Nasi Francesca, Fiocchi Federica, Pecchi Annarita, Rivasi Francesco, Torricelli Pietro
Dipartimento Integrato dei Servizi Diagnostici e per Immagini, Università di Modena e Reggio Emilia, Modena.
Radiol Med. 2005 Sep;110(3):199-210.
The depth of myometrial invasion by endometrial carcinoma strongly affects the incidence of metastasis to regional nodes and influences the surgical strategies. The aim of this paper is to compare the results of FSE T2-w and Gadolinium-enhanced FMPSGR MR sequences in assessing the depth of myometrial invasion by endometrial cancer.
Forty-five women with histopathologically-proven endometrial carcinoma underwent preoperative MRI. Axial SE T1w, axial, sagittal and para-coronal FSE T2w and para-coronal Gadolinium-enhanced FMPSGR sequences were performed using a high field strength magnet (1.5T). Within one month of MR all patients underwent hysterectomy, and anatomical evaluation of the surgical specimen was done sectioning the uterus along the short axis. Based upon the results of the histological evaluation the results of the FSE T2w and Gadolinium-enhanced sequences were compared and the statistical difference between the results obtained was statistically evaluated.
The histological evaluation showed intramucosal neoplasm in 11 patients, myometrial infiltration less than 50% in 31 patients, myometrial infiltration more than 50% in 12 patients and transmural cancer in 1 patient. Statistical evaluation showed that the FSE T2w sequence had a global sensitivity and specificity of 80.6% and 87.6%, respectively, with a mean Negative Predictive Value of 92.6% and a mean Positive Predictive Value of 86%. Gadolinium-enhanced FMPSPGR sequence had a global sensitivity and specificity of 90.6% and 93.3%, respectively, with a mean Negative Predictive Value of 96,3% and a mean Positive Predictive Value of 88%. The staging accuracy (chi2 test) on FMPSPGR images (95%) was higher than that on FSE T2w images (78%).
In our experience Gadolinium-enhanced dynamic sequences increase the accuracy of MR imaging in diagnosing the depth of myometrial invasion. In particular they improve the visualisation of the inner myometrium, the so called subendometrial enhancing zone, whose disruption or changes are essential for diagnosing myometrial invasion. The major diagnostic advantages of the enhanced sequences were found in postmenopausal women, where visualisation of the junctional zone may be difficult in the T2w sequences. We believe that Gadolinium-enhanced dynamic sequences should be used whenever the diagnosis is unclear at FSE T2w sequences.
子宫内膜癌肌层浸润深度严重影响区域淋巴结转移发生率并影响手术策略。本文旨在比较FSE T2加权成像和钆增强FMPSGR MR序列在评估子宫内膜癌肌层浸润深度方面的结果。
45例经组织病理学证实为子宫内膜癌的女性患者术前行MRI检查。使用高场强磁体（1.5T）进行轴位SE T1加权成像、轴位、矢状位和斜冠状位FSE T2加权成像以及斜冠状位钆增强FMPSGR序列成像。在MR检查后1个月内，所有患者均接受子宫切除术，并沿子宫短轴对手术标本进行解剖评估。根据组织学评估结果，比较FSE T2加权成像和钆增强序列的结果，并对所得结果之间的统计学差异进行评估。
组织学评估显示，11例患者为黏膜内肿瘤，31例患者肌层浸润小于50%，12例患者肌层浸润大于50%，1例患者为全层癌。统计学评估显示，FSE T2加权序列的总体敏感性和特异性分别为80.6%和87.6%，平均阴性预测值为92.6%，平均阳性预测值为86%。钆增强FMPSPGR序列的总体敏感性和特异性分别为90.6%和93.3%，平均阴性预测值为96.3%，平均阳性预测值为88%。FMPSPGR图像的分期准确性（卡方检验）（95%）高于FSE T2加权图像（78%）。
根据我们的经验，钆增强动态序列提高了MR成像诊断肌层浸润深度的准确性。特别是它们改善了肌层内层（即所谓的子宫内膜下增强带）的可视化，其破坏或改变对于诊断肌层浸润至关重要。增强序列的主要诊断优势在绝经后女性中发现，在T2加权序列中可能难以可视化结合带。我们认为，当FSE T2加权序列诊断不明确时，应使用钆增强动态序列。
