超声造影与磁共振弥散加权成像对Ⅰ期子宫内膜癌肌层浸润的对比研究

The study for myometrial invasion of stage Ⅰ endometrial carcinoma by contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging

目的运用超声造影和磁共振弥散加权成像两种技术探讨Ⅰ期子宫内膜癌肌层浸润病灶的图像特征,并对子宫内膜癌进行分期评估。方法运用超声造影和磁共振成像两种技术分别对74例(超声造影组和磁共振成像组各37例)病理证实为Ⅰ期子宫内膜癌伴有肌层浸润患者术前影像表现及诊断准确率进行对比分析。结果 (1)术前超声造影诊断Ⅰa期(3例)、Ⅰb期(17例)和Ⅰc期(11例)子宫内膜癌31例,与病理诊断符合率为83.8%(31/37);31例子宫内膜癌病变超声造影表现:Ⅰa期(3例):病变区子宫内膜呈不均匀性低或等增强,与肌壁分界清,肌壁呈均匀性强化;Ⅰb期(17例):病变区子宫内膜呈不均匀性中等或高增强,与肌壁分界不清,受累肌壁厚度≤1/2肌层厚度;Ⅰc期(11例):病变区子宫内膜呈不均匀性高或中等增强,与肌壁分界不清,受累肌壁厚度>1/2肌层厚度,内膜及受累肌壁增强及消退多早于正常肌壁。(2)术前磁共振弥散加权成像诊断Ⅰa期(3例)、Ⅰb期(18例)和Ⅰc期(10例)子宫内膜癌31例,与病理诊断符合率亦为83.8%(31/37);31例子宫内膜癌病变磁共振弥散加权成像表现:Ⅰa期(3例):病变的子宫内膜呈不均匀高信号,结合带完整;Ⅰb期(18例):病变的子宫内膜呈不均匀高信号,结合带中断且子宫肌层内缘边界不清,受累肌壁呈不均匀性高信号,受累肌壁厚度≤1/2肌层厚度;Ⅰc期(10例):病变的子宫内膜呈不均匀高信号,结合带中断且子宫肌层内缘边界不清,受累肌壁呈不均匀性高信号,受累肌壁厚度>1/2肌层厚度。(3)以病理诊断结果为金标准,术前超声造影与磁共振弥散加权成像评估Ⅰ期子宫内膜癌浸润肌层深度诊断的准确率均为83.8%(31/37)。结论术前正确认识超声造影与磁共振弥散加权成像图像特征有助于正确诊断Ⅰ期子宫内膜癌,超声造影对子宫内膜癌肌层浸润的诊断及术前分期与磁共振弥散加权成像的诊断及术前分期有相同价值。

Objective To explore the image features of stageⅠ endometrial carcinoma with myometrial invasion by contrast-enhanced ultrasound（CEUS） and diffusion-weighted Magnetic Resonance Imaging（MRI）,and to determine the stages of endometrial carcinoma.Methods Seventy-four cases of stageⅠendometrial carcinoma proved by operation and pathology were examined by CEUS（37 cases） or diffusion-weighted MRI（37 cases）.Results（1） Based on CEUS,the tumors were divided into stage Ⅰa（3 cases）,stage Ⅰb（17 cases）,stage Ⅰc（11 cases） before operation.The accuracy of diagnosis by CEUS was 83.8%（31/37）.The CEUS characteristics of endometrial carcinoma were： stage Ⅰa lesions showed the inhomogeneous hypo-enhancement or iso-enhancement,and the boundary between endometrium and myometrium was clear;stageⅠb lesions showed the inhomogeneous iso-enhancement or hyper-enhancement,the boundary between endometrium and myometrium were not clear,and cancerous myometrial invasion was less than 1/2 myometrium;stageⅠc lesions showed inhomogeneous hyper-enhancement or iso-enhancement,the boundary between endometrium and myometrium was not clear,cancerous myometrial invasion was more than 1/2 myometrium,and some of these tumors started to enhance and wash-out earlier than surrounding normal myometrium.（2） Based on diffusion weighted MRI,the tumors were divided into stage Ⅰa（3 cases）,stageⅠb（18 ca es）,and stageⅠc（10 cases） befor operation.The accuracy of diagnosis by diffusion weighted MRI was 83.8%（31/37）too.The characteristics of endometrial carcinoma in diffusion weighted MRI were： stageⅠa lesions showed inhomogeneous hyperintensity signal and the junctional zone were complete;stageⅠb lesions showed inhomogeneous hyperitensity signal,the junctional zone were cut,and cancerous myometrial invasion were less than 1/2 myometrium and showed hyperintensity signal;stageⅠc lesions showed inhomogeneous hyperintensity signal,the junctional zone were cut,cancerous myometrial invasion were more than 1/2 myometrium and showed hyperintensity signal.（3） Prior to operation,the diagnostic accuracy of CEUS and diffusion weighted MRI were both 83.8%（31/37）.Conclusions CEUS and diffusion weighted MRI are helpful for the diagnosis of stageⅠendometrial carcinoma.CEUS has the same value as diffusion weighted MRI in determining the extent of myometrial invasion and pre-operational staging of stageⅠendometrial carcinoma.