Fukunaga Takeru, Fujii Shinya, Inoue Chie, Kato Ayumi, Chikumi Jun, Kaminou Toshio, Ogawa Toshihide
Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan.
Division of Reproductive-Perinatal Medicine and Gynecological Oncology, Department of Surgery, Faculty of Medicine, Tottori University, Yonago, Japan.
J Magn Reson Imaging. 2015 Jun;41(6):1662-8. doi: 10.1002/jmri.24730. Epub 2014 Aug 19.
To investigate type II endometrial carcinoma characterization using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and evaluate the diagnostic accuracy of semiquantitative DCE-MRI in differentiating type II from type I tumors.
Seventy-seven patients with endometrial carcinoma were retrospectively evaluated using 3T DCE-MRI. The maximum absolute enhancement of signal intensity (SImax), maximum relative enhancement (SIrel), wash-in rate (WIR), and the SImax/SI (piriformis) ratio were analyzed. To differentiate type I from type II tumors, optimal threshold criteria were established. The Mann-Whitney U-test was used for statistical comparison and receiver operating characteristic curve analysis was used to determine optimal cutoff values.
The SIrel (P < 0.001), WIR (P < 0.0001), and SImax/SI (piriformis) ratio (P < 0.0001), but not SImax, differed significantly between type I and type II carcinomas. Cutoff values of SIrel ≥58.8, WIR ≥37.0, and SImax/SI (piriformis) ratio ≥1.55 had sensitivities of 93%, 93%, and 67%, specificities of 60%, 60%, and 79%, accuracies of 66%, 66%, and 67%, respectively, for predicting type II endometrial carcinoma.
Endometrial carcinoma with strong (high level) enhancement on DCE-MRI is suggestive of type II endometrial carcinoma. Semiquantitative evaluation of DCE-MRI may be useful for differentiating type II from type I tumors.
利用动态对比增强磁共振成像（DCE-MRI）研究Ⅱ型子宫内膜癌的特征，并评估半定量DCE-MRI在鉴别Ⅱ型与Ⅰ型肿瘤中的诊断准确性。
回顾性分析77例子宫内膜癌患者的3T DCE-MRI图像。分析信号强度最大绝对增强（SImax）、最大相对增强（SIrel）、流入率（WIR）以及SImax/SI（梨状肌）比值。为鉴别Ⅰ型与Ⅱ型肿瘤，制定了最佳阈值标准。采用曼-惠特尼U检验进行统计学比较，并使用受试者操作特征曲线分析确定最佳截断值。
Ⅰ型和Ⅱ型子宫内膜癌之间，SIrel（P < 0.001）、WIR（P < 0.0001）和SImax/SI（梨状肌）比值（P < 0.0001）差异有统计学意义，但SImax无差异。预测Ⅱ型子宫内膜癌时，SIrel≥58.8、WIR≥37.0和SImax/SI（梨状肌）比值≥1.55的截断值的敏感度分别为93%、93%和67%，特异度分别为60%、60%和79%，准确率分别为66%、66%和67%。
DCE-MRI上强化明显（高水平）的子宫内膜癌提示为Ⅱ型子宫内膜癌。DCE-MRI的半定量评估可能有助于鉴别Ⅱ型与Ⅰ型肿瘤。
