From the Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Radiology. 2015 Mar;274(3):734-41. doi: 10.1148/radiol.14140920. Epub 2014 Oct 7.
To retrospectively investigate the value of fused T2-weighted and high-b-value diffusion-weighted imaging with background body signal suppression (DWIBS) at 3 T to evaluate parametrial invasion in cervical cancer.
In this institutional review board-approved study, 152 consecutive patients with biopsy-proven cervical cancer who underwent radical hysterectomies also underwent pretreatment magnetic resonance imaging (T2-weighted imaging and DWIBS) at 3 T. Two radiologists independently evaluated the presence of parametrial invasion at T2-weighted imaging, fused T2-weighted imaging and high-b-value DWIBS (ie, fused T2-weighted DWIBS), and combined T2-weighted imaging and fused T2-weighted DWIBS, and the results were compared with histopathologic findings.
Parametrial invasion was identified by pathologic analysis in 37 of 152 patients (24.3%). For association with parametrial invasion, the specificity and accuracy of fused T2-weighted DWIBS (97.4% and 90.1%, respectively, for reader 1; 95.7% and 89.5%, respectively, for reader 2) and combined T2-weighted imaging and fused T2-weighted DWIBS (99.1% and 93.4%, respectively, for reader 1; 96.5% and 92.8%, respectively, for reader 2) were significantly better than those of T2-weighted imaging alone (88.7% and 85.5%, respectively, for reader 1; 85.2% and 83.6%, respectively, for reader 2) (all P < .05). The respective sensitivity of T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS was 75.7%, 67.6%, and 75.7% for reader 1 and 78.4%, 70.3%, and 81.1% for reader 2, and did not show significant differences (P value, ≤.375 to >.999). The respective area under the curve for association with parametrial invasion of T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS was 0.912, 0.951, and 0.976 for reader 1 and 0.890, 0.932, and 0.968 for reader 2 (P < .05). Interreader agreements were excellent (κ = 0.89, 0.9, and 0.86 for T2-weighted imaging, fused T2-weighted DWIBS, and combined T2-weighted imaging and fused T2-weighted DWIBS, respectively).
Fusion of high-b-value DWIBS with T2-weighted imaging can improve the diagnostic performance in association with parametrial invasion in cervical cancer compared with T2-weighted imaging alone.
回顾性研究在 3T 上应用背景抑制的 T2 加权和高 b 值弥散加权成像（DWIBS）评估宫颈癌旁组织侵犯的价值。
本研究经机构审查委员会批准，连续纳入 152 例经活检证实的宫颈癌患者，这些患者在根治性子宫切除术前均接受了 3T 磁共振成像（T2 加权成像和 DWIBS）检查。两位放射科医生分别评估 T2 加权成像、融合 T2 加权成像和高 b 值 DWIBS（即融合 T2 加权 DWIBS）以及 T2 加权成像和融合 T2 加权 DWIBS联合评估对宫颈癌旁组织侵犯的存在，将结果与组织病理学发现进行比较。
37 例（24.3%）患者经病理分析证实存在宫颈癌旁组织侵犯。在与宫颈癌旁组织侵犯相关联方面，融合 T2 加权 DWIBS（观察者 1 为 97.4%和 90.1%，观察者 2 为 95.7%和 89.5%）和 T2 加权成像与融合 T2 加权 DWIBS（观察者 1 为 99.1%和 93.4%，观察者 2 为 96.5%和 92.8%）的特异性和准确性明显优于 T2 加权成像（观察者 1 为 88.7%和 85.5%，观察者 2 为 85.2%和 83.6%）（均 P<.05）。T2 加权成像、融合 T2 加权 DWIBS 和 T2 加权成像与融合 T2 加权 DWIBS 联合的各自敏感性分别为观察者 1 为 75.7%、67.6%和 75.7%，观察者 2 为 78.4%、70.3%和 81.1%，但无统计学差异（P 值，≤.375 至>.999）。T2 加权成像、融合 T2 加权 DWIBS 和 T2 加权成像与融合 T2 加权 DWIBS 联合评估与宫颈癌旁组织侵犯相关的曲线下面积分别为观察者 1 为 0.912、0.951 和 0.976，观察者 2 为 0.890、0.932 和 0.968（P<.05）。两位观察者间的一致性均为极好（κ=0.89、0.9 和 0.86，用于 T2 加权成像、融合 T2 加权 DWIBS 和 T2 加权成像与融合 T2 加权 DWIBS 联合评估）。
与单独使用 T2 加权成像相比，高 b 值 DWIBS 与 T2 加权成像融合可提高与宫颈癌旁组织侵犯相关联的诊断性能。
