3.0T MRI术前诊断子宫内膜癌肌层浸润的价值

Diagnostic accuracy of 3.0-T MRI routine scanning combined with diffusion-weighted imaging in preoperative assessment of myometrial infiltration in endometrial cancer

目的:探讨和评价3.0T MRI常规序列结合弥散加权成像(DWI)术前判断子宫内膜癌肌层浸润的准确率及其临床应用价值。方法:术前对50例病理证实为子宫内膜癌的患者行3.0T MRI检查,由2位放射科医师分别采用T2加权成像(T2WI)、DWI、动态对比增强(DCE)、T2WI与DWI(T2WI-DWI)融合图像(b=1 000 s/mm2)分析肿瘤肌层浸润深度,并与手术病理对照。结果:医师对T2WI-DWI融合图像的阅片一致性好(K=0.904),且在肌层浸润深度方面与病理检查结果有较好的相关性(r=0.923,P<0.001)。T2WI-DWI融合图像对于肿瘤浸润子宫肌层的判断明显优于T2WI、DCE、DWI图像(P均<0.05)。T2WI-DWI融合图像和DCE图像对于肿瘤浸润子宫深肌层判断均优于T2WI和DWI图像(P均<0.05)。T2WI-DWI、DCE诊断肿瘤浸润子宫深肌层灵敏度、特异度和准确率分别为91%、97%、96%和100%、95%、95%,而两者判断肿瘤浸润子宫深肌层方面差异无统计学意义(P>0.05)。肿瘤的平均表观弥散系数(ADC)值为0.92×10-3mm2/s,其与肿瘤侵犯肌层的深度间无明显相关性(r=-0.18,P=0.32)。结论:T2WI与高b值DWI融合图像对于术前诊断子宫内膜癌肌层浸润能提供准确信息。T2WI与高b值DWI融合图像和DCE图像均可作为优选序列来用于判断子宫内膜癌深肌层的浸润情况。

Objective To study the diagnostic accuracy of 3.0-T MRI routine scanning combined with diffusion-weighted image（DWI） for the preoperative evaluation of myometrial infiltration in endometrial cancer.Methods Fifty patients（mean age 56 years） with pathologically proved endometrial cancer who had undertaken 3.0-T MRI preoperatively were enrolled.Two radiologist interpreted the depth of myometrial infiltration by using T2-weighted imaging（T2WI）,DWI,dynamic contrast enhanced（DCE） imaging,fused T2WI and DWI（b=1 000 sec/mm2） imaging and then compared with the surgical pathologic finding.Results The reading consistency of fused T2WI and DWI imaging was excellent（K= 0.904）,and a significant correlation with pathologic finding in depth of myometrial infiltration was seen（r =0.923,P 0.001）.For assessing myometrial infiltration,fused T2WI and DWI imaging was significantly better than T2WI,DCE and DWI（P0.05）.For assessing the infiltration of deep myometrium,fused T2WI and DWI imaging and DCE imaging both were better than T2WI and DWI（P0.05）.No significant difference was found between fused T2WI and DWI imaging and DCE imaging for assessing the infiltration of deep myometrium（P0.05）.The mean apparent diffusion coefficients were 0.92×10-3mm2/sec,with no significant correlation with depth of myometrial infiltration（r=-0.18 P=0.32）.Conclusions Fused T2WI and high b value DWI imaging can provide accurate information for preoperative assessment of myometrial infiltration.Fused T2WI and high b value DWI imaging and DCE imaging both can be selected for assessing the infiltration of deep myometrium.