FLASH-3D动态增强技术在子宫内膜癌检查中的应用

The Application of FLASH-3D Dynamic Contrast-enhanced Technique in Examination of Endometrial Carcinoma

目的探讨FLASH-3D动态增强技术在子宫内膜癌检查中的应用价值及术前分期中的作用。方法前瞻性的对2012年10月-2013年04月间具有完整临床资料及病理组织学证实的子宫内膜癌患者48例,在术前常规MRI检查的基础上,行FLASH-3D动态增强MRI扫描,分析宫壁及肿瘤的MRI动态增强特点,采用双盲法,将FLASH-3D动态增强对子宫内膜癌分期及判断肌层浸润深度的结果,与术后病理组织学FIGO结果对照。结果本组48例中,Ⅰ期34例(Ia22例,Ib12例),Ⅱ期9例,Ⅲ期3例,Ⅳ期2例。FLASH-3D动态增强序列分期准确性为81%(39/48),正确判断深肌层侵犯的敏感性为84%、特异性为90%、准确性为88%、与术后病理组织学结果对照,差异无显著意义(P>0.05)。结论 FLASH-3D动态增强技术在子宫内膜癌早期诊断和术前分期中具有重要作用,能显著提高判断肿瘤肌层浸润深度的准确性,为临床手术方式的选择和术后评估具有指导作用,有望成为女性盆腔肿瘤的常规检查方法。

ObjectiveTo investigate the application value and preoperative staging role of FLASH-3D dynamic contrast-enhanced technique in examination of endometrial carcinoma.Methods From October 2012 to April 2013, the prospective study included 48 patients with complete clinical data and pathologically confirmed endometrial carcinoma. After routine MRI examination, the subjects were underwent FLASH-3D （a fast low angle shot technique with three dimensional fat-suppressed angiographic sequences） dynamic contrast-enhanced examination. The dynamic enhancement features of uterine wall and tumors were analyzed respectively. With a double-blind manner, FLASH-3D preoperative staging and findings in assessing myometrial invasion were compared with the postoperative pathological results. Results 48 cases with pathologically-proven endometrial carcinoma were composed of 34 patients in stage I（Ia 22 cases, Ib 12 cases）, 9 cases in stage II, 3 cases in stage III, 2 cases in stage IV. The staging accuracy for endometrial carcinoma was 81% （39/48） by using FLASH-3D dynamic contrast-enhanced sequence. In the determining of deep myometrial invasion, the sensitivity, specificity and accuracy were 84%, 90%, 88% respectively. There were no significant difference compared with the postoperative results of pathology（p：〉0.05）. Conclusion FLASH-3D dynamic contrast-enhanced technique is valuable for early diagnosis of endometrial carcinoma and assessing preoperative staging. The high accuracy for assessing deep myometrial invasion achieved makes FLASH-3D sequence as an important examination method in selecting the optimal therapeutic protocol and prognosis estimation.