| bjective:To investigate the quantitative parameter of apparent diffusion weighted?ADC?histogram and dynamic contrast enhanced-magnetic resonance imaging?DCE-MRI?with selected the peripheral and central areas that show correlations with clinicopathological features and prognostic factors of cervical squamous cell carcinoma.Methods:A total of 148 patients admitted to hospital pathologically confirmed as cervical squamous cell carcinoma between October 2015 and October 2018 was collected prospectively who had routine,DWI?b=50,400,800 s/mm2?and DCE-MRI scans.According to inclusion and exclusion criteria,136 patients were included in the final analysis.Clinicopathological features associated with prognosis were recorded,including maximum diameter,stage,histological grade,parametrial infiltration and lymph node status.The ROI of all lesions based on T2WI and T1WI enhanced was achieved by image registration to get the parameters of ADC and DCE-MRI.The average ADC value of the tumor was measured and that of normal myometrium and gluteus maximus muscles was used as a reference to calculate relative ADC?rADC?.The types of TIC which was measured in the peripheral areas and the central of the lesions were recorded,and semi-quantitative parameters and perfusion quantitative parameters of DCE-MRI were measured.Semi-quantitative parameters including the maximum slope increase?MSI?,the maximum slope decrease?MSD?,the maximum relative enhancement ratio?MRE?.Perfusion quantitative parameters including the wash-in,the wash-out,the time to peak?TTP?,the maximum intensity project over time?MIPt?,the positive enhancement integral?PEI?.Various ADC histogram parameters were contained:mean,variance,skewness,kurtosis,1 percentile,10th percentile,50th percentile,90th percentile,99th percentile.The correlation between the ADC value and DCE-MRI parameter was evaluated Spearman test.Results were analyzed with statistics to analyze the differences of quantitative parameters and prognostic factors between the peripheral and central areas in lesions.Parameters showed difference in prognostic factors was selected.The sensitivity and specificity of value to diagnose different prognostic factors and the diagnostic thresholds were calculated based on the area carried by ROC.Results:The total coincidence rate of clinical stage and pathological stage of cervical squamous cell carcinoma was 61.76%,and the incidence of parametrial infiltration and lymph-nodes metastasis was elevated with the increasing staging.Type?is the main type of the peripheral and central area.The value of ADCskewness was?0.83±0.54?.The average ADC value,rADCnormal myometrium,rADC gluteus maximus,MSI,MSD,MRE,wash-in,wash-out,Mipt,TTP,PEI value in the marginal region were all greater than those in the central region,and the curves of cumulative frequency polygon were moved to the right.The average ADC value,rADCnormal myometrium,rADCgluteus maximus had the most significant correlation with ADC50%?r=0.424,0.376,0.454,P=0.000?.MSI had positive correlations with Wash-in,MIPt,PEI,and had negative correlation with Wash-out,TTP.MSD had positive correlations with Wash-out,TTP,MIPt,had no correlation with Wash-in and PEI.MRE had positive correlations with Wash-in?MIPt?PEI,had no correlation with Wash-out and TTP.There is a weak negative correlation between the average ADC value and MSI,MRE,Wash-in.MIPt,PEI,and had positive correlation with TTP,had no correlation with MSD,Wash-out.There is a weak negative correlation between rADCnormal myometrium and MRE.There was no significant differences between rADC gluteus maximus and DCE-MRI parameters?P>0.05?.Wash-in and MRE of the peripheral areas had negative correlation with ADC1%,ADC10%,ADC90%,ADC99%.TTP had positive correlation with ADCmean,ADCskewness,ADC1%,ADC10%.Between the group of staging??b?a?and??b??,the area under the curve of the MRI quantitative parameters(MSD,Wash-out,TTP in the peripheral area,and MSD,Wash-out,TTP,MIPt,PEI in the central area,ADCskewness,ADCkurtosis)that had statistical significance was 0.350 to 0.399.The area under the curve of quantitative parameters of MRI?Wash-out in the peripheral area,and TTP,PEI in the central area?was 0.360 to 0.433 in the group with and without parasycnal infiltration,and the difference was statistically significant.There have no MRI parameters of diagnostic value were found in both groups?AUC<0.5?.In the degree of differentiation group,MSD,Wash-out in the marginal area,rADCgluteus maximus,MRE and MIPt in the central area,ADCmean,ADCvariance,ADCkurtosis,ADC1%,ADC10%and ADC50%were significantly different?P<0.05?.The area under each parametric surface is 0.3610.647.Areas of ADC 10%and ADC50%under ROC curve to diagnostic tumor grading were 0.646 and 0.647,the Youden index were 0.449 and0.376,with with a sensitivity of 90.2%and 86.9%,with a specificity of 54.7%and 50.7%,the former was considered the best diagnostic parameter.In the lymph node metastasis group,rADCgluteus maximus,MSI,MRE,TTP,MIPt,PEI in the marginal area,and rADCgluteus maximus,MRE,TTP,MIPt,ADCvariance,ADCkurtosisurtosis in the central area were significantly different?P<0.05?.The area under each parametric surface is 0.3110.663.MIPt was the best diagnostic parameter,with a maximum area under the curve of 0.663,the Youden index of 0.352,and a sensitivity and specificity of 51.3%and 83.9%,respectively.Conclusion:?1?The ADC histogram of cervical squamous cell carcinoma showed mild positive skewness.In addition to MSD and Wash-out,all the ADC values(the average ADC value,rADCuterine muscle,rADCgluteus maximus)and DCE-MRI quantitative parameters?MSI,MRE,Wash-in,TTP,Mipt,PEI?in the peripheral and central areas were statistically different.?2?There is a certain correlation between the measured quantitative MRI parameters based on the standardized ADC.The ADC histogram containing texture features and the TIC curve calculation model,which can better reflect the pathological characteristics of tumors.?3?Parts of MRI quantitative parameters can be used as a reference to identify the degree of differentiation and lymph node metastasis of cervical squamous cell carcinoma,but whether it has diagnostic value in tumor stage and uterine infiltration should be further studied.In short,there were a certain correlation between ADC value,ADC histogram and DCE-MRI quantitative parameters,multiple parameters can reflect the clinicopathological features,and had high diagnostic efficacy in identifying prognostic factors,in some degree has a certain reference value for predicting the prognosis of cervical squamous cell carcinoma. |
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