不同模态MRI扫描与子宫内膜癌患者术后病理对比研究

Comparative Study of Different Modalities of MRI Scans and Postoperative Pathology in Patients with Endometrial Cancer

目的:以术后病理为“金标准”,比较不同模态MRI扫描在宫颈癌术前评估中的价值。方法:选择2019年3月—2020年10月河南省省立医院收治84例的经手术证实为子宫内膜癌患者作为研究对象,患者术前1周行多模态MRI检查,影像学资料完整,以手术病理结果为“金标准”,分析多模态MRI在宫内膜癌术前分期中的应用价值。结果:病灶在T2WI及扩散加权成像(diffusion-weighted imaging,DWI)序列中均呈高信号,ADC中呈低信号,T1WI序列中,病灶与子宫肌层均呈等信号;病理分期提示Ⅰa期36例,Ⅰb期22例,Ⅱ期17例,Ⅲ期9例,腺癌74例,腺鳞癌10例,以手术病理结果为“金标准”,常规MRI、MRI+DWI及MRI+DWI+DCE-MRI子宫内膜癌术前分期准确率分别为60.71%、75.00%和92.86%,三种模态术前分期准确率比较,差异有统计学意义(χ^(2)=24.019,P<0.05),其中常规MRI、MRI+DWI术前分期准确率比较,差异无统计学意义(P>0.05),两者均显著低于MRI+DWI+DCE-MRI,差异有统计学意义(P<0.05)。结论:MRI+DWI+DCE-MRI能有效提高子宫内膜癌术前分期准确度,为患者手术治疗与预后评估提供可靠参考。

Objective: The postoperative pathology was taken as the “gold standard”, the value of different modalities of MRI scans in the preoperative evaluation of cervical cancer was compared. Methods: A total of 84 patients with endometrial cancer who were admitted to the hospital from March 2019 to October 2020 were selected as the research subjects. The patients underwent multimodal MRI examination 1 week before surgery, and the imaging data were complete. The surgical and pathological results were taken as the “gold standard”, the application value of multimodal MRI in preoperative staging of endometrial cancer was analyzed. Results: The lesions showed high signal in T2WI and diffusion-weighted imaging(DWI) sequences, and low signal in ADC. In T1WI, the lesions and myometrium were isointense. Pathological staging revealed 36 cases of stage Ⅰa, 22 cases of stage Ⅰb, 17 cases of stage Ⅱ, 9 cases of stage Ⅲ, 74 cases of adenocarcinoma, and 10 cases of adenosquamous carcinoma. The preoperative staging accuracy rates of conventional MRI, MRI + DWI and MRI + DWI + DCE-MRI for endometrial cancer were 60.71%, 75.00% and 92.86%, and the differences were statistically significant among the three modalities(χ~2=24.019, P<0.05).There was no statistically significant difference in the accuracy of preoperative staging between conventional MRI and MRI+DWI(P>0.05). Both were significantly lower than MRI+DWI+DCE-MRI, and the difference was statistically significant(P<0.05). Conclusion: MRI+DWI+DCE can effectively improve the accuracy of preoperative staging of endometrial cancer, and provide a reliable reference for surgical treatment and prognosis evaluation of patients.