不同影像学方法判断子宫内膜癌肌层浸润比较

Comparison of various imaging diagnostics in estimation of infiltrating colepitril-myometrium in endometrial cancer

目的比较3种影像学方法术前判断子宫内膜癌肌层浸润的准确性,为提高子宫内膜癌术前诊断水平提供参考。方法术前诊断为子宫内膜癌并接受彩色多普勒超声(US)检查的患者41例,其中29例同时接受MRI检查,12例同时接受CT检查,所有患者均接受手术治疗。将患者术前检查结果与术后病理诊断进行比较。结果US、CT和MRI检查术前判断子宫肌层浸润的准确率分别为58．5%、75．0%和93．1%,肌层浸润深度的敏感性为54．1%、72．7%和92．6%,MRI与US检查的差异均有显著性(P值均＜0．01)。MRI和US检查判断深度浸润肌层的精确性优于CT检查,但差异无显著性(P＞0．05)；MRI检查判断浅肌层浸润的精确性显著优于US检查(P＜0．01)；当无肌层浸润时,MRI检查优于US和CT检查,但差异无显著性(P＞0．05)。结论US和MRI检查术前判断子宫肌层浸润优于CT检查。对于子宫肌层浸润的精确度,特别是US检查不易发现的极浅肌层浸润,MRI检查优于US检查。MRI检查术前判断子宫内膜癌肌层浸润具有优越性,MRI检查增强扫描的优越性更为突出,对特殊病例或怀疑宫腔外转移的病例可作为首选。

Objective Comparing the accuracies of the estimation for infiltrating depth of myometrium by various imaging diagnostics as US, CT and MRI to promote the preoperative diagnostic level in endometrial cancer. Methods Comparing the results obtained from postoperative histopathological examination and pre-operative ima- ging diagnostics to obtain the accuracy and effectiveness of various imaging diagnostics for myometrial invasion depth in endometrial cancer. Among the 41 patients, 29 of them received Doppler US and MRI, another 12 received Doppler US and CT before operation. Results The study showed that the accuracy and sensitivity of various imaging diagnostic methods for the estimation of myometrial invasion depth of endometrial cancer were as follows： US 58.5%, CT 75.0%, and MRI 93.1%. The specificities were 54.1%, 72.7% and 92.6% respectively, those of MRI and US showed significant difference （P〈0.01 ）. MRI and US were superior to CT in estimating the depth of muscle infiltration, but with no significant difference （P 〉 0.05） MRI was more accurate in estimating superficial muscular infiltration than that of US （P 〈 0.01） ; MRI was superior to US and CT under absence of muscular infiltration, but with no significant difference （P 〉 0.05）. but the specificity was the same. Conclusion Doppler US and MRI give a better estimation over CT on demonstration of myometrial invasion depth of endometrial cancer. MRI is superior to US（P 〈 0.01） in the detection of myometrial invasion depth of myometrium of the endometrial cancer. Assessment of myometrial invasion by plain and gadolinium-enhaneed MR imaging ought to be first choice.