Rockall A G, Meroni R, Sohaib S A, Reynolds K, Alexander-Sefre F, Shepherd J H, Jacobs I, Reznek R H
Department of Radiology, St Bartholomew's Hospital, West Smithfield, 59 Bartholomew Close, West Smithfield, London, United Kingdom.
Int J Gynecol Cancer. 2007 Jan-Feb;17(1):188-96. doi: 10.1111/j.1525-1438.2007.00805.x.
Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy.
我们的目的是评估T2加权（T2W）和动态钆增强T1加权（T1W）磁共振成像（MRI）在子宫内膜癌肌层和宫颈浸润术前评估中的诊断性能，并确定预测淋巴结转移的影像学特征。两位放射科医生回顾性分析了96例子宫内膜癌患者的MR图像。记录肿瘤大小、肌层和宫颈浸润深度以及淋巴结肿大情况，然后与组织学结果进行对照。T2W图像上识别任何肌层浸润（浅表或深部）的灵敏度、特异度、阳性预测值和阴性预测值（PPV和NPV）分别为0.94、0.50、0.93、0.55，动态T1W图像上分别为0.92、0.50、0.92、0.50；T2W图像上识别深部肌层浸润的分别为0.84、0.78、0.65、0.91，动态T1W图像上分别为0.72、0.88、0.72、0.88。T2W图像上识别任何宫颈浸润（宫颈管内或间质）的灵敏度、特异度、PPV和NPV分别为0.65、0.87、0.57、0.90，动态T1W图像上分别为0.50、0.90、0.46、0.92；T2W图像上识别宫颈间质受累的分别为0.69、0.95、0.69、0.95，动态T1W图像上分别为0.50、0.96、0.57、0.95。73%的误诊病例中可见平滑肌瘤或子宫腺肌病。检测淋巴结转移的灵敏度和特异度分别为66%和73%。MRI显示宫颈浸润的患者中有50%发生淋巴结转移。总之，MRI检测肌层浸润的灵敏度高，检测深部浸润的NPV高。MRI检测宫颈浸润的特异度和NPV高。动态增强并未提高诊断性能。MRI可将病例准确分为低风险或高风险组，以确保手术范围和辅助治疗的合理性。
