Developing and validating a multivariable prediction model to improve the diagnostic accuracy in determination of cervical versus endometrial origin of uterine adenocarcinomas: A prospective MR study combining diffusion-weighted imaging and spectroscopy

被引：8

作者：

Lin, Gigin ^{[1
,2
,3
,4
]}

Lin, Yu-Chun ^{[1
,2
,3
]}

Wu, Ren-Chin ^{[3
,5
]}

Yang, Lan-Yan ^{[3
,6
,7
,8
]}

Lu, Hsin-Ying ^{[1
,2
,3
,4
]}

Tsai, Shang-Yueh ^{[9
]}

Huang, Yu-Ting ^{[10
]}

Huang, Yen-Ling ^{[1
]}

Lu, Kuan-Ying ^{[1
,2
,3
,4
]}

Ng, Koon-Kwan ^{[10
]}

Yen, Tzu-Chen ^{[11
,12
,13
]}

Chao, Angel ^{[6
,7
,8
]}

Lai, Chyong-Huey ^{[6
,7
,8
]}

Hong, Ji-Hong ^{[2
,3
,14
]}

机构：

[1] Chang Gung Mem Hosp LinkouGuishan, Dept Med Imaging & Intervent, Taoyuan, Taiwan

[2] Chang Gung Mem Hosp Linkou, Inst Radiol Res, Imaging Core Lab, Taoyuan, Taiwan

[3] Chang Gung Univ, Taoyuan, Taiwan

[4] Chang Gung Mem Hosp Linkou, Clin Metabol Core Lab, Taoyuan, Taiwan

[5] Chang Gung Mem Hosp Linkou, Dept Pathol, Taoyuan, Taiwan

[6] Chang Gung Mem Hosp Linkou, Dept Obstet & Gynecol, Taoyuan, Taiwan

[7] Chang Gung Mem Hosp Linkou, Gynecol Canc Res Ctr, Taoyuan, Taiwan

[8] Chang Gung Mem Hosp Linkou, Clin Trial Ctr, Taoyuan, Taiwan

[9] Natl Chengchi Univ, Grad Inst Appl Phys, Taipei, Taiwan

[10] Chang Gung Mem Hosp Keelung, Dept Diagnost Radiol, Keelung, Taiwan

[11] Chang Gung Mem Hosp, Dept Nucl Med, Taoyuan, Taiwan

[12] Chang Gung Mem Hosp, Ctr Adv Mol Imaging & Translat, Taoyuan, Taiwan

[13] Chang Gung Univ, Linkou Med Ctr, Taoyuan, Taiwan

[14] Chang Gung Mem Hosp Linkou, Dept Radiat Oncol, Taoyuan, Taiwan

来源：

JOURNAL OF MAGNETIC RESONANCE IMAGING | 2018年 / 47卷 / 06期

关键词：

cervical carcinoma; diffusion-weighted imaging; diagnostic accuracy; endometrial carcinoma; magnetic resonance imaging; magnetic resonance spectroscopy; MYOMETRIAL INVASION; HISTOGRAM ANALYSIS; CANCER; COEFFICIENT; DISTINCTION; PROGNOSIS;

D O I：

10.1002/jmri.25899

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

Background: A triage test to assist clinical decision-making on choosing primary chemoradiation for cervical carcinomas or primary surgery for endometrial carcinomas is important. Purpose or Hypothesis: To develop and validate a multiparametric prediction model based on MR imaging and spectroscopy in distinguishing adenocarcinomas of uterine cervical or endometrial origin. Study Type: Prospective diagnostic accuracy study. Population: Eighty-seven women: 25 cervical and 62 endometrial adenocarcinomas divided into training (n=43; cervical/endometrial adenocarcinomas=11/32) and validation (n=44; 14/30) datasets. Field Strength/Sequence: The 3T diffusion-weighted (DW) MR imaging and MR spectroscopy. Assessment: Morphology, volumetric DW MR imaging and spectroscopy (MDS) scoring system with total points 0-5, based on presence of the following MR features assessed independently by two radiologists: (a) epicenter at the cervix, (b) rim enhancement, (c) disrupted cervical stromal integrity, (d) mean volumetric apparent diffusion coefficient values (ADCmean) higher than 0.98 x 10-3 mm(2)/s, (e) fatty acyl delta 1.3 ppm more than 161.92mM. Histopathology as gold standard. Statistical Tests: Logistic regression and receiver operator characteristic (ROC) curves analysis. Results: For both the training and validation datasets, the MDS score achieved an accuracy of 93.0% and 84.1%, significantly higher than that of morphology (88.4% and 79.5%), ADC value (74.4% and 68.2%), and spectroscopy (81.4% and 68.2%; P<0.05 for all). The performances of the scoring were superior to the morphology in the training dataset (areas under the receiver operating characteristics curve [AUC]=0.95 vs. 0.89; P=0.046), but not in the validation dataset (AUC=0.90 vs. 0.85; P=0.289). Data Conclusion: MDS score has potentials to improve distinguishing adenocarcinomas of cervical or endometrial origin, and warrants large-scale studies for further validation. Technical Efficacy: Stage 3

引用

页码：1654 / 1666

页数：13

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