetic Resonance Imaging And Apparent Diffusion Coefficient In Cervical Carcinoma

Part1 The normal anatomic structure of uterine in high resolution magnetic resonance imaging and diffusion weighted imagingObjective :1. High resolution magnetic resonance imaging and diffusion weighted imaging were performed to observe the uterine anatomy and apparent diffusion coefficient in myometrium, to provide the magnetic resonance annatomy basis for uterine malignant lesions.2. Investigating the thickness, signal intensity and apparent diffusion coefficient of the normal myometrium in different phases of the menstrual cycle among healthy female, in order to select the correct time to test in different types of uterine lesions.Materials and methods:1. Objects36 healthy young women volunteers, age from 24 to 42 years old, the average age was 28.28 + 4.66 years. Inclusion criteria were: regular menstrual cycles, pregnancy, lactation, contraceptives and hormone therapy, no uterine leiomyoma, adenomyosis and other neoplastic diseases. Thirty six healthy women were underwent magnetic resonance imaging(MRI) test in the mid-proliferative( the tenth day in menstrual cycle), the late-secretory(the twenty-fifth day in menstrual cycle), and menses(the second day in menstrual cycle).2. Methods3.0T superconducting Siemens Trio Tim magnetic resonance scanner and body phased coil were applied to examine. Volunteers were supine position, pelvis was placed in the center of body phased coil and laser positioning line was arranged above5cm on the pubic. Subjects breathe freely. First, fix a position for pelvic median transverse on localization phase, and then locate sagittal by the line paralleled to the long axis of the uterine body. Magnetic resonance scanning sequences included fast spin echo TSE sequence: transverse T2 WI fat suppression, sagittal T2 WI high resolution, diffusion weighted imaging(DWI). In order to ensure consistency of image position with the sagittal T2 WI, positioning parameters are directly copied parameter sagittal T2 WI.3. Data measurement and analysis3.1 Select the measure sliceSelecting the largest anteroposterior diameter level in sagittal position to measure the thickness and selecting the junction zone and myometrium most clear level to measure the signal intensity on T2 WI and apparent diffusion coefficient.3.2 Measurement of thicknessTake the largest anteroposterior diameter level, drawing a straight line perpendicular to the long axis of the uterus body. On the basis of this line, measuring the sickness of the anterior and posterior myometrium wall and junction zone. Taking the average values of three measurements. The same method of measuring cervical stroma.3.3 Measurement of signal intensityThe same method for measuring thickness, drawing a line perpendicular to the long axis of the uterine body, drawing four circular ROI on this line, every circle not less than 20 pixels. Simultaneously measuring the junction zone and myometrium signal intensity in the anterior and posterior wall of uterine body, taking the average of three measurements as the final result. Drawing a straight line perpendicular to the long axis of the cervix, and then drawing four circular ROI on this line. Simultaneously measuring the junction zone and myometrium signal intensity in the anterior and posterior wall of cervix, taking the average of three measurements as the final result. The signal intensity on T2 WI was automatically generated by the Siemens Syngosoftware.3.4 Measurment of apparent diffusion coefficientAvoid deformation zone and artifact interference region to measure apparent diffusion coefficient. Drawing a straight line perpendicular to the long axis of the uterine body and cervix, and then drawing circular ROI on these line, every circle not less than 9 pixels. ADC values were automatically generated by the Siemens Syngo software.3.5 Data analysisThe data were analyzed by SPSS 18.0 statistical software, P<0.05 considered statistically significant. All the data were represented by mean ± standard deviationation, myometrium thickness, the signal intensity and ADC between different menstrual cycle were used independent samples t test to value.Results:1. The thickness of myometrium of uterine body and junction zone and cervical stroma in different phases of the menstrual cycleThe thickness of myometrium of uterus body were1.09±0.25 cm and 1.20±0.31 cm and 0.84±0.26 cm corresponding to proliferative phase and secretory phase and menstrual phase.The thickness of myometrium of uterus body in proliferative phase was significantly different with menstrual period(p=0.013). The thickness of myometrium of uterus body in secretory phase was significantly different with menstrual period(p=0.001). No statistical difference was observed in thickness of myometrium of uterus body between proliferative and secretory phase. The thickness of junction zone of uterus body were 0.52±0.21 cm and 0.46±0.18 cm and 0.83±0.34 cm corresponding to proliferative phase and secretory phase and menstrual period. The thickness of junction zone of uterus body in proliferative phase was significantly different with menstrual period(p=0.008). The thickness of junction zone of uterus body in secretory phase was significantly different with menstrual period(p=0.001). No statistical difference was observed in thickness of junction zone of uterus body between proliferative and secretory phase. The thickness of cervical stroma were 0.33±0.12 cm and 0.38±0.19 cm and 0.33±0.09 cm corresponding to proliferative phase and secretory phase and menstrual period. No statistical difference was observed in different menstrual cycle.2. The signal intensity of myometrium and junction zone in uterus body and cervixThe signal intensity of myometrium of uterus body were 332.38±84.66 and 394.97±94.33 and 275.82±69.45 corresponding to proliferative phase and secretory phase and menstrual phase. The signal intensity of myometrium of uterus body in secretory phase was significantly different with menstrual period(p=0.047). No statistical difference was observed in signal intensity of myometrium of uterus body between proliferative and secretory phase. No statistical difference was observed in signal intensity of myometrium of uterus body between proliferative and menstrual phase. The signal intensity of junction zone of uterus body were 180.53±57.28 and 217.94±64.21 and 147.23±36.97 corresponding to proliferative phase and secretory phase and menstrual phase. The signal intensity of junction zone of uterus body in secretory phase was significantly different with menstrual period(p=0.003). No statistical difference was observed in signal intensity of junction zone of uterus body between proliferative and secretory phase. No statistical difference was observed in signal intensity of junction zone of uterus body between proliferative and menstrual phase. The signal intensity of cervical stroma were 130.43±37.09 and 98.05±51.60 and 103.99 ± 32.72 corresponding to proliferative phase and secretory phase and menstrual phase. The signal intensity of cervical stroma in proliferative phase was significantly different with menstrual period(p=0.048). No statistical difference was observed in signal intensity of cervical stroma between proliferative and secretory phase. No statistical difference was observed in signal intensity of cervical stroma between secretory phase and menstrual period. The signal intensity of myometrium of cevix were 234.25±59.21 and 179.53±68.62 and 235.38±47.53 corresponding to proliferative phase and secretory phase and menstrual phase. The signal intensity of myometrium of cervix in proliferative phase was significantly different with secretoryphase(p=0.034). The signal intensity of myometrium of cervix in secretory phase was significantly different with menstrual period(p=0.011).3. The ADC values of myometrium and junction zone in uterus body and cervixThe ADC values of myometrium of uterus body were 1.42±0.22mm2/s and 1.54±0.17mm2/s and 0.81±0.12mm2/s corresponding to proliferative phase and secretory phase and menstrual phase. No statistical difference was observed in different menstrual cycle. The ADC values of juction zone of uterus body were 0.97±0.10mm2/s 、1.04±0.12mm2/s 及 0.82±0.11mm2/s corresponding to proliferative phase and secretory phase and menstrual phase. The ADC values of junction zone of uterus body in proliferative phase was significantly different with menstrual phase(p=0.000). The ADC values of junction zone of uterus body in secretory phase was significantly different with menstrual phase(p=0.000). No statistical difference was observed in ADC values of junction zone of uterus body between proliferative phase and secretory phase. The ADC values of cervical stroma were 0.13±0.19mm2/s and 0.10±0.03mm2/s and 0.12±0.21mm2/s corresponding to proliferative phase and secretory phase and menstrual phase. The ADC values of cervical stroma in proliferative phase was significantly different with sectory phase(p=0.011). No statistical difference was observed in ADC values of cervical stroma between proliferative phase and menstrual phase. No statistical difference was observed in ADC values of cervical stroma between secretory phase and menstrual phase. The ADC values of cervical myometrium were 1.88±0.10mm2/s and 1.86±0.09mm2/s and 1.25±0.72mm2/s corresponding to proliferative phase and secretory phase and menstrual phase. No statistical difference was observed in different menstrual cycle.Conclusion:1. High resolution MRI can clearly display the anatomic structure of uterine body and cervix, can provide theoretical basis for MRI staging in endometrial carcinoma and cervical carcinoma.2. In different menstrual cycle, there are different degrees of difference ofmyometrium thickness, signal intensity and ADC values. In diagnosis of the different types of uterine diseases should fully consider these factors, in order to select the correct time to test.Part2 Correlations between quantitative parameters of dynamic contrast enhanced magnetic resonance imaging and apparent diffusion coefficient in cervical carcinomaObjective :To summary the relationship between DCE-MRI quantitative parameters: Ktrans、Kep and Vp with ADC values in cervical carcinoma.Materials and methods:1. ObjectsCollected twenty three patients with cervical carcinoma and all patients were taken DCE-MRI and DWI examination, and all cases were confirmed by pathology as cervical squamous cell carcinoma. Ages from 41 to 63 years old, mean age was 53.1 ± 7.0 years old. Before MR examination all patients had biopsy pathology, not received chemotherapy, no MR contraindication. DCE-MRI and DWI examinations were taken on the premise of informed consent.2. Methods3.0T superconducting Siemens Trio Tim magnetic resonance scanner was applied to examine. When scanning, bladder filling partly. All patients were taken routine MRIand DWI and DCE-MRI examination. Field of vision ranges from the iliac bone margin to the lower edge of pubic symphysis. Signal acquisition using a 32 channel body phased array coil, without respiratory gating, ask the patient to breathe freely, reduce abdominal breathing. Magnetic resonance scanning sequences included fast spin echo TSE sequence: transverse T2 WI fat suppression, sagittal T2 WI, sagittal T1 WI, DWI and three times T1 WI vibe fat suppression(flip: 5°,10°,15°) sequence examinations. In order to ensure consistency of image position with the sagittal T2 WI, positioning parameters are directly copied parameter sagittal T2 WI. Multiphase dynamic enhanced scanning was used flip 12°. In order to ensure consistency of image position with the sagittal T2 WI, positioning parameters are directly copied parameter sagittal T2 WI.3. Data measurement and analysis3.1 Data measurementDynamic contrast-enhanced imaging data was analyzed in the GE Omni Kinetics software and Reference Region Model was used to analyze. Region of interest(ROI) was selected the fifth period as a reference which shows abdominal muscle clearly. The ROI position in different patients should be as possible as consistent. Using polygonal as big as possible include the lesions, avoid the necrosis and cystic degeneration and hemorrhage, simultaneously calculate five slices. Because the typesetting and the model software selection, the three quantitative parameters were obtained: RRKtrans and Vp(leision Kep)and Kep(leison Ktrans/RRVep).ADC values were automatically generated by the Siemens Syngo software. The position and size of ROI was consistent with the dynamic image.3.2 Data analysisThe data were analyzed by SPSS 18.0 statistical software, P<0.05 considered statistically significant. All the data were represented by mean ± standard deviationation. The relationship between Ktrans, Kep, Vp and ADC values by using Pearson analysis and linear correlation analysis, regression analysis between eachvariable quantity using simple linear regression analysis. The ADC value, Ktrans, Kep and Vp between different period of cervical carcinoma using Spearson rank correlation analysis.Result1. All 23 cases were cervical squamous cell carcinoma. According to FIGO staging criteria, including 1 case of stage I B1, 2 cases of stage I B2, 2 cases of stage II A1, 3 cases of stage II A2, 13 cases of stage II B, 2 cases of stage IVA combined HR-MRI with DCE-MRI.2. Squamous carcinoma of the cervix into the group of 23 cases, the Ktrans was 4.15±2.79min-1, Vp was 0.59±0.82, Kepwas 0.89±0.90min-1, ADC value was 0.83±0.07mm2/s.3. ADC values as independent variables, the Kep values as the dependent variables to do linear regression analysis showed that the model correlation coefficient R=0.921, adjusted R2=0.840, F statistic value was 116.56, P=0.000, model equation was Y=0.076X+0.763.4. ADC values as independent variables, the Ktrans and Vp values as the dependent variables to do linear regression analysis did not conform to the linear distribution, so there is no linear relationship between Ktrans, Vp value and ADC value.5. In this group of cases, cervical carcinoma in different stage of ADC values of rank correlation coefficient rs=0.01, less than rs(0.05, 23), p>0.05, showed no significant difference in different stages cervical carcinoma.6. In this group of cases, cervical carcinoma in different stage of Ktrans values of rank correlation coefficient rs=0.63, more than rs(0.05, 23), p>0.05, showed significant difference in different stages cervical carcinoma.7. In this group of cases, cervical carcinoma in different stage of Kep values of rank correlation coefficient rs=0.49 more than rs(0.05, 23), p<0.05, showed significant difference in different stages cervical carcinoma.8. In this group of cases, cervical carcinoma in different stage of Vp values of rankcorrelation coefficient rs=0.26, less than rs(0.05, 23), p>0.05, showed no significant difference in different stages cervical carcinoma.Conclusion:1. With the increasing of ADC value, the value of Kep increased in cervical squamous cell carcinoma.2. There is no correlation between ADC value and Ktrans value in cervical squamous cell carcinoma.3. There is no correlation between ADC value and Vp value in cervical squamous cell carcinoma.4. In this group of cases, there is no obvious correlation between ADC value withcervical squamous cell carcinoma stages.5. The Ktrans in different stages of cervical carcinoma had significant differences, but the two did not exist a positive or a negative correlation. The Kep and Vp in different stages of cervical carcinoma had no significant differences.