三维肝脏容积超快速采集MR动态增强扫描及其定量数据对子宫内膜癌的诊断价值

Diagnostic value of dynamic contrast-enhanced MRI in the staging of endometrial cancer

目的 探讨子宫内膜癌MRI动态增强数据及曲线类型对诊断、分期的价值.方法 回顾性分析经分段诊断性刮宫证实为子宫内膜癌的55例患者MRI动态增强表现,绘制病灶区及邻近正常组织的动态增强时间-信号曲线（TIC）,测量及计算动态早期相对信号增强率（ARSI％）、最大相对信号增强率（MRSI％）和总体相对信号增强率（SER％）,并对曲线分型,对不同征象分组间MRSI％的差异行独立样本t检验,ARSI％和SER％的差异行Mann-Whitney U检验.结果 病灶动态增强扫描早期信号强度为716 ±215,正常组织为894±355,差异有统计学意义（t=-2.911,P＜0.01）；病灶动态增强扫描晚期强化率为803±289,正常组织为1111±289,差异有统计学意义（t=-4.926,P＜ 0.01）.低分化组16例患者ARSI％（中位数为1.07％）高于中高分化组的39例（中位数为0.36％）,深肌层浸润组19例的ARSI％（中位数为0.76％）高于无或浅肌层浸润组36例患者（中位数为0.32％）,宫颈受累组27例患者的ARSI％（中位数为0.84％）高于未受累组的28例患者（中位数为0.25％）,宫颈受累组SER％（中位数为2.90％）高于未受累组（中位数为1.40％）,宫旁及其他组织受侵、转移组7例患者的SER％（中位数为2.03％）高于局限在子宫内组48例患者（中位数为1.60％）,差异有统计学意义（Z值分别为-2.038、-2.260、-2.172、-2.695及-2.621,P值均＜0.05）.病灶区动态增强曲线：I型13例（13/55）,Ⅱ型22例（22/55）,Ⅲ型9例（9/55）,Ⅳ型11例（11/55）.结论 MR动态增强扫描能定量分析子宫内膜癌在各阶段的强化特点,根据其TIC及定量数据可以进一步判断预后、指导分期.

Objective To explore the relationship between the characteristics of dynamic contrastenhanced MRI （DCE-MRI） and the stages of endometrial cancer.Methods A retrospective analysis of DCE-MRI manifestation in 55 patients with scratch-pathologically confirmed endometrial cancer was performed.All patients were divided into different groups according to differentiation,muscle layer infiltration,cervix involvement and metastasis.The enhanced rate,including the arterial phase relative signal increase ratio （ARSI%）,the maximal relative signal increase ratio （MRSI%） and the signal enhancement ratio （SER%）,was calculated at different time （i.e.16 s,32 s,48 s,64 s and 300 s）,respectively.Time-intensity curves （TIC） of lesions were also obtained and divided into 4 subtypes.Two sample t test was performed to compare the MRSI% among groups,and the Mann-Whitney U test was performed in ARSI% and SER% as well.Results The early phase enhanced rate of normal tissue was 894 ± 355,higher than that of tumor 716 ± 215 （t =-2.911,P 〈 0.01）.The delayed phase enhanced rate of normal tissue was 1111 ± 289,higher than that of tumor 803-± 289 （t =-4.926,P 〈 0.01）.ARSI% of low differentiation group （n =16,M =1.07%） was higher than that of middle to high differentiation group （n =39,M=0.36%）.ARSI% of deep muscle layer infiltration group （n =19,M =0.76%） was higher than that of no muscle layer infiltration group （n =36,M =0.32%）.ARSI% of cervix involvement group （n =27,M =0.84%） was higher than that of no cervix involvement group （n =28,M =0.25%）.SER% of cervix involvement group （n =27,M =2.90%） was higher than that of no involvement group （n =28,M =1.40%） and SER% of parauterine involvement and metastasis group （n =7,M =2.03%） was higher than that of uterine involvement group （n =48,M =1.60%）.The differences between these groups were statistically significant （Z =-2.038,-2.260,-2.172,-2.695 and-2.621 respectively,P 〈 0.05）.Based on the TIC types,type Ⅰ occurred in 13 tumors （23.6%）,type Ⅱ in 22 tumors （40%）,type Ⅲ in 9 tumors （16.4%）,and type Ⅳ in 11 tumors （20%）.Conclusions Based on TIC curves,most of endometrial cancers showed significant enhancement which reflected of their rich blood supply.The parameters of DCE-MRI is helpful in staging of uterus tumors.