深部盆腔子宫内膜异位症：用于疾病诊断及预测病变范围的磁共振成像

Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease.

作者信息

Bazot Marc, Darai Emile, Hourani Roula, Thomassin Isabelle, Cortez Annie, Uzan Serge, Buy Jean-Noël

机构信息

Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 rue de la Chine, Paris 75020, France.

出版信息

Radiology. 2004 Aug;232(2):379-89. doi: 10.1148/radiol.2322030762. Epub 2004 Jun 17.

DOI:10.1148/radiol.2322030762

PMID:15205479

Abstract

PURPOSE

To prospectively evaluate the accuracy of magnetic resonance (MR) imaging for the preoperative diagnosis of deep pelvic endometriosis and extension of the disease.

MATERIALS AND METHODS

One hundred ninety-five patients (mean age, 34.2 years; range, 20-71 years) who were suspected of having pelvic endometriosis were recruited at two institutions. Two experienced radiologists evaluated the MR images independently. Deep pelvic endometriosis was defined as implants or tissue masses that appeared as hypointense areas and/or hyperintense foci on T1- or T2-weighted MR images in the following locations: torus uterinus, uterosacral ligaments (USLs), vagina, rectovaginal septum, rectosigmoid, and bladder. MR imaging results were compared with surgical and pathologic findings. Sensitivity, specificity, predictive values, and accuracy of MR imaging for prediction of deep pelvic endometriosis were assessed.

RESULTS

Pelvic endometriosis was confirmed at pathologic examination in 163 (83.6%) of 195 patients. Endometriomas, peritoneal lesions, and deep pelvic endometriosis were diagnosed on the basis of surgical findings, alone or combined with pathologic findings, in 111 (68.1%), 83 (50.9%), and 103 (63.2%) of 163 patients, respectively. Torus uterinus and USL were the most frequent sites of deep pelvic endometriosis. The sensitivity, specificity, positive and negative predictive values, and accuracy of MR imaging for deep pelvic endometriosis were 90.3% (93 of 103), 91% (84 of 92), 92.1% (93 of 101), 89% (84 of 94), and 90.8% (177 of 195), respectively. The sensitivity, specificity, and accuracy, respectively, of MR imaging for the diagnosis of endometriosis in specific sites were as follows: USL, 76% (57 of 75), 83.3% (100 of 120), and 80.5% (157 of 195); vagina, 76% (16 of 21), 95.4% (166 of 174), and 93.3% (182 of 195); rectovaginal septum, 80% (eight of 10), 97.8% (181 of 185), and 96.9% (189 of 195); rectosigmoid, 88% (53 of 60), 97.8% (132 of 135), and 94.9% (185 of 195); and bladder, 88% (14 of 16), 98.9% (177 of 179), and 97.9% (191 of 195).

CONCLUSION

MR imaging demonstrates high accuracy in prediction of deep pelvic endometriosis in specific locations.

摘要

目的

前瞻性评估磁共振（MR）成像对盆腔深部子宫内膜异位症术前诊断及疾病范围的准确性。

材料与方法

在两家机构招募了195例疑似盆腔子宫内膜异位症的患者（平均年龄34.2岁；范围20 - 71岁）。两名经验丰富的放射科医生独立评估MR图像。盆腔深部子宫内膜异位症定义为在以下部位的T1加权或T2加权MR图像上表现为低信号区和/或高信号灶的植入物或组织块：子宫圆韧带、子宫骶韧带（USLs）、阴道、直肠阴道隔、直肠乙状结肠和膀胱。将MR成像结果与手术及病理结果进行比较。评估MR成像预测盆腔深部子宫内膜异位症的敏感性、特异性、预测值及准确性。

结果

195例患者中163例（83.6%）经病理检查确诊为盆腔子宫内膜异位症。根据手术结果单独或结合病理结果，分别在163例患者中的111例（68.1%）、83例（50.9%）和103例（63.2%）中诊断出子宫内膜瘤、腹膜病变和盆腔深部子宫内膜异位症。子宫圆韧带和子宫骶韧带是盆腔深部子宫内膜异位症最常见的部位。MR成像对盆腔深部子宫内膜异位症的敏感性、特异性、阳性和阴性预测值及准确性分别为90.3%（103例中的93例）、91%（92例中的8例）、92.1%（101例中的93例）、89%（94例中的84例）和90.8%（195例中的177例）。MR成像对特定部位子宫内膜异位症诊断的敏感性、特异性及准确性分别如下：子宫骶韧带，76%（75例中的57例）、83.3%（120例中的100例）和80.5%（195例中的157例）；阴道，76%（21例中的16例）、95.4%（174例中的166例）和93.3%（195例中的182例）；直肠阴道隔，80%（10例中的8例）、97.8%（185例中的181例）和96.9%（195例中的189例）；直肠乙状结肠，88%（60例中的53例）、97.8%（135例中的132例）和94.9%（195例中的185例）；膀胱，88%（16例中的14例）、98.9%（179例中的177例）和97.9%（195例中的191例）。