固体组织的表观扩散系数分析有助于区分边缘性和浸润性恶性附件肿块，O-RADS MRI 4.

IF 4.9 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Diagnostic and Interventional Imaging Pub Date : 2024-06-14 DOI:10.1016/j.diii.2024.05.004

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Receiver operating characteristics curve (ROC) was used to determine the optimum cutoff of the ADC for distinguishing invasive from non-invasive tumors in the O-RADS MRI score 4 population.</div></div><div><h3>Results</h3><div>The final study population included 180 women with a mean age of 57 ± 15.5 (standard deviation) years; age range: 19–95 years) with 93 benign, 23 borderline, and 137 malignant masses. The median ADC values of solid tissue was greater in borderline masses (1.310 × 10<sup>−3</sup> mm<sup>2</sup>/s (Q1, Q3: 1.152, 1.560 × 10<sup>−3</sup> mm<sup>2</sup>/s) than in benign masses (1.035 × 10<sup>−3</sup> mm<sup>2</sup>/s; Q1, Q3: 0.900, 1.560 × 10<sup>−3</sup> mm<sup>2</sup>/s) (<em>P</em> <em>=</em> 0.002) and in benign tumors compared by comparison with invasive masses (0.850 × 10<sup>−3</sup> mm<sup>2</sup>/s; Q1, Q3: 0.750, 0.990 × 10<sup>−3</sup> mm<sup>2</sup>/s) (<em>P</em> < 0.001). 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引用次数: 0

摘要

目的：本研究旨在评估附件肿块实性组织表观扩散系数（ADC）分析对优化肿瘤特征描述的贡献，并在可能的情况下完善 O-RADS MRI 4 类风险分层：对EURAD队列进行回顾性分析，挑选出所有具有实性组织和可行ADC测量的附件肿块患者。两名放射科医生独立测量了实性组织的 ADC 值，排除了坏死区域、周围结构和磁感应伪影。分析了整体人群和实体组织形态方面的扩散定量参数的显著差异，以确定其对 ADC 可靠性的影响。利用接收者操作特征曲线（ROC）确定了在O-RADS MRI评分为4分的人群中区分浸润性和非浸润性肿瘤的最佳ADC临界值：最终研究对象包括 180 名女性，平均年龄为 57 ± 15.5（标准差）岁；年龄范围为 19-95 岁：19-95岁），其中有93个良性肿块、23个边缘性肿块和137个恶性肿块。边界肿块的实体组织 ADC 中位值（1.310 × 10-3 mm2/s，Q1、Q3：1.152、1.560 × 10-3 mm2/s）大于良性肿块（1.035 × 10-3 mm2/s，Q1、Q3：0.900，1.560 × 10-3 mm2/s）（P= 0.002），以及良性肿瘤与浸润性肿块相比（0.850 × 10-3 mm2/s；Q1，Q3：0.750，0.990 × 10-3 mm2/s）（P < 0.001）。18.6%（47/253）的附件肿块为实性组织，46.2%（117/253）为壁结节或混合肿块，35.2%（89/253）为纯实性肿块。在混合性肿块或有壁结节的肿块亚组中，浸润性肿块的 ADC（0.830 × 10-3 mm2/s（Q1、Q3：0.738、0.960））明显低于边缘性肿块（1.385；Q1、Q3：1.300、1.930）（P= 0.0012）和良性肿块（P= 0.04）。ADC 临界值为 1.08 × 10-3 mm2/s，在混合或壁结节亚组中识别浸润性病变的敏感性为 71.4%，特异性为 100%，AUC 为 0.92（95% 置信区间：0.76-0.99）：附件肿块实体组织的 ADC 分析有助于区分 O-RADS MRI 4 类中的浸润性肿块，尤其是混合性肿块或有壁结节的肿块。

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Apparent diffusion coefficient analysis of solid tissue helps distinguish borderline from invasive malignant adnexal masses rated O-RADS MRI 4

Purpose

The purpose of this study was to evaluate the contribution of apparent diffusion coefficient (ADC) analysis of the solid tissue of adnexal masses to optimize tumor characterization and possibly refine the risk stratification of the O-RADS MRI 4 category.

Materials and methods

The EURAD cohort was retrospectively analyzed to select all patients with an adnexal mass with solid tissue and feasible ADC measurements. Two radiologists independently measured the ADC values of solid tissue, excluding necrotic areas, surrounding structures, and magnetic susceptibility artifacts. Significant differences in diffusion quantitative parameters in the overall population and according to the morphological aspect of solid tissue were analyzed to identify its impact on ADC reliability. Receiver operating characteristics curve (ROC) was used to determine the optimum cutoff of the ADC for distinguishing invasive from non-invasive tumors in the O-RADS MRI score 4 population.

Results

The final study population included 180 women with a mean age of 57 ± 15.5 (standard deviation) years; age range: 19–95 years) with 93 benign, 23 borderline, and 137 malignant masses. The median ADC values of solid tissue was greater in borderline masses (1.310 × 10⁻³ mm²/s (Q1, Q3: 1.152, 1.560 × 10⁻³ mm²/s) than in benign masses (1.035 × 10⁻³ mm²/s; Q1, Q3: 0.900, 1.560 × 10⁻³ mm²/s) (P = 0.002) and in benign tumors compared by comparison with invasive masses (0.850 × 10⁻³ mm²/s; Q1, Q3: 0.750, 0.990 × 10⁻³ mm²/s) (P < 0.001). Solid tissue corresponded to irregular septa or papillary projection in 18.6% (47/253), to a mural nodule or a mixed mass in 46.2% (117/253), and to a purely solid mass in 35.2% (89/253) of adnexal masses. In mixed masses or masses with mural nodule subgroup, invasive masses had a significantly lower ADC (0.830 × 10⁻³ mm²/s (Q1, Q3: 0.738, 0.960) than borderline (1.385; Q1, Q3: 1.300, 1.930) (P = 0.0012) and benign masses (P = 0.04). An ADC cutoff of 1.08 × 10⁻³ mm²/s yielded 71.4% sensitivity and 100% specificity for identifying invasive lesions in the mixed or mural nodule subgroup with an AUC of 0.92 (95% confidence interval: 0.76–0.99).

Conclusion

ADC analysis of solid tissue of adnexal masses could help distinguish invasive masses within the O-RADS MRI 4 category, especially in mixed masses or those with mural nodule.

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来源期刊

Diagnostic and Interventional Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

8.50

自引率

29.10%

发文量

126

审稿时长

11 days

期刊介绍： Diagnostic and Interventional Imaging accepts publications originating from any part of the world based only on their scientific merit. The Journal focuses on illustrated articles with great iconographic topics and aims at aiding sharpening clinical decision-making skills as well as following high research topics. All articles are published in English. Diagnostic and Interventional Imaging publishes editorials, technical notes, letters, original and review articles on abdominal, breast, cancer, cardiac, emergency, forensic medicine, head and neck, musculoskeletal, gastrointestinal, genitourinary, interventional, obstetric, pediatric, thoracic and vascular imaging, neuroradiology, nuclear medicine, as well as contrast material, computer developments, health policies and practice, and medical physics relevant to imaging.