Manfredi Riccardo, Mirk Paoletta, Maresca Giulia, Margariti Pasquale A, Testa Antonia, Zannoni Gian Franco, Giordano Deborah, Scambia Giovanni, Marano Pasquale
Department of Radiology, A. Gemelli University Hospital, 8 Largo A. Gemelli, Rome 00168, Italy.
Radiology. 2004 May;231(2):372-8. doi: 10.1148/radiol.2312021184. Epub 2004 Mar 18.
To assess magnetic resonance (MR) imaging in depicting the depth of myometrial infiltration, cervical invasion, and presence of enlarged lymph nodes in patients with endometrial adenocarcinoma compared with surgicopathologic findings.
Thirty-seven consecutive patients with endometrial carcinoma were included in this prospective study. All patients underwent MR imaging and surgery. Qualitative image analysis included the depth of myometrial infiltration, infiltration of the uterine cervix, and presence of enlarged lymph nodes. Quantitative image analysis included tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging. MR imaging findings were compared with surgicopathologic findings. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration and in lymph node assessment were calculated.
Respective sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values in assessing myometrial infiltration were 87%, 91%, 89%, 87%, and 91%; those for cervical infiltration, 80%, 96%, 92%, 89%, and 93%; and those for lymph node assessment, 50%, 95%, 90%, 50%, and 95%. There was significant agreement between MR imaging and surgicopathologic findings in assessment of myometrial invasion (P <.001). Myometrial and cervical invasion and lymph node enlargement were correctly assessed with MR imaging in 28 (76%) of 37 patients. Quantitative analysis showed a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and precontrast phases (P <.001).
MR imaging coupled with contrast material-enhanced dynamic MR imaging is highly accurate in local-regional staging of endometrial carcinoma; more challenging is the assessment of pelvic and lumboaortic lymph nodes.
与手术病理结果相比，评估磁共振（MR）成像在描绘子宫内膜腺癌患者子宫肌层浸润深度、宫颈侵犯及肿大淋巴结情况方面的表现。
本前瞻性研究纳入了37例连续的子宫内膜癌患者。所有患者均接受了MR成像及手术。定性图像分析包括子宫肌层浸润深度、宫颈浸润情况及肿大淋巴结的存在。定量图像分析包括动态成像不同阶段肿瘤和子宫肌层的对比噪声比。将MR成像结果与手术病理结果进行比较。计算MR成像在描绘子宫肌层和宫颈浸润以及淋巴结评估方面的敏感性、特异性、诊断准确性以及阳性和阴性预测值。
评估子宫肌层浸润时，各自的敏感性、特异性、诊断准确性以及阳性和阴性预测值分别为87%、91%、89%、87%和91%；评估宫颈浸润时分别为80%、96%、92%、89%和93%；评估淋巴结时分别为50%、95%、90%、50%和95%。在评估子宫肌层侵犯方面，MR成像与手术病理结果之间存在显著一致性（P <.001）。37例患者中有28例（76%）通过MR成像正确评估了子宫肌层和宫颈侵犯以及淋巴结肿大情况。定量分析显示，与动脉期和增强前相比，平衡期肿瘤和子宫肌层的对比噪声比有显著改善（P <.001）。
MR成像结合对比剂增强动态MR成像在子宫内膜癌的局部区域分期中具有高度准确性；对盆腔和腰主动脉旁淋巴结的评估更具挑战性。
