磁共振弥散加权成像联合DCE-MRI诊断子宫内膜癌的价值

Application value of diffusion-weighted imaging combined with DCE-MRI in the diagnosis of endometrial cancer

目的分析磁共振弥散加权成像(DWI)联合动态对比增强磁共振成像(DCE-MRI)诊断子宫内膜癌的应用价值。方法抽取2018年1月至2021年8月洛阳市第三人民医院收治的疑似子宫内膜癌患者95例,另抽取同期收治的子宫内膜良性病变者42例。均行DWI、DCE-MRI诊断,以病理结果为"金标准",比较DWI、DCE-MRI单独和联合诊断子宫内膜癌的诊断结果、诊断效能,并对比子宫内膜癌患者和子宫内膜良性病变者表观扩散系数(ADC)值、DCE-MRI参数[体积转运常数(Ktrans)、速率转运常数(Kep)、细胞外空间的体积分数(Ve)]。结果149例疑似子宫内膜癌患者经病理证实阳性107例,阴性42例;DWI诊断出阳性94例,阴性55例;DCE-MRI诊断出阳性100例,阴性49例;二者联合诊断出阳性107例,阴性42例。DWI联合DCE-MRI诊断灵敏度(98.13%,105/107)、特异度(95.24%,40/42)、准确度(97.32%,145/149)高于DWI单独诊断(78.50%,84/107;76.19%,32/42;77.85%,116/149)和DCE-MRI单独诊断(85.05%,91/107;78.57%,33/42、83.22%,124/149),漏诊率(1.87%,2/107)、误诊率(4.76%,2/42)低于DWI单独诊断(21.50%,23/107;23.81%,10/42)和DCE-MRI单独诊断(14.95%,16/107;21.43%,9/42),P<0.05;DWI联合DCE-MRI诊断阳性预测值(98.13%,105/107)及阴性预测值(72.73%,40/42)高于DWI单独诊断(89.36%,84/94;58.18%,2/55)和DCE-MRI单独诊断(91.00%,91/100;60.00%,33/49),P<0.05;子宫内膜癌患者ADC值低于良性病变者,Ktrans、Kep、Ve参数高于良性病变者(P<0.05)。结论DWI联合DCE-MRI诊断子宫内膜癌,可提高诊断效能和预测值,且子宫内膜癌患者ADC值、DCE-MRI检查定量参数显著异常,能为临床诊断鉴别良性和恶性病变提供较多依据。

Objective To analyze the application value of diffusion-weighted imaging(DWI)combined with dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of endometrial cancer.Methods Ninety-five patients with suspected endometrial cancer treated in Luoyang Third People’s Hospital from January 2018 to August 2021 were selected,and another 42 patients with benign endometrial lesions admitted at the same time were selected.All patients were diagnosed by DWI and DCE-MRI.Taking the pathological results as the gold standard,the diagnostic results and diagnostic efficacy of DWI,DCE-MRI,and combination of them in the diagnosis of endometrial cancer were compared.ADC values and DCE-MRI parameters,including transfer constant(Ktrans),rate constant(Kep),extravascular extracellular volume fraction(Ve)were compared between patients with endometrial cancer and benign endometrial lesions.Results Among 149 patients with suspected endometrial cancer,pathology confirmed that 107 cases were positive,and 42 cases were negative;DWI diagnosed 94 positive cases and 55 negative cases;DCE-MRI diagnosed 100 positive cases and 49 negative cases.The combination of the two examinations diagnosed 107 positive cases and 42 negative cases.The diagnostic sensitivity,specificity and accuracy of DWI combined with DCE-MRI(98.13%,105/107;95.24%,40/42;97.32%,145/149)were higher than those of DWI alone(78.50%,84/107;76.19%,32/42;77.85%,116/149)and DCE-MRI alone(85.05%,91/107;78.57%,33/42;83.22%,124/149),and the rate of missed diagnosis and misdiagnosis of DWI combined with DCE-MRI(1.87%,2/107;4.76%,2/42)were lower than those of DWI alone(21.50%,23/107;23.81%,10/42)and DCE-MRI alone(14.95%,16/107;21.43%,9/42),all P<0.05.The positive predictive value and negative predictive value of DWI combined with DCE-MRI(98.13%,105/107;72.73%,40/42)were higher than those of DWI alone(89.36%,84/94;58.18%,32/55)and DCE-MRI alone(91.00%,91/100;60.00%,33/49),P<0.05.The ADC values of endometrial cancer patients were lower than those of patients with benign of DWI combined with DCE-MRI lesions,while the Ktrans,Kep and Ve parameters were higher than those of patients with benign endometrial lesions(P<0.05).Conclusions DWI combined with DCE-MRI in the diagnosis of endometrial cancer can improve the diagnostic efficiency and predictive value,and the ADC value and DCE-MRI quantitative parameters of patients with endometrial cancer are significantly abnormal,which can provide more evidence for the clinical diagnosis of benign and malignant lesions.