Volume 4,Issue 7
MRI影像组学结合临床分类诊断宫颈癌FIGO2A期和2B期
目的 构建一个基于多参数磁共振（MRI）影像组学特征的模型，结合临床危险因素融合模型评估其术前预测宫颈癌ⅡA期和ⅡB期的价值。材料与方法 回顾性收集西北妇女儿童医院89例术前行MRI检查并经手术病理证实的ⅡA期和ⅡB期宫颈癌患者的临床和MRI资料，在MRI轴位T2WI压脂序列和DWI序列上，逐层手动勾画病灶及同层宫颈所在区域，提取影像组学特征，构建并筛选出最佳的影像组学模型，再将筛选出的有意义的临床和实验室指标与影像组学融合构建联合模型。结果 DWI序列（病灶和宫颈区域）分期模型的受试者工作特征曲线下面积（Area Under Curve，AUC）分别为0.856、0.865；T2WI压脂序列（病灶和宫颈区域）分期模型的受试者工作特征曲线下面积（Area Under Curve，AUC）分别为0.827、0.842。多因素分析结果显示，鳞状细胞癌抗原（SCCA）是宫颈癌患者ⅡA期和ⅡB分期预测的独立危险因素（P＜0.05），联合预测因子AUC为0.839。最优 融合模型AUC为0.933，预测效能优于影像组学预测模型和临床特征模型。结论 多参数MRI影像组学特征联合临床因素构建的融合模型，有助于临床评估分期并制定个体化治疗方案。
[1]Sung Hyuna;Ferlay Jacques;Siegel Rebecca L.;Laversanne Mathieu;Soerjomataram Isabelle;Jemal Ahmedin;Bray Freddie.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries[J].CA: A Cancer Journal for Clinicians,2021(3):209-249.
[2]Zhang Xiaojing;;Lv Zunfu;;Xu Xiaoxian;;Yin Zhuomin;;Lou Hanmei.Comparison of adenocarcinoma and adenosquamous carcinoma prognoses in Chinese patients with FIGO stage IB-IIA cervical cancer following radical surgery.[J].BMC cancer,2020(1):664.
[3]Siegel Rebecca L;;Miller Kimberly D;;Jemal Ahmedin.Cancer statistics, 2018.[J].CA: a cancer journal for clinicians,2018(1):7-30.
[4]苏兰芳,刘越雄,万江花,刘旭东.动态增强MRI与DWI在中老年宫颈癌分期诊断中的价值比较[J].中国老年学杂志,2022(07):56-59.
[5]Maarten G. Thomeer;Cees Gerestein;Sandra Spronk;Helena C. Doorn;Els Ham;Myriam G. Hunink.Clinical examination versus magnetic resonance imaging in the pretreatment staging of cervical carcinoma: systematic review and meta-analysis[J].European Radiology,2013(7).
[6]Wang W, Jiao Y, Zhang L, et al. Multiparametric MRI-based radiomics analysis: differentiation of subtypes of cervical cancer in the early stage[J]. Acta Radiol, 2022, 63(6): 847-856. DOI: 10.1177/02841851211014188.
[7]田士峰, 刘爱连, 郭妍, 等. 基于扩散峰度成像序列平均扩散峰度图的影像组学鉴别宫颈鳞癌与腺癌的应用[J].中国医学影像学杂志, 2021, 29(7): 716-720. DOI: 10.3969/j.issn.1005-5185.2021.07.015.
[8]Yan L, Yao H, Long R, et al. A preoperative radiomics model for the identification of lymph node metastasis in patients with early-stage cervical squamous cell carcinoma[J]. Br J Radiol,2020, 93(1116): 20200358. DOI: 10.1259/bjr. 20200358.
[9]Xia X, Li D, Du W, et al. Radiomics based on nomogram predict pelvic lymphnode metastasis in early-stage cervical cancer[J]. Diagnostics (Basel), 2022, 12(10): 2446. DOI:10.3390/diagnostics12102446.
[10]Du W, Wang Y, Li D, et al. Preoperative prediction of lymphovascular space invasion in cervical cancer with radiomics-based nomogram[J]. Front Oncol, 2021, 11:637794. DOI: 10.3389/fonc.2021.637794.
[11]Cui L, Yu T, Kan Y, et al. Multi-parametric MRI-based peritumoral radiomics on prediction of lymph-vascular space invasion in early-stage cervical cancer[J]. Diagn Interv Radiol, 2022, 28(4): 312-321. DOI: 10.5152/dir.2022.20657.
[12]包美静,贾荣霞,石贽堃,等.老年女性阴道微生物特点与HPV感染及宫颈病变的研究进展[J].中国老年学杂志,2023,43(10):2538-2543.
[13]吴璐娟.ADC值及IVIM-DWI定量参数对FIGO Ⅱ期宫颈癌宫旁浸润的诊断效能[J].中国医疗器械信息,2023,29(22):116-118.DOI:10.15971/j.cnki.cmdi.2023.22.040.
[14]Mongula JE,Bakers FC,Mihl C,et al.Assessment of parametrial invasion of cervical carcinoma,the role of T2-weighted MRIand diffusion weighted imaging with or without fusion[J].Clin Radiol,2019(74):790-796.
[15]刘沁峰,刘伟军,王云鹏,等. 基于医学工程学的放射组学研究应用探讨 [J]. 中国医疗设备, 2019, 34 (11): 165-168+176.
[16]Gillies RJ,Kinahan PE,Hricak H.Radiomics:images are more than pictures,they are data[J].Radiology,2016,278(2):563-577.
[17]余滢,金艺林,罗心一,等.基于肺癌CT建立淋巴结转移的诺莫图预测模型研究[J].中国医疗设备,2020,35(5):100-103.
[18]陈倩，钱伟亮，张继斌，等.分段读出平面回波成像与单次激发平面回波成像DWI序列ADC值在评估子宫内膜癌肌层浸润中的对比分析[J].放射学实践，2023,38:738-743.
[19]He Y,Wang M,Yi S,et al.Diffusion-weighted imaging in the assessment of cervical cancer:comparison of reduced field-of-view diffusion-weighted imaging and conventional techniques[J].Acta Radiol,2023,64:2485-2491.
[20]林娟,陈文春,姜剑榕,等. MRI平扫联合DWI对宫颈癌术前病理分期及宫旁浸润的评估价值分析 [J]. 临床放射学杂志, 2025, 44 (05): 914-918. DOI:10.13437/j.cnki.jcr.2025.05.021.
[21]Li W,Mouli SK.Editorial for “Diffusion-Weighted Imaging of the Abdomen:Correction for Gradient Nonlinearity Bias in Apparent Diffusion Coefficient”[J].J Magn Reson Imaging,2023,58:232-233.
[22]魏荣富,陈晓萍. MRI联合血清SCCA、CA125对宫颈癌的诊断意义 [J]. 中国CT和MRI杂志, 2020, 18 (07): 97-99.
[23] Yoon SM,Shin KH,Kim JY,et al.The clinical values of squamous cell carcinoma antigen and carcinoembryonic antigen in patients with cervical cancer treated with concurrent chemoradiotherapy[J].Int J Gynecol Cancer,2007,17(4):872-878.
[24]乔晓亮.血浆纤维蛋白原和鳞状细胞癌抗原在宫颈癌中的临床价值[J].安徽医药,2018,22(6):1123-1125.
[25]叶辉霞,李小毛,邓柳枝,等.CA125在子宫内膜癌诊断预测中的价值[J].广东医学,2014,35(16):2562-2563.
[26]白朝怡,王颖梅,滕飞,等.血清人附睾分泌蛋白E4及CA125联合检测对子宫内膜癌淋巴结转移的预测价值[J].中华妇产科杂志,2014,49(7):543-546.