Sumi Akiko, Terasaki Hiroshi, Sanada Sakiko, Uchida Masafumi, Tomioka Yoshito, Kamura Toshiharu, Yano Hirohisa, Abe Toshi
Department of Radiology, Kurume University School of Medicine.
Magn Reson Med Sci. 2015;14(4):295-304. doi: 10.2463/mrms.2014-0023. Epub 2015 Jun 23.
We retrospectively compared and quantified magnetic resonance (MR) images to distinguish major histological types of uterine sarcomas and malignant and benign tumors.
MR images were obtained from patients who underwent preoperative examinations. We compared 25 pathologically confirmed uterine sarcomas (8 leiomyosarcomas, 11 carcinosarcomas, 6 endometrial stromal sarcomas) with 25 uterine leiomyomas. MR findings included tumor size, location, contour, signal intensity (SI), and contrast enhancement. Analysis focused on the contrast ratio (CR) of SI in T2-weighted images for the areas of lowest, highest, and main SI of each tumor as well as the contrast-enhanced ratio (CER) for the main solid part of each tumor in contrast-enhanced T1-weighted images. We evaluated diffusion-weighted (DW) images and apparent diffusion coefficient (ADC) values in 18 tumors (4 sarcomas, 14 leiomyomas).
Uterine sarcomas and leiomyomas differed significantly in tumor location, contour, hemorrhaging, necrotic and cystic components, CR for the area of lowest SI (P < 0.05), CR for the area of main SI (P < 0.01), and CER (P < 0.05). Leiomyosarcomas were larger than carcinosarcomas or endometrial stromal sarcomas, and the CR for the area of lowest SI of leiomyosarcomas (P < 0.05) was significantly lower. The CER for endometrial stromal sarcomas (P < 0.05) showed the most homogeneous enhancement. Hemorrhagic or necrotic and cystic components were found more often in larger tumors, although there was no significant difference in their occurrence between sarcoma types. All uterine sarcomas showed high intensity on DW images. The ADC values were lower of uterine sarcomas than leiomyomas, although the difference was not statistically significant.
Quantitative assessment using the CR or CER was useful for distinguishing benign and malignant uterine tumors as well as major histological types of uterine sarcomas.
我们通过回顾性比较和量化磁共振（MR）图像，以区分子宫肉瘤的主要组织学类型以及恶性和良性肿瘤。
从接受术前检查的患者获取MR图像。我们将25例经病理证实的子宫肉瘤（8例平滑肌肉瘤、11例癌肉瘤、6例子宫内膜间质肉瘤）与25例子宫平滑肌瘤进行比较。MR表现包括肿瘤大小、位置、轮廓、信号强度（SI）和对比增强。分析重点在于每个肿瘤最低、最高和主要SI区域在T2加权图像中的SI对比率（CR），以及每个肿瘤主要实性部分在对比增强T1加权图像中的对比增强率（CER）。我们评估了18个肿瘤（4例肉瘤、14例平滑肌瘤）的扩散加权（DW）图像和表观扩散系数（ADC）值。
子宫肉瘤和平滑肌瘤在肿瘤位置、轮廓、出血、坏死和囊性成分、最低SI区域的CR（P < 0.05）、主要SI区域的CR（P < 0.01）和CER（P < 0.05）方面存在显著差异。平滑肌肉瘤比癌肉瘤或子宫内膜间质肉瘤更大，平滑肌肉瘤最低SI区域的CR（P < 0.05）显著更低。子宫内膜间质肉瘤的CER（P < 0.05）显示出最均匀的增强。出血或坏死及囊性成分在较大肿瘤中更常见，尽管不同肉瘤类型之间其发生率无显著差异。所有子宫肉瘤在DW图像上均表现为高信号。子宫肉瘤的ADC值低于平滑肌瘤，尽管差异无统计学意义。
使用CR或CER进行定量评估有助于区分子宫良性和恶性肿瘤以及子宫肉瘤的主要组织学类型。
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