表观扩散系数在子宫内膜样腺癌MRI诊断中的价值

ADC value in the diagnosis of endometrioid adenocarcinoma

目的分析表观扩散系数(ADC值)在子宫内膜样腺癌术前诊断中的价值。方法回顾性收集2013年10月至2018年8月就诊于唐山市妇幼保健院的194例子宫内膜样腺癌的MRI影像资料,并测量病灶的ADC值,比较不同病理分化程度的病灶及有无受累宫颈内口的ADC值是否存在差异。结果高分化子宫内膜样腺癌患者ADC值为(812.22±55.75)×10^-6 mm^2/s,中分化为(798.33±45.23)×10^-6 mm^2/s,均高于低分化ADC值(616.78±42.16)×10^-6 mm^2/s,差异有统计学意义(P<0.01);高分化与中分化ADC值比较差异无统计学意义(P>0.05)。宫颈内口无浸润患者ADC值为(1168.88±79.19)×10^-6 mm^2/s,宫颈内口有浸润患者ADC值为(916.80±32.75)×10^-6 mm^2/s,宫颈有无浸润患者ADC值比较差异有统计学意义(P<0.01)。ADC值对宫颈有无浸润的ROC曲线下面积为0.853(95%CI:0.725~0.980),最佳诊断界值为1030.40×10^-6 mm^2/s,敏感性100%,特异性65%。结论采用MRI定量分析技术(ADC值)对子宫内膜样腺癌的分化程度、宫颈浸润与否具有一定的鉴别价值,可作为MRI定量诊断较重要的参考指标。

Objective To analyze the value of apparent diffusion coefficient(ADC)value in the diagnosis of endometrioid adenocarcinoma.Methods MR imaging data of 194 patients with endometrioid adenocarcinoma admitting to Tangshan Maternal and Child Health Hospital from October 2013 to August 2018 were collected and retrospectively analyzed.ADC values of the lesions were measured to compare the difference of ADC values in lesions with different pathological differentiation and in cervix with or without invasion(of whether there were cervical involvement or not).Results The ADC values of highly and moderately differentiated endometrioid adenocarcinoma were(812.22±55.75)×10^-6 mm^2/s,and(798.33±45.23)×10^-6 mm^2/s,respectively and were statistically higher than that of poorly differentiated endometrioid adenocarcinoma[(616.78±42.16)×10^-6 mm^2/s,P<0.01)].There was no significant difference in ADC value between high and moderately differentiated endometrioid adenocarcinoma(P>0.05).The ADC values were(1168.88±79.19)×10^-6 mm^2/s in patients without cervical infiltration and(916.80±32.75)×10^-6 mm^2/s in patients with cervical infiltration,and there was a significant difference between them(P<0.01).The area under ROC curve of ADC value for cervical infiltration was 0.853(95%CI:0.725-0.980),and the optimal diagnostic threshold was 1030.40×10^-6 mm^2/s,with sensitivity of 100%and specificity of 65%.Conclusion Quantitative analysis of ADC value has a certain value in differentiating endometrioid adenocarcinoma and cervical infiltration and can be used as an important reference index for quantitative diagnosis of MRI.