Application Of Quantitative Parameters Of DCE-MRI In Evaluating The Depth Of Endometrial Cancer Invasion

Objective:To investigate the correlation between the quantitative parameters Ktrans,Kep,Ve of DCE-MRI and the depth of endometrial cancer invasion on the basis of MRI-pathology comparison.Materials and Methods:1.Patient information Methods from September 2019 to December 2020,37 female patients underwent routine pelvic and uterine MRI scan,enhanced scan and DCE-MRI scan,which were confirmed by surgical biopsy and pathology.Among them,33 patients were endometrial cancer aged from 49 to 69 years old,average age: 58.6 years.2.Techniques of MRI examination(1)MRI equipment and techniques: 33 patients with endometrial cancer underwent conventional and enhanced MRI and DCE-MRI before surgery,using GE Discovery 750 3.0 T superconducting MRI scanner and associated abdominal phased array coil(RF receiving coil).(2)Image post-processing and data acquisition: The original image of DCE-MRI was imported into GE-ADW 4.7 post-processing workstation,and the pseudo-color images of quantitative parameters of Ktrans,Kep,Ve were obtained by Gen IQ software,the region of interest was checked in the optimal region of tumor display and the quantitative parameters were obtained.3.Methods of MRI diagnosis Two doctors with more than 10 years of medical imaging and diagnostic examination of the female reproductive system were assigned to perform the procedure.The results of conventional and enhanced MRI and DCE-MRI in 33 patients with endometrial cancer were recorded and compared with the results of surgical pathology.4.Observation Index(1)Conventional and enhanced MRI findings: Tumor location,size,margin,depth of myometrial invasion,signal intensity,degree of enhancement and mode of enhancement.(2)Signs and parameters of DCE-MRI : degree and mode of enhancement,false color image,Ktrans,Kep,Ve.(3)Histopathology features: depth of muscularis invasion.5.Statistical method SPSS 22.0 was used to analyze the data,and Shapiro-Wilk test was used to evaluate the normality of the quantitative parameters of DCE-MRI.The mean ±standard deviation(x ± s)and the median value(P25,P75)were used in normal distribution and non-normal distribution respectively.The interclass correlation Coefficient(ICC)and Q-Q diagram were used to evaluate the consistency of DCE-MRI Quantitative Parameters(ICC<0.04 was poor,ICC > 0.75 was good).T test or Wilcoxon rank sum test were used to compare the quantitative parameters of DCE-MRI between different endometrial cancer invasion groups.For the parameters with statistical difference,receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of ROC curve for the depth of endometrial cancer invasion,and cut off value,sensitivity and specificity were calculated.P<0.05 was statistically significant.Results:1.MRI manifestations of endometrial cancer(1)Conventional MRI signs of endometrial cancer Endometrial cancer originated from the endometrium;15 cases of fundus,12 cases of uterine corpus,6 cases of fundus and uterine corpus;18 cases of lesions with myometrial invasion depth less than 1/2,most of which showed abnormal endometrium on conventional MRI.The thickness is uniform,the signal is more uniform,the boundary is clear,and the joint band is displayed clearly.Myometrial infiltration depth> 1/2 lesions in 15 cases,mostly manifested as uneven thickening of the endometrium or tumors growing into the cavity,irregular in shape,may have lobules,necrosis,cysts,and the joint zone is unclear.Muscle tissue is invaded.It is not accurate enough to judge the infiltration depth of the lesion from the analysis of morphological manifestations by relying solely on conventional MRI scanning.(2)DCE-MRI manifestations of endometrial cancer The solid components of 18 cases of endometrial cancer showed mild continuous enhancement,and enhancement appeared in the early stage of the lesion.The pseudo-color images of Ktrans,Kep and Ve are images with different color levels from blue to red.The red high perfusion area is the manifestation of obvious enhancement of the lesion,the yellow and green medium perfusion areas are moderate enhancement,and the blue low perfusion or no perfusion area is slightly strengthened or not strengthened.(3)DCE-MRI parameter values of endometrial cancer1 Different groups of myometrial infiltrating endometrial cancer DCE-MRI quantitative parameter values Ktrans,Kep,Ve valuesl are all normally distributed.2 With the increase in the depth of endometrial cancer invasion,Ktrans increased,the difference was statistically significant(P less than 0.05).The Ktrans value of 18 cases of superficial muscle infiltration group ranged from 0.27 to 0.69/min,with an average value of 0.455 /min;the Ktrans value of 15 cases of deep muscle layer infiltration group ranged from 0.44 to 0.76/min,with an average value of 0.572/ min.3 With the increase of endometrial cancer infiltration depth,Kepand Ve increased,the difference was not statistically significant(P>0.05).The Kep value of the18 cases of superficial muscle infiltration group ranged from 0.79 to 1.02/min,with an average of 0.893 min;the Ve value ranged from 0.24 to 0.74,with an average of 0.471;the Kep value of 15 cases of deep muscle layer infiltration ranged from 0.78 to 1.03/min,the average value is 0.923min;the range of Ve value is 0.36~0.71,the average value is0.511.4 Among the DCE-MRI related parameters,Ktransis the best in distinguishing the superficial muscle group from the deep muscle group of endometrial cancer(cutoff value is 0.500/min,sensitivity is 85.0%,specificity is 65.0%).Conclusion:On the basis of MRI-pathology comparison,through 33 cases of endometrial cancer DCE-MRI quantitative parameters Ktrans,Kep,Ve and endometrial cancer myometrial invasion depth of the correlation study,the following conclusions can be drawn:1.The quantitative parameters of DCE-MRI The Ktrans value of the deep muscle infiltration group of endometrial cancer was higher than that of the no or superficial muscle infiltration group,the difference was statistically significant(P<0.05),there was no statistical difference in Kep and Ve between the two groups Significance(all P>0.05).2.Among the quantitative parameters of DCE-MRI,the value of Ktrans is helpful to evaluate the depth of endometrial cancer myometrial invasion;the values of Kep and Ve in the quantitative parameters of DCE-MRI have no correlation with the depth of endometrial cancer myometrial invasion.