| Objective To evaluate and contrast Intravoxel incoherent motion(IVIM)and diffusion-weighted imaging(DWI)in differentiating cervical cancer and normal cervical tissue and cervical cancer’s degree of differentiation.Methods Collecting 9 normal person and 37 patients diagnosed with cervical squamous cell carcinoma according to surgery or biopsy with pelvic MRI routine scan sequence and IVIM sequences.In the 37 patients,including 9 high differentiation cervical squamous cell cancer,20 medium differentiation cervical squamous cell cancer and 8 low differentiation cervical squamous cell cancer.Everyone underwent cervical magnetic resonance imaging(MRI)examination before treatment,the sequence includes conventional axial T1-weighted image(T1 weighted imaging,TIWI),axial T2-weighted images(T2 weighted imaging,T2WI),sagittal T2-weighted images(T2WI),coronal T2-weighted images(T2WI),axial DWI(b=0s/mm~2,800s/mm~2),IVIM was performed using a prototype single shot echo planar imaging(SS-EPI)sequence with 10 b values of 0,50,100,150,200,300,500,1000,1500,2000s/mm~2 on 3 gradient directions.In the three levels of tumor avoid capsule,liquefaction necrosis and hemorrhage(ROI)draw areas of interest along the edge of tumor inside.Values for apparent diffusion coefficient(ADC),D,D*and f were calculated after processing the collected raw image.Compared mean value of ADC,D,D*and f of cervical squamous cell cancer,normal cervical tissue and high,medium and low differentiation cervical squamous cell cancer.Evaluate the discriminability of ADC,D,D*and f in cervical squamous cell cancer,normal cervical tissue and high,medium and low differentiation cervical squamous cell cancer by Receiver operating characteristics(ROC)curves,then seek out the optimal threshold value.ADC,D,D *,f values between the two pairs of correlation analysis selected Pearson correlation test.Results1.Application of IVIM and DWI in differentiating cervical squamous cell cancer and the normal cervical tissueThe values of ADC in normal cervical tissue is(1.03±0.12)×10-3mm~2/s,the values of D in normal cervical tissue is(0.92±0.09)×10-3mm~2/s,the values of D* in normal cervical tissue is(10.43±1.16)×10-3mm~2/s,The values of f in normal cervical tissue is(18±5.15)%,the values of ADC in cervical squamous cell carcinoma is(0.84±0.06)×10-3mm~2/s,the values of D in cervical squamous cell carcinoma is(0.77±0.07)×10-3mm~2/s,the values of D* in cervical squamous cell carcinoma is(12.29±2.02)×10-3mm~2/s,the values of f in cervical squamous cell carcinoma is(23.03±2.59)%.The values of ADC,D in cervical squamous cell carcinoma were lower than those in normal cervical tissue,the values of D*,f in cervical squamous cell carcinoma were higher than those in normal cervical tissue,they all have obvious differences(P<0.05),the mean values of ADC has the best diagnostic efficiency with a largest AUC(0.967)(P=0.001),regard ADC=0.915×10-3mm~2/s as threshold,the youden index were 0.919,the sensitivity was 91.9% and specificity was 100%.2.Application of IVIM and DWI in differentiating degree of differentiation of cervical squamous cell carcinomaWhen differentiating high differentiated squamous cell carcinoma from the normal cervical tissue,ADC,D,D* and f all have obvious differences(P<0.05).In different differentiated degree differentiation cervical squamous cell carcinoma,the mean values of ADC in high differentiated squamous cell carcinoma is(0.89±0.06)×10-3mm~2/s,in medium differentiated squamous cell carcinoma is(0.84±0.03)×10-3mm~2/s and in low differentiated squamous cell carcinoma is(0.76±0.04)×10-3mm~2/s;the mean values of ADC between any differentiated degree differentiation cervical squamous cell carcinoma has obvious difference(P<0.001);the mean values of D in high differentiated squamous cell carcinoma is(0.83±0.04)×10-3mm~2/s、in medium differentiated squamous cell carcinoma is(0.78±0.05)×10-3mm~2/s and in low differentiated squamous cell carcinoma is(0.69±0.03)×10-3mm~2/s the mean values of D between any differentiated degree differentiation cervical squamous cell carcinoma has obvious difference(P<0.001);the mean values of D* in high differentiated squamous cell carcinoma is(11.43±1.16)×10-3mm~2/s,in medium differentiated squamous cell carcinoma is(12.41±1.77)×10-3mm~2/s and in low differentiated squamous cell carcinoma is(12.97±3.08)×10-3mm~2/s,the mean values of D* between any differentiated degree differentiation cervical squamous cell carcinoma has no obvious difference(P>0.05);the mean values of f in high differentiated squamous cell carcinoma is(21.78±2.91)%,in medium differentiated squamous cell carcinoma is(22.85±2.25)% and in low differentiated squamous cell carcinoma is(24.88±2.23)%;the mean values of f between high and poorly differentiation cervical squamous cell carcinoma has obvious difference(P<0.05).When differentiating high from medium differentiated squamous cell carcinoma,The ROC of ADC is 0.77(P=0.021)and the ROC of D is 0.76(P=0.025),When differentiating poorly from medium differentiated squamous cell carcinoma,The ROC of ADC is 0.93(P<0.001)and the ROC of D is 0.95(P<0.001).When differentiating high from medium differentiated squamous cell carcinoma,regard D=0.79×10-3mm~2/s,ADC=0.89×10-3mm~2/s as threshold,the youden index were 0.439、0.506 respectively,the sensitivity and specificity were D(88.9%,55%)and ADC(55.6%,99.5%).When differentiating poorly from medium differentiated squamous cell carcinoma,regard D=0.75×10-3mm~2/s,ADC=0.81×10-3mm~2/s as threshold,he youden index were 0.75、0.725 respectively,the sensitivity and specificity were D(100%,75%)and ADC(87.5%,85%).ADC and D are positively correlated with the degree of differentiation of cervical squamous cell carcinoma(r were 0.832**,0.813** respectively),D* and f are negatively correlated with the degree of differentiation of cervical squamous cell carcinoma(r were-0.385**,-0.558**respectively).The ADC was significantly positive correlation with the D(r= 0.952**),The D* was significantly positive correlation with the f(r= 0.824 **).Conclusion1.IVIM and DWI can differentiate cervical squamous cancer and the normal cervical tissue,DWI is better than IVIM.2.IVIM and DWI in cervical squamous carcinoma differentiation can identify each have an advantage.when differentiating poorly from medium differentiated squamous cell carcinoma,the mean value of D had the best diagnostic ability,when differentiating high from medium differentiated squamous cell carcinoma,the mean value of ADC had the best diagnostic ability.3.ADC and D are positively correlated with the degree of differentiation of cervical squamous cell carcinoma,D* and f are negatively correlated with the degree of differentiation of cervical squamous cell carcinoma. |
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