| BackgroundUterus cervical cancer(UCC)is the fourth most common diagnosed malignancy and the fourth leading cause of malignant-tumor death among women worldwide in2018.Cervical squamous carcinoma(CSC)is the most common pathological type of UCC,its histologic grade is closely related to the choice of treatment plan and prognostic evaluation.The pathological features of UCC are diagnosed and evaluated clinically by puncture biopsy,but the size of lesions,accuracy of sampling and other factors tend to lead to certain differences between the results and the final pathology.Therefore,imaging methods is used as a complementary for CSC grading.In recent years,with the continuous development and innovation of MRI imaging technology,the application of new MRI technology including amide proton transfer-weighted imaging(APTWI)and diffusion weighted models such as diffusion weighted imaging(DWI),diffusion kurtosis imaging(DKI)in cervical cancer has attracted much attention.The new MRI imaging technology above can be used to detect the microstructure of tumors and protein / peptide content information,providing a new direction for the early diagnosis,efficacy evaluation and monitoring of recurrence of cervical cancer.Part ? The value of diffusion kurtosis imaging and diffusion weighted imaging in evaluating the grade of cervical squamous carcinomaObjectiveTo explore the value of diffusion kurtosis imaging(DKI)and diffusion weighted imaging(DWI)in evaluating the pathological grade of cervical squamous carcinoma.Materials and MethodsAll of 49 patients from November 2017 to March 2019 with cervical squamous cell carcinoma confirmed by pathological diagnosis were retrospectively enrolled.According to the pathological results as the gold standard,they were divided into the well/moderately differentiated squamous cell carcinoma(n=32)and the poorly differentiated squamous cell carcinoma(n=17).All patients underwent conventional MR,DWI and DKI scan.The DWI and DKI images were transmitted to the GE AW 4.6 workstation.Then the ADC and DKI software in the Functool toolkit were used to analysis and process the images.The mean kurtosis(MK),mean diffusion coefficient(MD),and mean apparent diffusion coefficient(ADC),minimum ADC value were measured individually by 2 experienced radiologists under the premise of unknown pathological results.The radiologists measured each lesion3 times in succession,and recorded the average value measured by each observer respectively.The intraclass correlation coefficients(ICC)was used to evaluate the consistency of the results calculated by 2 experienced radiologists.If the consistency is good or above,the statistical analysis index is based on the data measured by senior doctors.The differences of parameters between different groups of cervical squamous cell carcinoma were compared by using Student,s t-test.The diagnostic efficiency and optimal diagnostic threshold of each parameter value were evaluated by ROC curve,and the corresponding sensitivity and specificity of each parameter were determined according to the Yoden index.P <0.05 indicates the difference is statistically significant.ResultsThe parameters measured by 2 radiologists exhibited good interobserver agreement(all ICC>0.60,P<0.05).The MK value of poorly differentiated group was higher than that of well/moderately differentiated group.The MD,mean ADC and minimum ADC value were lower than those of well/moderately differentiated group(all P<0.05).The AUC for the mean and minimum ADC values of MK and MD to differentiate between poorly differentiated and well/moderately differentiated group were 0.903,0.833,0.788,and0.847,respectively.If the MK were 0.885,the MK had the highest diagnostic efficacy,of which sensitivity,specificity and yoden index were81.3%?88.2%?0.695.When combined with MK + MD + minimum ADC value diagnosis,the AUC was 0.984.Compared with the AUC of MD,mean ADC and minimum ADC value,the difference was statistically significant(Z = 2.449,2.848,2.638,P = 0.014,0.004,0.008).ConclusionCompared with traditional DWI,DKI can more effectively identify poorly differentiation and well/moderately differentiated squamous cell carcinoma,and the combination of DKI and DWI parameters can effectively improve diagnostic effectiveness.Part ? The value of amide proton transfer imaging and diffusion kurtosis imaging in evaluating the grade of cervical squamous carcinomaObjectiveTo explore the value of amide proton transfer imaging(APT)and diffusion kurtosis imaging(DKI)in evaluating the pathological grade of cervical squamous carcinoma.The APT and DKI images of 42 patients with cervical squamous cell carcinoma confirmed by pathology from April 2018 to May 2019 were retrospectively analyzed.According to the pathological results as the gold standard,they were divided into the well differentiated group(n = 11),the moderately differentiated group(n = 16),and the poorly differentiated group(n = 9).All the patients underwent conventional MRI,DKI and APT sequence scan.Transfer the APT and DKI images to the GE AW 4.6 workstation,and use the APT /DKI software in the Functool toolkit to analysis and process the images.The magnetization transfer ratio(MTRasym),mean kurtosis(MK)and mean diffusion coefficient(MD)value were measured individually by 2 experienced radiologists under the premise of unknown pathological results.The radiologists measured each lesion 3 times in succession,and recorded the average value measured by each observer respectively.The ICC was used to evaluate the consistency of the results calculated by 2 experienced radiologists.If the consistency is good or above,the statistical analysis index is based on the data measured by senior doctors.one-way ANOVA was used compared the differences of obtained parameters between the well,moderately and poorly differentiated group.LSD test was used for comparison between any the two groups above.ROC curve analysis was used to evaluate the diagnostic performance of parameters obtained by APT and DKI.Spearman correlation analysis was performed to analyze the correlation between these parameters and the grade differentiation of cervical squamous cell carcinoma.P<0.05 was considered statistically significant.ResultsThe parameters measured by 2 radiologists exhibited good interobserver agreement(all ICC > 0.75,P<0.01).The differences of MTRasym,MK and MD values were statistically significant among the well,moderately and poorly differentiation groups(P<0.01).The parameters between any differentiated degree differentiation cervical squamous carcinoma has significant difference(P<0.01).MK and MTRasym value were positively correlated with pathological grade(r=0.80,0.71,P<0.01),the MD value was negatively correlated with pathological grade(r=-0.74,P<0.01).When differentiating the highly from the moderately and differentiating the moderately from the poorly cervical squamous cell carcinoma,MTRasym all had the highest diagnostic performance.The areas under the curve of MTRasym were 0.86,0.91,respectively(P<0.01),which was higher than MK(AUC=0.84,0.85,P<0.01)and MD(AUC=0.84?0.85,P<0.01),the differences above are not statistically significant(P>0.05).If the MTRasym were 2.98% and 3.06%respectively,the MTRasym had the highest diagnostic sensitivity(84.2%,90.9%)and specificity(83.3%,84.2%).ConclusionThe MTRasym,MK,and MD values from APT and DKI parameters are helpful to diagnosis the grades of cervical squamous cell carcinoma.Compared to DKI,APT is more conducive,and can be used as a preferred complementary of conventional MRI. |
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