不同月经状态女性正常子宫动态增强MRI定量参数变化特性及其临床意义

Changes of quantitative parameters of dynamic contrast-enhanced MRI in normal uterus of women with different menstrual states and clinical significance

目的探讨不同月经状态女性正常子宫动态增强MRI定量参数值的特点及其临床意义。方法收集我院46例不同月经状态女性资料,均行动态增强MR检查,测量子宫内膜、结合带及肌层定量参数值,包括体积转运常数(Ktrans)、速率转运常数(Kep)及体积分数(Ve)。根据不同月经状态将受试者分为绝经前[增殖期(n=16)、分泌期(n=16)]和绝经后(n=14)。采用单因素方差或秩和检验比较子宫不同层面、不同月经状态的定量参数。结果相同子宫层面,不同月经状态子宫内膜Ktrans、Kep值及子宫结合带Ve值总体比较差异有统计学意义(P均<0.05);子宫内膜绝经后Ktrans、Kep值与分泌期和增殖期、分泌期Kep值与增殖期差异均有统计学意义(P均<0.05);结合带增殖期Ve值与绝经后间差异有统计学意义(P<0.05)。相同的月经状态,子宫内膜、结合带及肌层的Ktrans值、Kep值及Ve值差异均有统计学意义(P均<0.05);子宫各层面分泌期Ktrans值两两比较差异均有统计学意义(P均<0.05),子宫结合带和肌层的增殖期和绝经后Ktrans值与子宫内膜同一月经状态差异有统计学意义(P均<0.05);除绝经后结合带与肌层间Kep值差异无统计学意义,子宫各层面同一月经状态Kep值两两比较差异均有统计学意义(P<0.05)。结论采用动态增强MRI定量参数评判子宫疾病时应考虑不同月经状态下Ktrans、Kep和Ve的变化。

Objective To investigate the changes and clinical significance of quantitative parameters of dynamic contrast-enhanced MRI in normal uterus of women during different menstrual states. Methods Totally 46 women with different menstrual states who underwent dynamic contrast-enhanced MRI were divided into premenopausal phase(proliferative phase [n=16], secretory phase [n=16]) and postmenopausal phase(n=14) according to different menstrual states. The quantitative parameters(Ktrans, Kep and Ve) of endometrium, junctional zone and myometrium were measured. One-way ANOVA or rank sum test was used to compare the quantitative parameters with different uterus structures and menstrual states. Results The Ktrans value and Kep value of endometrium between the same menstrual states were statistically significant(all P<0.05). There were significant differences of Ktrans, Kep, in secretory phase, proliferative phase and postmenopausal phase, Kep in secretory phase and proliferative phase(P<0.05). There was statistically significant difference of Ve in junctional zone between proliferative phase and postmenopausal phase(P<0.05). There were significant differences in Ktrans, Kep and Ve among endometrium, junctional zone and myometrium under the same menstrual state(all P<0.05). The Ktrans was statistically significant during the secretory phase(all P<0.05). There was no significant difference in Kep between the junctional zone and the myometrium except postmenopausal phase, and the Kep were statistically significant between the structures in different menstrual states(P<0.05). Conclusion The changes of Ktrans, Kep and Ve in different menstrual states should be considered when using the quantitative parameters of dynamic enhanced MRI to evaluate uterine diseases.