Diagnostic Value Of MR Multimodal Imaging For Pathological Features Of Cervical Cancer

Objective: To investigate the value of MR multimodal imaging in the diagnosis of pathological features of cervical cancer.Materials and Methods: Ninety-seven cases of cervical cancer who underwent preoperative pelvic MR routine T1 WI,T2WI,DWI(b=0,600 s/mm2),DTI(b=0,600s/mm2,in 6 directions),DCE-MRI(40 cycles,4 minutes and 10 seconds)were retrospective reviewed from September 2015 to December 2018 in our hospital.All patients were confirmed by surgery or biopsy pathology.According to the degree of pathological differentiation,they were divided into poorly differentiated group(n=50,age 29-72 years,mean age 54.0±15.5 years),moderately-highly differentiated group(n=21,age 42-68 years,mean age 55.0±14.5 years).According to the histological classification,they were divided into squamous cell carcinoma group(n=18,age 32-70 years,mean age 57.0±17.0 years),adenocarcinoma group(n=9,age 41-71 years,mean age 51.0±19.5 years.According to the with or without lymph vascular space invasion,they were divided into with lymph vascular space invasion(n=29,age 29-67 years,mean age 56.0±13.0 years),without lymph vascular space invasion group(n=69,age32-72 years,mean age 54.0±14.0 years).On the ADW4.6 workstation,the Functool post-processing software was used to post-processe the DWI,DTI sequence images and the Gen IQ post-processing software was used to post-process the DCE-MRI sequence images to generate the ADC(ADCDWI)map of DWI,the ADC(ADCDTI)map and FA map of DTI,Ktrans map,Ve map,Kep map of DCE-MRI,respectively.The region of interest(ROI)was placed in the focal part of the lesion.The ROI area was larger than1/3 of the parenchymal part of the lesion.The ADCDWI,ADCDTI,FA,Ktrans,Ve and Kep values of each ROI were measured by double radiologists by two radiologists.Spearman correlation analysis was used to evaluate the correlation between the two observers.If the correlation coefficient(r)value was >0.75,the average of the two observers was used for subsequent comparison.The Mann-Whitney U test was used to compare the differences between the poorly differentiated and moderately-highly differentiated group,the squamous cell carcinoma and the adenocarcinoma group,with or without lymph vascular space invasion group.The ROC curve was used to analyze the diagnostic efficacy of each parameter and analyze the combined diagnostic efficacy of differential parameters in DWI,DTI and DCE-MRI sequences.Results: The correlation of two observers measured of each parameter was good(rvalues > 0.75).ADCDWI,ADCDTI,FA and Ktrans values were statistically different between the poorly differentiated group and the moderately-highly differentiated group of cervical cancer(P<0.05).The ADCDWI,ADCDTI and FA values in the poorly differentiated group were significantly lower than moderately-highly differentiated group [(0.838±0.101)×10-3mm2/s and(0.921±0.209)×10-3mm2/s,P=0.003.(0.828±0.172)×10-9mm2/s and(0.892±0.201)×10-9mm2/s,P=0.001.(0.127±0.047)and(0.160±0.067),P=0.010].Ve and Kep values were not statistically different between the poorly differentiated group and the moderately-highly differentiated group(P>0.05).Ktrans value in the poorly differentiated group was significantly higher than moderately-highly differentiated group [(0.488±0.252)min-1 and(0.398±0.226)min-1,P=0.020].The Ktrans value of squamous cell carcinoma group was significantly lower than adenocarcinoma group [(0.430±0.140)min-1 and(0.696±0.459)min-1,p=0.040].ADCDWI,ADCDTI,FA,Ve,and Kep values were not significantly different between the squamous cell carcinoma group and the adenocarcinoma group(P>0.05).There was no significant difference between ADCDWI,ADCDTI,FA,Ktrans,Ve and Kep values in cervical cancer with or without lymph vascular space invasion(P>0.05).Among the four parameters of ADCDWI,ADCDTI,FA and Ktrans to identify the ROC curve of the cervical cancer poorly differentiated group and the moderately-highly differentiated group,the area under the ROC curve of ADCDTI was the largest,0.763,the threshold was 0.858×10-9mm2/s,and the diagnostic sensitivity and specificity were 81.0% and60.0%,respectively.The combination of ADCDWI,ADCDTI,FA and Ktrans had higher diagnostic efficiency to identify the poorly differentiated group and moderately-highly differentiated group of cervical cancer.The area under the ROC curve was 0.857,and the sensitivity was as high as 95.2%.The Ktrans value identified the area under the ROC curve of the cervical squamous cell carcinoma group and the adenocarcinoma group was 0.756,the threshold value was 0.475 min-1,and the diagnostic sensitivity and specificity were 77.8% and 80.0%,respectively.Conclusion: DWI,DTI,and DCE-MRI multimodal imaging parameters can effectively identify poorly differentiated and moderately-highly differentiated cervical cancer,and the ADCDTI value of DTI sequence is the most efficient.ADCDWI,ADCDTI,FA and Ktrans combined diagnosis can improve the diagnostic efficiency and sensitivity for poorly differentiated and moderately-highly differentiated cervical cancer.The Ktrans value in DCE-MRI can effectively identify cervical squamous cell carcinoma and adenocarcinoma,while the parameters of DWI and DTI sequence have no differential diagnosis value between squamous cell carcinoma and adenocarcinoma.There is no ifferential diagnosis value between DWI,DTI and DCE-MRI sequence parameters for cervical cancer with or without lymph vascular space invasion.