多参数MRI对子宫肉瘤与良性子宫肌瘤的鉴别诊断价值及与肿瘤细胞恶性程度的关系

doi:10.7517/issn.1674-0475.200613

摘要/Abstract

摘要： 本文选取子宫肉瘤（US）患者103例作为观察组，另选取同期良性子宫肌瘤患者103例作为对照组，探究多参数MRI对US与良性子宫肌瘤的鉴别诊断效果及与肿瘤细胞恶性程度的关系。结果发现，观察组达峰时间（TTP）、扩散系数（ADC）低于对照组；随临床分期增加，TTP、ADC呈下降趋势，TopoⅡα、AgNOR、PDGFα、Matriptase mRNA相对表达量呈升高趋势，TTP、ADC与TopoⅡα、AgNOR、PDGFα、Matriptase mRNA相对表达量呈负相关，且TTP、ADC联合鉴别诊断US和良性子宫肌瘤的AUC值最大，提示US与良性子宫肌瘤MRI参数存在显著差异，且TTP、ADC值与增殖分子、侵袭分子活性直接相关，可为临床鉴别诊断提供数据支持。

关键词: MRI, 子宫肉瘤, 子宫肌瘤, 肿瘤细胞, Matriptase, Topoip, 增殖分子

Abstract: In this research, 103 uterine sarcoma (US) patients were selected as the observation group, and 103 patients with benign uterine fibroids were selected as the control group. The value of MRI multi-parameters in the differential diagnosis of US and benign uterine fibroids were explored, as well as the relationship between the MRI parameters and the malignancy of tumor cells. The time to peak (TTP) and apparent diffusion coefficient (ADC) of the observation group were lower than those of the control group. TTP and ADC showed a downward trend with the increase of clinical stage, while the relative expression of TopoⅡα, AgNOR, PDGFα, and Matriptase mRNA showed an increasing trend with the increase of clinical stage. TP, ADC were negatively correlated with TopoⅡα, AgNOR, PDGFα and Matriptase mRNA relative expression. And the combined AUC value of TTP and ADC was the largest in differential diagnosis of US and benign uterine fibroids. These results indicated that there were significant differences in MRI parameters between US and benign uterine fibroids. TTP and ADC values are directly related to the activities of proliferation molecules and invasion molecules, which can provide data support for clinical differential diagnosis.

Key words: MRI, uterine sarcoma, uterine fibroids, tumor cells, matriptase, TopoⅡα, proliferation molecules

卜岛, 韩茜茜. 多参数MRI对子宫肉瘤与良性子宫肌瘤的鉴别诊断价值及与肿瘤细胞恶性程度的关系[J]. 影像科学与光化学, 2021, 39(1): 81-86.

BU Dao, HAN Qianqian. The Value of Multi-parameter MRI in the Differential Diagnosis of Uterine Sarcoma and Benign Uterine Fibroids and the Relationship with the Malignant Degree of Tumor Cells[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2021, 39(1): 81-86.

参考文献

[1] Chiang S, Cotzia P, Hyman D M, et al. NTRK fusions define a novel uterine sarcoma subtype with features of fibrosarcoma[J]. American Journal of Surgical Pathology, 2018, 42(6):791-798.
[2] 谢伟民, 杨佳欣. 高级别子宫内膜间质肉瘤的研究进展[J]. 中华妇产科杂志, 2017, 52(4):286-288.
[3] 陈苑, 程敬亮, 白洁, 等. DWI及动态增强MRI鉴别诊断Ⅰ别期子宫内膜癌与子宫内膜息肉[J]. 中国医学影像技术, 2017, 33(1):70-74.
[4] 刘柳恒, 吕富荣, 肖智博, 等. 动态增强MRI定量参数与高强度聚焦超声消融子宫肌瘤疗效的相关性研究[J]. 临床放射学杂志, 2017, 36(7):1024-1028.
[5] Akimoto E, Kadoya T, Kajitani K, et al. Role of 18F-PET/CT in predicting prognosis of patients with breast cancer after neoadjuvant chemotherapy[J]. Clinical Breast Cancer, 2018, 18(1):45-52.
[6] 中国抗癌协会妇科肿瘤专业委员会. 子宫肉瘤诊断与治疗指南(第四版)[J]. 中国实用妇科与产科杂志, 2018, 34(10):1106-1110.
[7] 子宫肌瘤的诊治中国专家共识专家组, 妇产科相关专家组. 子宫肌瘤的诊治中国专家共识[J]. 中华妇产科杂志, 2017, 52(12):793-800.
[8] Rao N, Qiu J, Wu J, et al. Significance of tumor-infiltrating lymphocytes and the expression of topoisomerase Ⅱα in the prediction of the clinical outcome of patients with triple-negative breast cancer after taxane-anthracycline-based neoadjuvant chemotherapy[J]. Chemotherapy, 2017, 62(4):246-255.
[9] Multinu F, Casarin J, Tortorella L, et al. Incidence of sarcoma in patients undergoing hysterectomy for benign indications:a population-based study[J]. American Journal of Obstetrics and Gynecology, 2019, 220(2):179. e1-179. e10.
[10] 王琳, 杜晶, 方华, 等. 乳腺病灶超声造影特征及定量分析联合应用与动态增强MRI诊断效能的比较研究[J]. 中国超声医学杂志, 2017, 33(6):505-508.
[11] 杨晶, 杨国财, 刘金昊. 动态增强MRI定量参数与乳腺癌生物因子的相关性[J]. 中国介入影像与治疗学, 2018, 15(2):86-89.
[12] Zhu J J, Qi H, Cai L R, et al. C-banding and AgNOR-staining were still effective complementary methods to indentify chromosomal heteromorphisms and some structural abnormalities in prenatal diagnosis[J]. Molecular Cytogenetics, 2019, 12(1):41.
[13] 蔡丽, 曹参. 子宫肉瘤动态增强MRI参数与病灶内肉瘤细胞增殖、侵袭的相关性研究[J]. 海南医学院学报, 2018, 24(8):881-884.
[14] 王月华, 蒋林哲, 鞠晓红, 等. 人类表皮生长因子受体2和拓扑异构酶Ⅱα在结肠癌中的表达及意义[J]. 中国老年学杂志, 2019, 39(18):4442-4444.
[15] 郭继文, 胡友. 基底细胞样型乳腺癌组织中TOPOⅡα的表达及意义[J]. 深圳中西医结合杂志, 2017, 27(23):10-12.
[16] Lanchec E, Désilets A, Béliveau F, et al. The type Ⅱ transmembrane serine protease matriptase cleaves the amyloid precursor protein and reduces its processing to β amyloid[J]. Journal of Biological Chemistry, 2017, 292(50):20669-20682.
[17] 赵莲, 郑子阳, 钟敏. 血清SE-CAD与Matriptase在急性髓系白血病患者中的表达水平及其临床意义[J]. 中国实验血液学杂志, 2019, 27(3):753-757.
[18] 杜晗, 刘慧萍, 王巍, 等. 上皮性卵巢癌组织中matriptase表达及临床意义[J]. 中华实用诊断与治疗杂志, 2019, 33(4):375-377.
[19] Xu R, Ji J, Zhang X, et al. PDGFA/PDGFRα-regulated GOLM1 promotes human glioma progression through activation of AKT[J]. Journal of Experimental & Clinical Cancer Research, 2017, 36(1):193.
[20] 刘音, 宁文虎, 申星花, 等. 细胞因子-基质金属蛋白酶轴促进小鼠血管内膜增生的机制研究[J]. 中华心血管病杂志, 2016, 44(11):961-967.
[21] 陈小凤, 范伟雄, 陈湘光, 等. 定量DCE-MRI参数联合ADC值评估乳腺浸润性导管癌的组织分级[J]. 实用放射学杂志, 2019, 35(7):1058-1061.
[22] 汤文瑞, 张焱, 程敬亮, 等. DCE-MRI和DWI对骶骨脊索瘤与骨巨细胞瘤的鉴别诊断价值[J]. 放射学实践, 2018, 33(3):280-284.