Study on the clinical effect of three-dimensional amide proton transfer imaging and diffusion-weighted imaging for diagnosis and prognosis evaluation of cervical cancer
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摘要:
目的 通过比较三维酰胺质子转移成像(3D-APT)与磁共振弥散加权成像(DWI)在宫颈组织病变定性诊断和预后评估方面的效能差异，探讨3D-APT用于宫颈癌诊疗的潜在价值。 方法 选取2020年12月—2021年12月铜仁市人民医院收治的260例宫颈病变患者为研究对象，全部受试者均进行MR扫描检查，分别进行3D-APT和DWI序列扫描，以组织病理检测结果为金标准，评价2种MR成像技术对宫颈组织病变定性诊断效能，分析2种成像指标与放化疗后肿瘤直径变化及无进展生存期的相关性差异。 结果 3D-APT检查与DWI检查对宫颈组织病变定性(良性与恶性)诊断灵敏度、特异度和准确率(3D-APT检查：98.91%、99.40%和99.23%，DWI检查：95.70%、98.20%和97.31%)差异均无统计学意义(P>0.05)；放化疗前后3D-APT指标变化(ΔAPT)与病灶最大径减小值的相关系数(r=0.824)高于DWI指标(r=0.781)；宫颈癌患者放化疗前3D-APT指标(APT)与患者无进展生存期的相关系数(r=-0.863)高于DWI指标(r=0.795)。 结论 与DWI检查比较，3D-APT在宫颈组织病变定性诊断和预后评估方面展现出更加优越的能力。 Abstract:Objective This study aims to explore the potential value of 3D amide proton transfer imaging (3D-APT) in the diagnosis and treatment of cervical cancer by comparing its differences in the qualitative diagnosis and prognostic evaluation of cervical tissue lesions with diffusion-weighted image (DWI). Methods A total of 260 patients with cervical lesions, admitted to Tongren People' s Hospital from December 2020 to December 2021, were selected as the study subjects. All subjects underwent MR scanning, including 3D-APT and DWI sequence scans. The tissue pathology test were used as the gold standard to evaluate the diagnostic efficacy of both MR imaging techniques for cervical tissue lesions. The study analyzed the correlation between imaging indicators from both techniques and changes in tumor diameter after radiotherapy and chemotherapy, as well as progression-free survival. Results The sensitivity, specificity, and accuracy of 3D-APT for distinguishing benign from malignant cervical lesions were 98.91%, 99.40%, and 99.23%, respectively, while for DWI they were 95.70%, 98.20%, and 97.31%. The differences between the two techniques were not statistically significant (P>0.05). The correlation coefficient (r=0.824) between changes in 3D-APT indicators (ΔAPT) and reduction in maximum lesion diameter after radiotherapy and chemotherapy was higher than that of DWI indicators (r=0.781). The correlation coefficient between the 3D-APT index (APT) and progression-free survival in cervical cancer patients before radiotherapy and chemotherapy (r=-0.863) was higher than that of DWI index (DWI, r=0.795). Conclusion Compared to DWI examination, 3D-APT demonstrates superior capabilities in both the qualitative diagnosis and prognostic evaluation of cervical tissue lesions. -
表 1 不同MR检查技术对宫颈组织病变的定性诊断情况比较(例)
Table 1. Comparison of qualitative diagnosis for cervical tissue lesions using different MRI techniques (cases)
病理检测结果 3D-APT DWI 合计 宫颈恶性病变 宫颈良性病变 宫颈恶性病变 宫颈良性病变 宫颈恶性病变 91 1 89 3 92 宫颈良性病变 1 167 4 164 168 合计 92 168 93 167 260 
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表 2 不同MR检查技术对宫颈组织病变定性诊断的ROC曲线分析
Table 2. ROC curve analysis of qualitative diagnosis for cervical tissue lesions using different MR examination techniques
MR检查技术 AUC SE P值 95% CI 3D-APT 0.994 0.006 ＜0.001 0.983~1.000 DWI 0.977 0.011 ＜0.001 0.955~0.999
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表 3 中晚期宫颈癌患者放化疗前后APT、ADC数值及病灶最大径变化情况(x ±s)
Table 3. Changes in ATP, ADC values, and maximum lesion diameter before and after radiotherapy and chemotherapy in patients with advanced cervical cancer(x ±s)
检查时间 例数 APT
(%)ADC
(10-3mm2/s)病灶最大直径
(mm)放化疗前 80 2.83±0.34 0.96±0.17 42.63±5.17 放化疗4周后 80 1.92±0.28 1.51±0.28 10.95±2.23 t值 31.495 -16.571 59.863 P值 < 0.001 < 0.001 < 0.001
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