多模态MRI在子宫内膜癌分期中的诊断价值

The diagnostic value of multimodality MRI in endometrial carcinoma staging

目的探讨多模态MRI(指融合结构及功能信息成像的MRI检查新技术)对子宫内膜癌分期的准确性及其诊断价值,为术前手术方式的选择和术后预后评估提供先期指导。方法86例术前进行多模态MRI检查,具有完整临床及手术病理资料的子宫内膜癌患者进行回顾性分析,采用双盲法,依据FIGO2009分期标准,将多模态MRI影像学分期结果,与其术后病理组织学结果相对照,采用配对四格表卡方检验,评价多模态MRI对子宫内膜癌准确分期的价值。结果本组86例中,子宫内膜样腺癌57例,占66.3%,浆液性腺癌8例,粘液性腺癌6例,透明细胞癌8例,混合型腺癌4例,腺鳞癌2例,小细胞癌2例。其病理组织学分期结果分别为:67.4%(58/86)为Ⅰ期,其中Ⅰa期40.7%(35/86),Ⅰb期26.7%(23/86),Ⅱ期20.9%(18/86),Ⅲ期8.1%(7/86),Ⅳ期3.5%(3/86)。多模态MRI对Ⅰ~Ⅳ期的分期准确性分别为91.9%(79/86),91.9%(79/86),93%(80/86),97.7%(84/86),总的分期敏感性为92.2%(71/77)、准确性82.6%(71/86)。结论多模态MRI是子宫内膜癌术前临床分期的重要影像学检查工具。FIGO新分期标准对指导临床实践更加简明、合理、实用。

Objective Based on FIGO 2009 staging criteria,the objective of the current study is to explore the accuracy and diagnostic value of multimodality MRI on the endometrial carcinoma(EC)staging,in order to provide advance instruction on preoperative surgical mode selection and postoperative prognosis prediction.Methods Eighty-six patients of EC underwent multimodality MRI examination with complete clinical and surgery pathological records and were recruited into the current study retrospectively.The age of the patients ranged between 24 and 77 years,with an average of 46.3±9.4 years.The lesions were staged and graded by histopathology.The staging results determined by multimodality MRI were compared with that determined by postoperative histopathology.By double-blind method and pairedχ^2 test of four-fold table(McNema test),we evaluated the accuracy of EC staging by multimodality MRI.Results There were 57,8,6,7,4,2,and 2 patients for endometrial adenocarcinoma,serous adenocarcinoma,mucinous adenocarcinoma,clear cell carcinoma,mixed type adenocarcinoma,adenosquamous carcinoma,and small cell carcinoma,respectively.According to the FIGO2009 staging system,there were 58,18,7,and 3 patients with stageⅠ,Ⅱ,Ⅲ,Ⅳrespectively.The accuracies of multimodality MRI for staging from I to IV were 91.9%(79/86),91.9%(79/86),93%(80/86),and 97.7%(84/86),respectively,which was highly consistent to that defined by histopathology(P>0.05).Conclusion Multimodality MRI was one of important imaging assessment for preoperative staging and therapeutic strategy design of EC.FIGO new staging criteria were more concise,reasonable,and practical for clinical guidance.