R2*值预估子宫内膜样腺癌病理分级的价值

R2* Value in Predicting the Pathologic Grade of Endometrial Adenocarcinoma

目的探讨增强T2*加权血管成像(ESWAN)序列的R2*值预估子宫内膜样腺癌(EA)病理分级的价值,以期准确判断EA分级,指导临床治疗。资料与方法回顾性分析在1.5T MRI行ESWAN序列检查并经手术病理证实为EA的82例患者,按照病理分级分为3组,其中高分化组37例,中分化组28例,低分化组17例。由2位观察者分别测量各组EA病灶实质区的R2*值,检验2位观察者测量数据的一致性,分析R2*值与EA病理级别的相关性,对不同级别EA的R2*值进行组间两两比较,评估R2*值预估不同病理级别组EA的效能,并找出相应界值。结果 2位观察者测量各组数据的一致性较高(ICC>0.75)。R2*值与EA病理级别呈弱相关(r=0.464,P<0.001),高、中、低分化组EA的R2*值分别为(12.54±2.75)Hz、(13.08±2.92)Hz、(18.71±3.80)Hz,高、低分化组间及中、低分化组间差异有统计学意义(P<0.001),高、中分化组间差异无统计学意义(P>0.05)。R2*值预估低分化EA的曲线下面积为0.893,R2*值≥16.17 Hz为其界值,敏感度82.4%,特异度87.7%。结论 R2*值可以作为非强化方式预估低分化EA的定量指标,有很好的应用前景。

Purpose To investigate the feasibility of R2＊ value generated from enhanced T2 star-weighted angiography（ESWAN） sequence in evaluating the pathological grade of endometrial adenocarcinoma（EA）, in order to grade the EA accurately and to guide clinical treatment. Materials and Methods Imaging data of 82 EA cases confirmed by pathology were retrospectively analyzed. MRI scan including ESWAN sequence was performed on a 1.5T scanner. The patients were classified into three groups as follows according to the pathological grade： 37 in well differentiated group, 28 in moderately differentiated group, and 17 in poorly differentiated group. The R2＊ values of EA tumors were measured by two observers, and the consistency of the two observers was tested. The correlation between R2＊ value and pathological grade was analyzed. The R2＊ values of different pathological grades were compared. The efficacy of R2＊ value in predicting the different pathological grade was evaluated to find out the corresponding threshold. Results The consistency of two observers was good（ICC0.75）. The R2＊ value was weak correlated with the pathological grade of EA（r=0.464, P0.001）. The R2＊ values of well, moderately, and poorly differentiated groups were（12.54±2.75）Hz,（13.08±2.92）Hz, and（18.71±3.80）Hz, respectively. There was statistic difference of R2＊ values between well and poorly group as well as moderately and poorly group（P0.001）, while there was no statistic difference of R2＊ values between well and moderately group（P0.05）. The Area Under Curve of R2＊value for diagnosis of poorly differentiated EA was 0.893, and the cut off value was ≥ 16.17 Hz with sensitivity of 82.4% and the specificity of 87.7%. Conclusion R2＊ value can be used as a non-enhancement quantitative index for determining the poorly differentiated EA, which has a good application prospect.