盆腔 MRI 在术前诊断子宫内膜异位症中的位置依赖性价值。
Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis.
机构信息
Department of Radiology, Vivantes - Network for Health, Humboldt-Hospital, Berlin, Germany.
出版信息
Eur J Obstet Gynecol Reprod Biol. 2013 Jul;169(1):93-8. doi: 10.1016/j.ejogrb.2013.02.007. Epub 2013 Mar 9.
OBJECTIVES
To investigate the value of magnetic resonance imaging (MRI) in the preoperative diagnosis of specific anatomical locations of endometriosis.
STUDY DESIGN
Between July 2008 and April 2011, 152 women (mean age 33.5 ± 6.1 years) with clinical and sonographic suspicion of endometriosis underwent pelvic MRI using T2 and unenhanced T1 sequences with and without fat saturation. Two radiologists interpreted the following regions by consensus according to a standardized protocol: ovaries, vagina, pouch of Douglas, rectosigmoid colon, uterosacral ligament (USL), bladder, peritoneum, and other pelvic regions. The results of MRI were retrospectively correlated with the laparoscopic and histopathologic findings. The main outcome parameters, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and the negative likelihood ratio (LR-), were determined.
RESULTS
Sensitivity, specificity, PPV, NPV, accuracy, positive and the negative likelihood ratio were 87.6%, 84.6%, 94.3%, 70.2%, 86.8%, 5.69 and 0.15 for the pouch of Douglas (vagina: 81.4%, 81.7%, 79.2%, 83.8%, 81.6%, 4.45, 0.23; rectosigmoid colon: 80.2%, 77.5%, 80.2%, 77.5%, 78.9%, 3.56, 0.25; USL: 77.5%, 68.2%, 77.5%, 68.2%, 73.7%, 2.44, 0.33; ovaries: 86.3%, 73.6%, 78.4%, 82.8%, 80.3%, 3.27, 0.19; urinary bladder: 81.0%, 94.7%, 70.8%, 96.9%, 92.8%, 15.15, 0.20; peritoneum: 35.3%, 88.1%, 60.0%, 73.0%, 70.4%, 2.97, 0.73). All endometriotic implants at other localization were detected (abdominal wall in 4, groin in one patient).
CONCLUSIONS
The value of MRI in preoperative diagnosis of endometriosis is dependent on the location of endometriosis. The highest accuracy was found in bladder endometriosis and the lowest in peritoneal endometriosis.
目的
探讨磁共振成像（MRI）在子宫内膜异位症特定解剖部位术前诊断中的价值。
研究设计
2008 年 7 月至 2011 年 4 月，152 例临床和超声怀疑子宫内膜异位症的女性患者接受盆腔 MRI 检查，使用 T2 和增强 T1 序列，包括和不包括脂肪饱和。两名放射科医生根据标准化协议对以下区域进行共识解读：卵巢、阴道、Douglas 窝、直肠乙状结肠、子宫骶韧带（USL）、膀胱、腹膜和其他盆腔区域。MRI 结果与腹腔镜和组织病理学结果进行回顾性比较。主要观察参数为灵敏度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、准确性、阳性似然比（LR+）和阴性似然比（LR-）。
结果
Douglas 窝（阴道：81.4%、81.7%、79.2%、83.8%、81.6%、4.45、0.23；直肠乙状结肠：80.2%、77.5%、80.2%、77.5%、78.9%、3.56、0.25；USL：77.5%、68.2%、77.5%、68.2%、73.7%、2.44、0.33；卵巢：86.3%、73.6%、78.4%、82.8%、80.3%、3.27、0.19；膀胱：81.0%、94.7%、70.8%、96.9%、92.8%、15.15、0.20；腹膜：35.3%、88.1%、60.0%、73.0%、70.4%、2.97、0.73）的敏感度、特异度、PPV、NPV、准确性、阳性和阴性似然比分别为 87.6%、84.6%、94.3%、70.2%、86.8%、5.69 和 0.15。其他定位的所有子宫内膜异位症病灶均被检测到（腹壁 4 例，腹股沟 1 例）。
结论
MRI 在子宫内膜异位症术前诊断中的价值取决于病变的位置。膀胱子宫内膜异位症的准确性最高，腹膜子宫内膜异位症的准确性最低。
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