Department of Gynecology and Obstetrics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
Eur J Cancer. 2012 Dec;48(18):3414-21. doi: 10.1016/j.ejca.2012.06.022. Epub 2012 Jul 24.
The purpose of this study is to investigate the diagnostic accuracy of 3.0Tesla (3T) diffusion-weighted magnetic resonance imaging (MRI) in addition to conventional MRI for the detection of lymphadenopathy in patients with early stage cervical cancer compared to histopathological evaluation of the systematically removed pelvic lymph nodes as reference standard.
68 fédération internationale de gynécologie obstétrique (FIGO) stage Ia2 to IIb cervical cancer patients were included. Sensitivity and specificity rates for two experienced observers were computed for the detection of lymphatic metastasis. Reproducibility of conventional MRI was tested by kappa statistics. The variables included in the analysis were: size of the long axis, short axis, ratio short to long axis and apparent diffusion coefficient (ADC).
Nine patients had 15 positive pelvic nodes at histopathological examination. The sensitivity and specificity of lymphatic metastasis detection by predefined conventional MRI characteristics was 33% (95% Confidence Interval (CI) 3-64) and 83% (95% CI 74-93) on patient level, and 33% (95% CI 7-60) and 97% (95% CI 95-99) on regional level respectively for observer 1. For observer 2 the sensitivity was 33% (95% CI 3-64) and the specificity 93% (95% CI 87-100) on patient level, and 25% (95% CI 1-50) and 98% (95% CI 97-100) on regional level, respectively. The kappa-value for reproducibility of metastasis detection on regional level was 0.50. The short axis diameter showed the highest diagnostic accuracy (area under the curve (AUC)=0.81 95% CI 0.70-0.91); ADC did not improve diagnostic accuracy (AUC=0.83 95% CI 0.73-0.93).
Diffusion-weighted MRI did not result in additional diagnostic value compared to conventional MRI.
本研究旨在探讨与系统切除的盆腔淋巴结的组织病理学评估作为参考标准相比，3.0 特斯拉（3T）弥散加权磁共振成像（MRI）对早期宫颈癌患者淋巴结病的诊断准确性。
纳入 68 例国际妇产科联合会（FIGO）分期为 Ia2 至 IIb 的宫颈癌患者。两名经验丰富的观察者计算了用于检测淋巴转移的灵敏度和特异性。通过 Kappa 统计测试常规 MRI 的重复性。分析中包括的变量：长轴大小、短轴大小、短轴与长轴的比值和表观扩散系数（ADC）。
9 例患者在组织病理学检查中有 15 个阳性盆腔淋巴结。观察者 1 对淋巴结转移的检测，根据预设的常规 MRI 特征，患者水平的灵敏度和特异性分别为 33%（95%置信区间（CI）3-64）和 83%（95% CI 74-93），区域水平分别为 33%（95% CI 7-60）和 97%（95% CI 95-99）。观察者 2 的灵敏度为 33%（95% CI 3-64），特异性为 93%（95% CI 87-100），在患者水平上，区域水平分别为 25%（95% CI 1-50）和 98%（95% CI 97-100）。区域水平转移检测的 Kappa 值为 0.50。短轴直径显示出最高的诊断准确性（曲线下面积（AUC）=0.81 95% CI 0.70-0.91）；ADC 并未提高诊断准确性（AUC=0.83 95% CI 0.73-0.93）。
与常规 MRI 相比，弥散加权 MRI 并没有带来额外的诊断价值。
