表观扩散系数对子宫内膜良恶性病变的诊断价值

Apparent diffusion coefficient value in the diagnosis of benign and malignant endometrial lesions

目的 磁共振成像(MRI)鉴别与组织病理学结果相关的良恶性子宫内膜病变,并定量分析表观扩散系数(ADC)值和组织学肿瘤分级及临床分期。方法 前瞻性分析120例子宫内膜厚度达病理值有或没有阴道出血的女性患者,行MRI检查,在后处理软件上测量ADC值。结果 MRI诊断48例可疑恶性子宫内膜病变和72例可疑良性子宫内膜病变,最终组织病理学确诊43例恶性病变,77例良性病变。子宫内膜恶性病变的ADC值低于良性病变[(0.79±0.11)×10^(-3)mm^(2)/s与(1.30±0.19)×10^(-3)mm^(2)/s],且差异具有统计学意义(P<0.05)。与病理组织学检查结果比较,MRI的灵敏度为100%,特异度为93.5%,阳性预测值为89.6%,阴性预测值为100%。ROC曲线分析子宫内膜良恶性病变间ADC临界值为1.01×10^(-3)mm^(2)/s,灵敏度为100%,特异度为91.7%。观察子宫内膜癌组织学分级不同分级间平均ADC值差异无统计学意义(P>0.05)。临床国际妇产科联合会(FIGO)分期中I_(A)期和I_(B)期患者最多,各分期间平均ADC值差异无统计学意义(P>0.05)。结论 DWI和ADC值是鉴别良恶性子宫内膜病变的有效方法,其具有高度的灵敏度和良好的特异度,但在鉴别子宫内膜癌组织学分级及临床FIGO分期中意义不大。

Objective To differentiate histopathology from benign and malignant endometrial lesions by MRI,and the quantitative analysis of apparent diffusion coefficient(ADC)values,histological tumor grades,and clinical stages.Methods A total of 120 women with or without vaginal bleeding and endometrial thickness up to the pathological value were prospectively analyzed.Results Forty-eight cases with suspected malignant endometrial lesions and 72 cases with suspected benign endometrial lesions were diagnosed by MRI,and 43 cases with malignant lesions and 77 cases with benign lesions were finally histopathology.The ADC value of malignant lesions was lower than that of benign lesions[(0.79±0.11)×10^(-3)mm^(2)/s vs(1.30±0.19)×10^(-3)mm^(2)/s],and the difference was statistically significant(P<0.05).The sensitivity,specificity,positive predictive value,and negative predictive value of MRI were 100%,93.5%,89.6%,and 100%,respectively.The cut-off value of ADC between benign and malignant lesions was 1.01×10^(-3)mm^(2)/s,with a sensitivity of 100%and a specificity of 91.7%.There was no significant difference in average ADC value among different grades of endometrial cancer histological grading(P>0.05).The most common clinical FIGO stage was stage I_(A) and I_(B),and there was no significant difference in the average ADC values among the stages(P>0.05).Conclusion DWI and ADC value are effective methods to differentiate benign from malignant endometrial lesions,which have high sensitivity and good specificity,however,it is of little significance in differentiating endometrial cancer histological grading and clinical FIGO staging.