影像学检查在子宫肉瘤与变性子宫肌瘤中的鉴别诊断价值

Value of Imagine Examination in Differential Diagnosis of Uterine Sarcoma and Degenerative Uterine Leiomyoma

【目的】探讨弥散加权成像(DWI)、动态增强磁共振成像(MRI)、彩色多普勒超声联合检查对子宫肉瘤与变性子宫肌瘤的鉴别诊断价值。【方法】选取2018年11月至2020年5月在本院诊治并经手术病理证实的82例变性子宫肌瘤患者(变性子宫肌瘤组)和79例子宫肉瘤患者(子宫肉瘤组)的临床资料,分析彩色多普勒超声参数指标动脉阻力指数(RI)、搏动指数(PI)、DWI参数指标表观扩散系数(ADC)、动态增强MRI参数指标达峰时间(TTP)和最大对比增强率(MCER)等对子宫肉瘤与变性子宫肌瘤的鉴别诊断价值。【结果】子宫肉瘤组RI、PI、ADC、TTP值显著均低于变性子宫肌瘤组,MCER显著高于变性子宫肌瘤组,其差异均有统计学意义(P<0.05)。RI、PI、ADC、TTP、MCER鉴别子宫肉瘤与变性子宫肌瘤的曲线下面积(AUC)分别为0.797、0.825、0.913、0.847、0.824,截断值分别为0.547、0.640、1.199×10-3 mm2/s、51.534 s、196.078%,特异性分别为92.4%、97.5%、92.4%、70.9%、72.2%,敏感度分别为54.9%、67.1%、79.3%、84.1%、81.7%;五者联合诊断的AUC为0.981,特异性为93.7%,敏感度为98.8%。【结论】彩色多普勒超声、DWI及动态增强MRI的相关参数对子宫肉瘤与变性子宫肌瘤有一定的鉴别诊断价值。

【Objective】To investigate the value of diffusion-weighted imaging(DWI),dynamic contrast-enhanced magnetic resonance imaging(MRI)and color Doppler ultrasound in the differential diagnosis of uterine sarcoma and degenerative uterine leiomyoma.【Methods】From November 2018 to May 2020,82 patients with degenerative uterine leiomyoma(the degenerative uterine leiomyoma group)and 79 patients with uterine sarcoma(the uterine sarcoma group),who were treated in our hospital and confirmed by operation and pathology,were selected as the research objects.All clinical data were analyzed to evaluate that color Doppler ultrasound parameters,arterial resistance index(RI),pulsatility index(PI),DWI parameters,apparent diffusion coefficient(ADC),dynamic contrast-enhanced MRI parameters,time to peak(TTP)and maximum contrast enhancement(MCER)in differential diagnostic value of uterine sarcoma and degenerative uterine leiomyoma.【Results】The levels of RI,PI,ADC and TTP in uterine sarcoma group were significantly lower than those in degenerative uterine leiomyoma group,and MCER was significantly higher than that in degenerative uterine leiomyoma group.The differences were statistically significant(P<0.05).The area under the curve(AUC)of RI,PI,ADC,TTP and MCER in the differential diagnosis of uterine sarcomas and degenerative uterine leiomyoma was 0.797,0.825,0.913,0.847 and 0.824,respectively,the cut-off value was 0.547,0.640,1.199×10^(-3) mm^(2)/s,51.534 s,196.078%,respectively,the specificity was 92.4%,97.5%,92.4%,70.9%and 72.2%,respectively,and the sensitivity was 54.9%,67.1%,79.3%,84.1%and 81.7%,respectively.The AUC of combination of the five methods was 0.981.The specificity was 93.7%and the sensitivity was 98.8%.【Conclusion】Color Doppler ultrasound,DWI and dynamic contrast-enhanced MRI have certain characteristics in uterine sarcoma and degenerative uterine leiomyoma.With the combination of relevant parameters,it is more helpful to differentiate the diagnosis of two diseases.