MRI 在评估子宫内膜异位症中宫旁组织受累的价值。

The value of MRI in assessing parametrial involvement in endometriosis.

机构信息

Department of Radiology, University Hospitals, Est Parisien, Tenon Hospital, 4 rue de la Chine, Paris 75020, France.

出版信息

Hum Reprod. 2012 Aug;27(8):2352-8. doi: 10.1093/humrep/des211. Epub 2012 Jun 12.

DOI:10.1093/humrep/des211

PMID:22693170

Abstract

STUDY QUESTION

What is the accuracy of magnetic resonance imaging (MRI) in the diagnosis of parametrial endometriosis in comparison with surgicopathological findings?

SUMMARY ANSWER

MRI displayed an accuracy of 96.4% in the preoperative diagnosis of parametrial involvement by deep infiltrating endometriosis (DIE).

WHAT IS KNOWN AND WHAT THIS PAPER ADDS

MRI is the best technique for preoperative mapping of DIE. This preliminary paper shows that T2-weighted MRI is a valuable tool for the preoperative evaluation of parametrial involvement by endometriosis.

DESIGN

A retrospective study of an MRI database was used to identify examinations performed in women, who had a clinical suspicion of pelvic endometriosis (n=666), between 2005 and 2009 in a university medical centre in France.

PARTICIPANTS AND SETTING

Exclusion criteria were previous surgery for DIE, incomplete surgical evaluation, repeat MRI examinations and incomplete MR protocol. Only symptomatic patients who underwent surgery with a pathological correlation were included (n=83). An experienced radiologist, blind to the surgical and histological findings, evaluated sagittal, axial and thin-section oblique axial MR images obtained from the 83 patients.

DATA ANALYSIS METHOD

Descriptive statistics and Fisher exact test were used.

MAIN FINDINGS

The prevalence of DIE and parametrial endometriosis was 76/83 (91.6%) and 12/83 (14.5%), respectively. The sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios for the diagnosis of parametrial endometriosis of low signal intensity on T2-weighted MRI, pelvic wall involvement and ureteral dilatation, were 83.3%, 98.6%, 90.9%, 97.2%, 96.4%, 59.2 and 0.17, 58.3%, 98.6%, 87.5%, 93.3%, 92.8%, 41.4 and 0.42 and 16.7%, 100%, 100%, 87.7%, 88%, infinity and 0.83, respectively, with the patient as the unit of analysis. BIAS AND LIMITATIONS: The study design was retrospective, and thus prone to bias. Only one experienced reader performed the analysis, so no data are available on intra- or interobserver variability. GENERALISABILITY: At present, no consensus exists on the optimal MR protocol to be used for the evaluation of DIE, thus limiting the wider implications of this study.

STUDY FUNDING AND COMPETING INTERESTS

No funding was obtained for this study. The authors have no conflict of interest.

摘要

研究问题

与手术病理结果相比，磁共振成像（MRI）在诊断宫旁子宫内膜异位症中的准确性如何？

总结答案

MRI 术前诊断深部浸润性子宫内膜异位症（DIE）宫旁受累的准确率为 96.4%。

已知和新增内容

MRI 是术前 DIE 定位的最佳技术。本初步研究表明，T2 加权 MRI 是术前评估子宫内膜异位症宫旁受累的有价值工具。

设计

对法国一所大学医学中心 2005 年至 2009 年间因盆腔子宫内膜异位症疑似接受 MRI 检查的 666 例女性的 MRI 数据库进行回顾性研究。

参与者和设置

排除标准为既往 DIE 手术、手术评估不完整、重复 MRI 检查和 MRI 方案不完整。仅纳入接受手术且有病理相关性的有症状患者（n=83）。一位有经验的放射科医生对 83 例患者的矢状位、轴位和薄层斜轴 MRI 图像进行评估，该医生对手术和组织学结果不知情。

数据分析方法

采用描述性统计和 Fisher 确切检验。

主要发现

DIE 和宫旁子宫内膜异位症的患病率分别为 76/83（91.6%）和 12/83（14.5%）。T2 加权 MRI 低信号、盆壁受累和输尿管扩张对宫旁子宫内膜异位症的诊断敏感度、特异度、阳性预测值、阴性预测值、准确率、阳性似然比和阴性似然比分别为 83.3%、98.6%、90.9%、97.2%、96.4%、59.2 和 0.17、58.3%、98.6%、87.5%、93.3%、92.8%、41.4 和 0.42，以及 16.7%、100%、100%、87.7%、88%、无穷大和 0.83，单位为患者。