Lin Yu-Ching, Lin Gigin, Chen Yu-Ruei, Yen Tzu-Chen, Wang Chun-Chieh, Ng Koon-Kwan
Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
Chang Gung Med J. 2011 Jan-Feb;34(1):93-100.
To determine whether magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) are able to distinguish between adenocarcinoma originating from the uterine cervix and endometrium.
Institutional review board approval and informed consent were obtained. From May 2006 to June 2008, 29 women 25-73 years old (mean age, 50.3 years) with a cervical biopsy yielding adenocarcinoma were enrolled for 3-T MR study with the imaging pulse-sequence protocol of T2-weighted imaging (T2WI) and dynamic contrast-enhanced (DCE) MRI and diffusion-weighted MRI (DWI, b = 0, 1000 sec/mm2). The extent and shapes of the tumor and ADC values were evaluated by two radiologists retrospectively. Surgical histopathology served as the reference standard of the tumor origin from the cervix (n = 22) or endometrium (n = 7). The Mann-Whitney U test was used for statistical comparison and receiver operating characteristic (ROC) analysis was used to obtain optimal ADC cut off values.
A longitudinal shape occurred significantly more frequently in endometrial cancer, and an oval shape was more frequently found in cervical cancer (p = 0.011). Mean ADC values were significantly lower in endometrial cancer (76.6 × 10(-5) mm2/sec) than in cervical cancer (96.9 × 10(-5) mm2/sec). Receiver operating characteristic analysis yielded an optimal ADC cutoff value of 70 × 10(-5) mm2/sec to distinguish cervical cancer from endometrial cancer.
MRI may distinguish between most uterine adenocarcinoma originating from the cervix and endometrium using distinctive characteristics found on T2WI and DCE. When tumors show an ambiguous morphology, the ADC value of the tumor may be helpful for further differentiation.
确定磁共振成像（MRI）和表观扩散系数（ADC）是否能够区分源自子宫颈和子宫内膜的腺癌。
获得机构审查委员会批准并取得知情同意。2006年5月至2008年6月，纳入29名年龄在25 - 73岁（平均年龄50.3岁）经宫颈活检确诊为腺癌的女性，进行3-T MR研究，采用T2加权成像（T2WI）、动态对比增强（DCE）MRI和扩散加权MRI（DWI，b = 0，1000 sec/mm²）的成像脉冲序列方案。两名放射科医生回顾性评估肿瘤的范围、形态及ADC值。手术组织病理学作为肿瘤源自子宫颈（n = 22）或子宫内膜（n = 7）的参考标准。采用曼-惠特尼U检验进行统计学比较，采用受试者操作特征（ROC）分析获得最佳ADC临界值。
子宫内膜癌纵向形态出现的频率显著更高，而椭圆形在子宫颈癌中更常见（p = 0.011）。子宫内膜癌的平均ADC值（76.6×10⁻⁵ mm²/sec）显著低于子宫颈癌（96.9×10⁻⁵ mm²/sec）。ROC分析得出区分子宫颈癌和子宫内膜癌的最佳ADC临界值为70×10⁻⁵ mm²/sec。
MRI可利用T2WI和DCE上发现的独特特征区分大多数源自子宫颈和子宫内膜的子宫腺癌。当肿瘤形态不明确时，肿瘤的ADC值可能有助于进一步鉴别。
