MRI动态增强联合DWI在子宫内膜癌肌层浸润评判中的研究  

Analysis of DCE-MRI combined with DWI in evaluating the myometrial invasion of endometrial carcinoma

作　　者：张秋妹 朱晓梅[2] 王建伟[2] 王敏[2] ZHANG Qiumei;ZHU Xiaomei;WANG Jianwei;WANG Min(Department of Radiology, Nanjing Central Hospital, Nanjing 210008, P.R.China;Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, P.R.China)

机构地区：[1]江苏省南京市中心医院放射科,江苏南京210008 [2]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《医学影像学杂志》2020年第12期2263-2266,2270,共5页Journal of Medical Imaging

基　　金：江苏高校优势学科建设工程资助项目(编号:JX10231801)。

摘　　要：目的探讨3.0T MRI动态增强扫描(DCE-MRI)联合扩散加权成像(DWI)评估诊断子宫内膜癌患者肌层浸润深度的准确性。方法选取35例经病理证实的子宫内膜癌患者的术前MRI,包括T1WI和T2WI、DCE-MRI和DWI序列,对照术后病理结果,评估应用DCE-MRI、DWI及DCE-MRI联合DWI法诊断子宫内膜癌肌层浸润敏感性、特异性、准确性、阴性预测值、阳性预测值;采用McNemar配对卡方检验比较不同诊断方法对肌层浸润的准确性。结果DCE-MRI、DWI及DCE-MRI联合DWI法判断肌层浸润深度的准确性分别为74.29%、71.43%和91.43%,DCE-MRI联合DWI法高于单独应用DCE-MRI和单独应用DWI法,差异具有统计学意义(P<0.05)。DCE-MRI联合DWI法判断肌层浸润深度与病理结果具有较好的一致性(Kappa值0.785,检验水准α=0.05)。结论联合应用DCE-MRI和DWI较单独应用DCE-MRI或DWI可以更准确的进行子宫内膜癌肌层浸润深度评估,应常规将两者联合应用于子宫内膜癌的术前评估。Objective To determine the diagnostic accuracy of the combination of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)in evaluating the myometrial invasion of endometrial carcinoma.Methods Thirty five cases of endometrial carcinoma confirmed by pathology were enrolled in the study.The MR protocol included T1-and T2-weighted imaging,dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI).Sensitivity,specificity,diagnostic accuracy,negative predict value and positive predict value of DCE-MRI,DWI,combination of DCE-MRI and DWI in evaluating of the depth of myometrial invasion were calculated,retrospectively,by comparing MR imaging findings to postoperative pathological findings.The accuracy of evaluation of myometrial invasion was compared using McNemar paired test.Results The diagnostic accuracies of DCE-MRI,DWI and combination of DCE-MRI and DWI for the identification of myometrial invasion were 74.29%,71.43%and 91.43%,respectively.The improvement in diagnostic accuracy of combination of DCE-MRI and DWI was significant(P<0.05).For evaluating myometrial invasion,combination of DCE-MRI and DWI was substantial with postoperative pathological findings(k value=0.785,α=0.05).Conclusion Combination of DCE-MRI and DWI has superior diagnostic efficiency in the assessment of myometrial invasion compared to DCE-MRI and DWI respectively,which should be routinely applied to patients with endometrial carcinoma before operation.

关 键 词：磁共振成像 动态增强 扩散加权成像 子宫内膜癌 分期 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]