DCE-MRI参数直方图术前评估胃癌分化程度的研究

金建国; 高丽渊; 王象萍; 潘孝本

doi:10.16766/j.cnki.issn.1674-4152.003211

DCE-MRI参数直方图术前评估胃癌分化程度的研究

doi: 10.16766/j.cnki.issn.1674-4152.003211

1.
浙江大学医学院附属第二医院临平院区放射科, 浙江杭州 311100
2.
杭州师范大学医学院, 浙江杭州 311100

基金项目:

国家自然科学基金常规面上项目 82070610

2021年杭州市医药卫生科技项目 B20220841

详细信息

通讯作者:
金建国，E-mail：3388035900@qq.com

中图分类号: R735.2 R730.4
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- 文章访问数: 166
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- PDF下载量: 14
- 被引次数: 0
出版历程
- 收稿日期: 2023-06-05
- 网络出版日期: 2023-11-23

Preoperative evaluation of gastric cancer differentiation using DCE-MRI parameter histograms

1.
Department of Radiology, Linping District, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 311100, China

摘要

摘要: 目的本研究以术前胃癌患者为研究对象，旨在分析DCE-MRI直方图定量参数对术前评估胃癌分化程度的诊断价值。方法选取2020年5月—2023年5月浙江大学医学院附属第二医院临平院区收治的128例胃癌患者为研究对象。术前行DCE-MRI检查，获得DCE-MRI定量参数直方图，包括血管外细胞外间隙容积比(V_e)、容积转运常数(K_trans)、速率常数(K_ep)的偏度、熵、峰度、平均值及10%、90%(P₁₀、P₉₀)。分析上述参数对胃癌分化程度的评估价值。结果低分化组V_e的P₁₀和K_trans及K_ep的熵、平均值、P₁₀、P₉₀高于中分化组和高分化组(均P < 0.05)；低分化组K_ep的偏度、峰度低于中分化组和高分化组(均P < 0.05)。Logistic回归分析结果显示K_trans的熵、平均值、P₁₀、P₉₀和K_ep的偏度、熵、平均值、P₁₀、P₉₀水平异常升高是影响胃癌分化程度的危险因素(均P < 0.05)。ROC结果显示，K_trans的熵、平均值、P₁₀、P₉₀和K_ep的偏度、熵、平均值、P₁₀、P₉₀诊断低分化胃癌的AUC分别为0.739、0.806、0.812、0.758、0.714、0.726、0.786、0.761、0.749。结论 DCE-MRI定量参数直方图对术前胃癌分化程度具有较高的诊断预测价值，其中K_trans的P₁₀诊断效能最佳。
- 磁共振动态对比增强成像 /
- 直方图分析 /
- 胃癌 /
- 分化程度
Abstract: Objective To analyze the diagnostic value of quantitative parameters of DCE-MRI histogram in preoperative evaluating the degree of differentiation of gastric cancer. Methods A total of 128 patients with gastric cancer admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from May 2020 to May 2023 were selected as the study objects. DCE-MRI was performed before surgery to obtain the histogram of quantitative parameters of DCE-MRI, including the skewness, entropy, kurtosis, average value and 10%, 90% (P₁₀, P₉₀) of extravascular extracellular space volume ratio (V_e), volume transport constant (K_trans) and rate constant (K_ep). The value of the above parameters in evaluating the differentiation degree of gastric cancer was analyzed. Results The entropy, mean value, P₁₀ and P₉₀ of P₁₀, K_trans and K_ep of V_e in low differentiation group were higher than those in middle differentiation group and high differentiation group (all P < 0.05). The skewness and kurtosis of K_ep in low differentiation group were lower than those in middle differentiation group and high differentiation group (all P < 0.05). Logistic regression analysis showed that abnormal increases in K_trans entropy, mean value, skewness, entropy, mean value, P₁₀, P₉₀ and K_ep levels were risk factors affecting the differentiation degree of gastric cancer (all P < 0.05). ROC results showed that the AUC of K_trans entropy, mean value, P₁₀, P₉₀ and K_ep skewness, entropy, mean value, P₁₀ and P₉₀ in the diagnosis of poorly differentiated gastric cancer were 0.739, 0.806, 0.812, 0.758, 0.714, 0.726, 0.786, 0.761 and 0.749, respectively. Conclusion DCE-MRI quantitative parameter histogram has high diagnostic value in predicting the differentiation degree of gastric cancer, and K_trans P₁₀ has the best diagnostic efficacy.
- Dynamic contrast enhanced magnetic resonance imaging /
- Histogram analysis /
- Gastric cancer /
- Degree of differentiation

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表 1 低分化组、中分化组、高分化组胃癌患者临床资料比较

Table 1. Comparison of clinical data of gastric cancer patients in low, medium, and high differentiation groups

项目	低分化组(n=61)	中分化组(n=38)	高分化组(n=29)	统计量	P值
性别[例(%)]				0.734^a	0.693
男性	45(73.77)	26(68.42)	19(65.52)
女性	16(26.23)	12(31.58)	10(34.48)
年龄(x ±s，岁)	62.15±9.87	62.57±10.24	61.89±11.15	0.040^b	0.962
Hp感染史[例(%)]				0.913^a	0.634
有	42(68.85)	25(65.79)	17(58.62)
无	19(31.15)	13(34.21)	12(41.38)
家族史[例(%)]				0.987^a	0.610
有	27(44.26)	14(36.84)	10(34.48)
无	34(55.74)	24(63.16)	19(65.52)
萎缩性胃炎病史[例(%)]				0.314^a	0.855
有	18(29.51)	10(26.32)	7(24.14)
无	43(70.49)	28(73.68)	22(75.86)
饮酒史[例(%)]				0.395^a	0.821
有	24(39.34)	17(44.74)	11(37.93)
无	37(60.66)	21(55.26)	18(62.07)
吸烟史[例(%)]				0.266^a	0.875
有	37(60.66)	25(65.79)	18(62.07)
无	24(39.34)	13(34.21)	11(37.93)
肿瘤直径[例(%)]				4.294^a	0.117
≤4 cm	35(57.38)	28(73.68)	22(75.86)
＞4 cm	26(42.62)	10(26.32)	7(24.14)
CA125(x ±s，U/mL)	54.36±8.57	54.12±8.62	53.23±9.24	0.167^b	0.846
CA199(x ±s，U/mL)	71.36±12.42	70.86±11.75	70.02±13.42	0.114^b	0.892
注：^a为χ²值，^b为 F值。

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表 2 低分化组、中分化组、高分化组胃癌患者DCE-MRI直方图定量参数比较[M(P₂₅, P₇₅)]

Table 2. Comparison of quantitative parameters of DCE MRI histograms in gastric cancer patients in the low-differentiation, middle-differentiation, and high-differentiation groups[M(P₂₅, P₇₅)]

参数	低分化组(n=61)	中分化组(n=38)	高分化组(n=29)	H值	P值
V_e
偏度	0.04(-0.92，0.45)	0.07(-0.48，0.92)	0.31(-0.09，1.68)	3.624	0.148
熵	5.89(4.51，6.41)	5.51(2.86，6.52)	3.53(0.78，5.12)	5.589	0.078
峰度	0.62(-0.59，2.18)	0.13(-0.79，1.02)	0.31(-1.29，1.23)	3.768	0.152
平均值	0.53(0.41，0.69)	0.49(0.35，0.63)	0.00(0.00，0.00)	5.108	0.056
P₁₀	0.00(0.00，0.38)	0.00(0.00，0.00)	0.00(0.00，0.26)	8.634	0.012
P₉₀	0.72(0.61，0.93)	0.75(0.49，0.86)	0.65(0.00，0.76)	2.641	0.238
K_trans(min)
偏度	1.38(0.78，1.83)	1.61(1.08，2.29)	2.08(0.82，2.69)	4.125	0.118
熵	6.52(6.31，6.87)	6.24(6.01，6.75)	6.05(5.54，6.37)	13.426	0.002
峰度	2.24(-0.07，4.27)	3.16(1.15，5.81)	6.01(0.78，9.62)	4.589	0.087
平均值	0.55(0.31，1.02)	0.28(0.21，0.58)	0.18(0.12，0.31)	22.873	< 0.001
P₁₀	0.14(0.10，0.22)	0.08(0.04，0.14)	0.07(0.01，0.10)	24.189	< 0.001
P₉₀	1.45(0.70，1.93)	0.79(0.47，1.35)	0.39(0.28，0.51)	19.325	< 0.001
K_ep(min)
偏度	0.91(0.48，1.46)	1.54(1.03，2.36)	1.78(1.48，4.56)	10.902	0.005
熵	6.86(4.28，6.97)	5.71(4.28，6.82)	4.15(1.69，5.68)	13.395	0.002
峰度	0.39(-0.52，3.08)	2.04(0.64，5.71)	2.76(1.58，2.89)	8.769	0.011
平均值	0.71(0.51，1.69)	0.47(0.22，0.83)	0.24(0.06，0.34)	20.725	< 0.001
P₁₀	0.11(0.01，0.28)	0.01(0.00，0.01)	0.00(0.00，0.01)	20.439	< 0.001
P₉₀	2.38(1.11，3.46)	1.49(0.94，2.24)	0.64(0.24，1.01)	15.987	< 0.001

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表 3 胃癌分化程度影响因素多分类logistic回归分析

Table 3. Multivariate logistic regression analysis of factors influencing the degree of differentiation of gastric cancer

变量	B	SE	Wald χ²	P值	OR值	95% CI
V_e
P₁₀	-0.315	0.308	1.046	0.107	0.730	0.515~0.945
K_trans
熵	1.024	0.331	9.571	< 0.001	2.784	1.254~4.315
平均值	1.685	0.394	18.290	< 0.001	5.392	1.964~8.821
P₁₀	1.739	0.402	18.713	< 0.001	5.692	2.026~9.357
P₉₀	1.314	0.342	14.762	< 0.001	3.721	1.430~6.012
K_ep
偏度	0.803	0.305	6.932	0.005	2.232	1.051~3.413
熵	0.892	0.316	7.968	0.001	2.440	1.159~3.721
峰度	-0.386	0.361	1.143	0.204	0.680	0.488~0.872
平均值	1.534	0.375	16.734	< 0.001	4.637	1.242~8.031
P₁₀	1.402	0.352	15.864	< 0.001	4.063	1.375~6.752
P₉₀	1.115	0.336	11.012	< 0.001	3.050	1.226~4.873

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表 4 DCE-MRI直方图定量参数对胃癌低分化的诊断价值

Table 4. Diagnostic value of quantitative parameters in DCE-MRI histogram for low differentiated gastric cancer

参数	AUC	临界值	灵敏度(%)	特异度(%)
K_trans
熵	0.739	6.332	84.30	77.20
平均值	0.806	0.312	86.80	61.30
P₁₀	0.812	0.132	68.90	86.70
P₉₀	0.758	1.417	57.80	83.90
K_ep
偏度	0.714	0.926	58.10	83.96
熵	0.726	6.789	57.80	86.40
平均值	0.786	0.473	81.70	61.30
P₁₀	0.761	0.013	63.20	81.90
P₉₀	0.749	2.349	55.40	86.50

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