FIGOⅠ Ⅱ期子宫内膜癌MRI征象分析与评价

Analysis and evaluation of MRI features in FIGO Stage Ⅰ and Ⅱ endometrial carcinoma

目的:按照FIGO2009分期标准,分析ⅠⅡ期子宫内膜癌的MRI征象及其病理基础,评价MRI对子宫内膜癌肌层和宫颈侵犯的诊断价值。方法:43例ⅠⅡ期子宫内膜癌患者术前均行MRI检查,采用双盲法,描述肿瘤的MRI表现特征,并将MRI术前分期及判断肌层和宫颈浸润结果,与术后病理结果对照分析。结果:Ⅰa 26例,Ⅰb 8例,Ⅱ期9例。Ⅰ期MRI主要表现为子宫内膜增厚、腔内局限型或弥漫性软组织肿块呈中等强化、T2WI低信号结合带中断及肌层侵犯等,其病理基础为癌细胞呈腺样乳突状结构,突破粘膜层,向肌壁间浸润性生长。Ⅱ期以宫颈内出现与宫体肿瘤相连续的异常信号影及宫颈纤维间质破坏为特征。MRI评价肿瘤浸润肌层深度的诊断准确性为86%,判断宫颈侵犯的敏感性、特异性、准确性分别为78%、91%、88%,与病理结果比较无显著性差异(P>0.05)。结论:MRI对Ⅰ、Ⅱ期子宫内膜癌的早期诊断、肌层和宫颈侵犯的判断及术前分期准确性高,具有较高的临床应用价值。

Objective：According to FIGO 2009 staging standard of endometrial carcinoma,MRI features and their pathological basis were analyzed for stage Ⅰ and Ⅱ endometrial carcinoma,and the diagnostic value of MRI was evaluated in assessing myometrial invasion and cervical involvement of endometrial carcinoma.Methods：43 cases of stage Ⅰ and Ⅱ endometrial carcinoma were performed preoperative MRI examination.In a double-blind manner,to describe the MRI performance characteristics of tumors,MRI preoperative staging and findings in assessing myometrial and cervical invasion were compared with the postoperative pathological results.Results：43 cases with pathologically-proven endometrial carcinoma were composed of stage Ⅰa 26 cases,Ⅰb 8 cases,Ⅱ 9 cases.The main MRI signs with stage Ⅰ endometrial carcinoma showed endometrial thickening,localized or diffuse soft tissue mass showed moderate enhancement in the endometrial cavity,the junctional zone（JZ） with low signal on T2WI interruption,and myometrial invasion.The pathological basis for such MRI features was that the endometrial carcinoma cells showing adenoid and papillary structure broke through the mucosal layer to the uterine myometrium by the intramural infiltrating growth.The characteristics of stage Ⅱ endometrial carcinoma were that the intracervical tumor signals were observed and consecutive with the tumor signals in the uterine body.The diagnostic accuracy of MRI on evaluation of tumor infiltration myometrial depth was 86%.The sensitivity,specificity and accuracy were 78%,91%,88% respectively for assessing cervical involvement.There were no significant difference compared with the results of pathology（P0.05）.Conclusion：MRI is accurate and reliable for stage Ⅰ and Ⅱ endometrial carcinoma in early diagnosis,assessing myometria1and cervical invasion,and preoperative staging.MRI has high value of clinical application.