子宫内膜癌的肌层浸润：3.0-T扩散加权磁共振成像的诊断准确性——初步经验

Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging--initial experience.

作者信息

Lin Gigin, Ng Koon-Kwan, Chang Chee-Jen, Wang Jiun-Jie, Ho Kung-Chu, Yen Tzu-Chen, Wu Tzu-I, Wang Chun-Chieh, Chen Yu-Ruei, Huang Yu-Ting, Ng Shu-Hang, Jung Shih-Ming, Chang Ting-Chang, Lai Chyong-Huey

机构信息

Department of Radiology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu-Shin Street, Kueishan, Taoyuan 333, Taiwan.

出版信息

Radiology. 2009 Mar;250(3):784-92. doi: 10.1148/radiol.2503080874.

DOI:10.1148/radiol.2503080874

PMID:19244045

Abstract

PURPOSE

To assess the diagnostic accuracy of fused T2-weighted and high-b-value diffusion-weighted (DW) magnetic resonance (MR) images at 3 T for evaluation of myometrial invasion in patients with endometrial cancer.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained. From May 2006 to October 2007, 48 consecutive patients aged 25-80 years (mean age, 57 years) who had endometrial cancer were prospectively enrolled for preoperative evaluation by using a 3-T MR unit. Two radiologists interpreted the depth of myometrial invasion on T2-weighted images, dynamic contrast material-enhanced MR images, and fused T2-weighted and DW MR images (b = 1000 sec/mm(2)). Statistical methods included kappa statistics for reader agreement, Pearson analysis for pathologic correlation, accuracy assessment, and receiver operating characteristic analysis for diagnostic performance comparison. Surgical pathologic findings were the reference standard.

RESULTS

Reader agreement was excellent for fused T2-weighted and DW images (weighted kappa, 0.79), with a significant pathologic correlation regarding the depth of myometrial invasion (r = 0.94, P < .0001). For assessing any myometrial involvement, addition of fused T2-weighted and DW imaging to dynamic contrast-enhanced or dynamic contrast-enhanced and T2-weighted imaging was significantly better compared with dynamic contrast-enhanced imaging alone (P < .001) or dynamic contrast-enhanced and T2-weighted (P = .001) imaging; T2-weighted imaging combined with fused T2-weighted and DW imaging also was better than dynamic contrast-enhanced and T2-weighted imaging (P = .001). Tumor apparent diffusion coefficients were 0.60-1.32 x 10(-3) mm(2)/sec (median, 0.75 x 10(-3) mm(2)/sec), with no significant correlation with the depth of myometrial invasion (P = .31, r = -0.15).

CONCLUSION

Fused T2-weighted and high-b-value DW images at 3 T can provide accurate information for preoperative evaluation of myometrial invasion.

摘要

目的

评估3T磁共振成像（MR）中融合的T2加权与高b值扩散加权（DW）图像对子宫内膜癌患者肌层浸润评估的诊断准确性。

材料与方法

获得机构审查委员会批准并取得知情同意。2006年5月至2007年10月，前瞻性纳入48例年龄25 - 80岁（平均年龄57岁）的子宫内膜癌患者，使用3T MR设备进行术前评估。两名放射科医生在T2加权图像、动态对比增强MR图像以及融合的T2加权与DW MR图像（b = 1000 sec/mm²）上解读肌层浸润深度。统计方法包括用于读者一致性的kappa统计、用于病理相关性的Pearson分析、准确性评估以及用于诊断性能比较的受试者操作特征分析。手术病理结果为参考标准。

结果

融合的T2加权与DW图像的读者一致性良好（加权kappa值为0.79），与肌层浸润深度存在显著病理相关性（r = 0.94，P <.0001）。对于评估任何肌层受累情况，相比于单独的动态对比增强成像（P <.001）或动态对比增强与T2加权成像（P =.001），在动态对比增强或动态对比增强与T2加权成像基础上增加融合的T2加权与DW成像显著更好；T2加权成像联合融合的T2加权与DW成像也优于动态对比增强与T2加权成像（P =.001）。肿瘤表观扩散系数为0.60 - 1.32×10⁻³ mm²/sec（中位数为0.75×10⁻³ mm²/sec），与肌层浸润深度无显著相关性（P =.31，r = -0.15）。