不同序列MRI术前评估Ⅰ期子宫内膜癌肌层侵犯深度的诊断价值

The diagnostic value of preoperative MRI with different Sequences in evaluating the depth of muscular invasion of stageⅠendometrial carcinoma

目的:探讨MR不同序列成像评估Ⅰ期子宫内膜癌肌层侵犯深度的诊断价值。方法:回顾性分析2018年1月—2020年8月首都医科大学北京友谊医院经手术病理证实的59例Ⅰ期子宫内膜癌患者的MR图像,参考2018欧洲泌尿生殖放射学会对子宫内膜癌MRI分期最新指南,对照术后病理,分析T2WI序列、DWI序列及动态增强(DCE)序列评估Ⅰ期子宫内膜癌侵犯肌层深度的准确性;同时分析T2WI序列、DWI序列及动态增强(DCE)序列与术后病理金标准对照的灵敏度、特异度、曲线下面积(AUC)的差异及统计学意义。结果:T2WI、DWI、DCE序列对Ⅰ期子宫内膜癌侵犯肌层深度评估的准确性分别为81.35%、61.02%、89.83%;T2WI、DWI、DCE序列对在区分ⅠA与ⅠB期子宫内膜癌的诊断灵敏度分别为84.09%、52.27%、90.91%,特异度分别为73.33%、86.67%、86.67%;AUC值分别为0.787、0.695、0.888,差异均有统计学意义(P<0.01)。结论:MR检查应该成为Ⅰ期子宫内膜癌术前准备重要组成部分;不同序列在评估肌层侵犯深度的诊断效能上,DCE序列>T2WI序列>DWI序列。

Objective To investigate the diagnostic value of MR sequence imaging in evaluating the depth of muscular invasion in stageⅠendometrial carcinoma.Methods Retrospective analysis was performed on MR images of 59 patients with stageⅠendometrial cancer confirmed by surgery and pathology in Beijing Friendship Hospital,Capital Medical University from January 2018 to August 2020.According to the latest guidelines of the European Society of Urogenital Radiology for MRI staging of endometrial cancer in 2018,postoperative pathology was compared.The accuracy of T2WI sequence,DWI sequence and dynamic enhancement(DCE)sequence in the assessment of muscularis invasion depth of stage I endometrial carcinoma was analyzed.The sensitivity,specificity,area under curve(AUC)of T2WI sequence,DWI sequence and dynamic enhancement(DCE)sequence were compared with the gold standard of postoperative pathology and their statistical significance were analyzed.Results The accuracy of T2WI,DWI and DCE sequences the assessment of the depth of muscular invasion of stageⅠendometrial carcinoma was 81.35%,61.02%and 89.83%,respectively.The sensitivity of T2WI,DWI and DCE sequences to distinguishⅠA andⅠB endometrial carcinoma were 84.09%,52.27%and 90.91%,and the specificity was 73.33%,86.67%and 86.67%,respectively.AUC values were 0.787,0.695 and 0.888,respectively,and the differences were statistically significant(P<0.01).Conclusions MR examination should be an important part of preoperative preparation for stage I endometrial carcinoma.DCE sequence>T2WI sequence>DWI sequence in evaluating the diagnostic efficacy of muscular invasion depth.