【摘要】 目的 探讨动态对比增强磁共振成像（DCEMRI）和体素内不相干运动（IVIM）成像鉴别雌激素依赖型（Ⅰ型）和非依赖型（Ⅱ型）子宫内膜癌（EC）的作用。方法 64例EC患者接受了DCEMRI和IVIM扫描，其中Ⅰ型EC 39例，Ⅱ型EC 25例。分别测量容量转移常数(K^trans)、速率常数(K_ep)、血管外细胞外组织间隙容积分数（V_e）、真性扩散系数（D）、假性扩散系数（D^*）和灌注分数（f）值并进行组间对比，之后评估各参数诊断效能、寻找独立预测因子并进行联合诊断。结果 Ⅰ型EC组的D和f值均高于Ⅱ型EC组（P<0.001）,Ⅱ型EC组的K^trans和V_e值均显著低于Ⅰ型EC组（P<0.001）,Ⅰ、Ⅱ型EC间K_ep、D^*值无明显差异（P=0.158、0.196）。D、K^trans、V_e和f的曲线下面积（AUC）依次为0.837、0.804、0.781和0.751。D和K^trans是Ⅰ、Ⅱ型EC鉴别的独立预测因子，两者结合的AUC为0.950,敏感性为88.00%,特异性为92.31%。DeLong分析显示，D+K^trans的AUC与D、K^trans、V_e和f的AUC之间的差异均有统计学意义（Z=2.437、2.943、3.147和3.304;P=0.015、0.003、0.002和0.001）。结论 DCEMRI和IVIM部分定量参数可用于EC临床分型的预测，其中K^trans和D的组合可能是有效的影像学标记物。更多还原

【Abstract】 Objective To explore the role of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI） and intravoxel incoherent motion（IVIM） in identifying estrogen-dependent（type Ⅰ） and nonestrogen-dependent（type Ⅱ） endometrial cancer（EC）.Methods A total of 64 EC patients underwent DCE-MRI and IVIM scans,including 39 cases of type Ⅰ and 25 cases of typeⅡ EC.The volume transfer constant(K^trans),rate transfer constant(K_ep),volume of extravascular extracellular space per unit volume of tissue（V_e）,diffusion coefficient（D）,pseudo diffusion coefficient（D^*）,and perfusion fraction（f） values were measured separately and compared between different groups,after which the diagnostic efficacy of each parameter was assessed,independent predictors were sought and a joint diagnosis was made.Results The D and f values in the type Ⅰ EC group were higher than those in the typeⅡ EC group（P<0.001）,and the K^trans and V_e values in the type Ⅱ EC group were lower than those in the type Ⅰ EC group（P<0.001）.No significant differences were found in K_ep and D^* values between type Ⅰ and type Ⅱ EC（P=0.158,0.196）.The area under the curve（AUC） of D,K^trans,V_e,and f were 0.837,0.804,0.781,and 0.751 Respectively.The D and K^trans were independent predictors,and the diagnostic efficiency,specificity,and sensitivity of the combination of them were 0.950,92.31%,and 88.00%,respectively.DeLong analysis demonstrated that the differences between AUC(D+K^trans) and AUC（D）,AUC(K^trans)AUC（V_e）,and AUC（f）were all significant（Z=2.437,2.943,3.147,and 3.304;P=0.015,0.003,0.002,and 0.001,respectively）.Conclusion Partial quantitative parameters of DCE-MRI and IVIM can be utilized for the prediction of the clinical type of EC,and the combination of K^trans and D may be a valid imaging marker.更多还原