磁共振成像在子宫内膜癌术前评估中的价值

Value of magnetic resonance imaging in preoperative assessment of endometrial carcinoma

目的:探讨磁共振成像(MRI)在子宫内膜癌术前评估中的价值。方法:对65例初次治疗的子宫内膜癌患者术前行MRI检查,进行术前评估,并与术后手术-病理分期进行对照研究。结果:MRI诊断肿瘤肌层浸润深度的准确率为84.8%,MRI对肿瘤局限在子宫内膜和浅肌层浸润的诊断敏感性、特异性、准确性分别为83.3%、92.6%、90.9%和82.4%、87.5%、84.8%。MRI鉴别浅表浸润(Ⅰa+Ⅰb)与深肌层浸润(Ⅰc)的准确性为93.9%,对深肌层浸润的诊断敏感性、特异性分别为90%、95.6%。MRI对宫颈间质受累诊断的敏感性、特异性、准确率分别为86.7%、100%、96.9%;对宫颈管内膜受累诊断的敏感性仅为40%,特异性、准确率分别为96.7%、92.3%。MRI对判断淋巴结转移的敏感性、特异性、准确率分别为50%、96.5%、90.8%。结论:MRI在判断子宫内膜癌肌层浸润深度及宫颈间质侵犯,尤其是深肌层浸润方面具有较高的价值,而MRI诊断子宫颈内膜受累和淋巴结转移敏感性不高,但具有一定的预测价值。

Objective： To explore the value of magnetic resonance imaging （MRI） in preoperative evaluation of endometrial carcinoma. Methods： 65 cases primarily treated were assessed by MRI preoperatively, the results were compared to operation - pathologic staging. Results： The accuracy of MRI in assessing the depth of myometrial invasion was 84. 8%. The sensitivity, specificity and accuracy of MRI assessment for tumor confined to endometrium, superficial myometrial invasion were 83.3%, 92. 6%, 90. 9% and 82.4% , 87.5%, 84. 8% , respectively. The accuracy of MRI in distinguishing the infiltration of superficial myometrium （ I a ＋ I b） and deep - myometrium （ I c） was 93.9%. The sensitivity and specificity of MRI assessment for deep - myometrial invasion were 90% and 95.6% , respectively. The sensitivity, specificity and accuracy of MRI assessment for cervical endometrial invasion, cervical stromal invasion and lymph node invasion were 40%, 96. 7%, 92. 3% ; 86. 7%, 100%, 96. 9% ; 50%, 96. 5%, 90. 8%, respectively. Conclusion： MRI is a valuable technique in assessing the depth of myometrial invasion and cervical stromal invasion of endometrial carcinoma, especially in deep - myometrial invasion. MRI has a certain predictive value in the assessment of infiltration of cervical endometrium and pelvic lymph nodes although its sensitivity is not so satisfied.