Lin Gigin, Huang Yu-Ting, Chao Angel, Lin Yu-Chun, Yang Lan-Yan, Wu Ren-Chin, Lu Hsin-Ying, Ng Shu-Hang, Ng Koon-Kwan, Lai Chyong-Huey
Department of Medical Imaging and Intervention, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
Clinical Phenome Center, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
Eur Radiol. 2017 May;27(5):1867-1876. doi: 10.1007/s00330-016-4583-0. Epub 2016 Sep 9.
To compare the diagnostic accuracy of diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance (MR) imaging for detecting cervical stromal invasion in endometrial cancer.
Eighty-three consecutive women with endometrial cancer underwent preoperative evaluation in a 3-T unit, including T2-weighted, DW (b = 0 and 1000 s/mm), and DCE MR imaging. Two radiologists independently assessed presence of cervical stromal invasion, with histopathological reference as gold standard.
For assessing cervical stromal invasion, the diagnostic accuracy, sensitivity, and specificity, respectively for Reader 1/Reader 2, were as follows: DW MR imaging- 95.2 %/91.6 %, 91.7 %/100 %, and 95.8 %/90.1 %; DCE MR imaging- 91.6 %/88 %, 58.3 %/50 %, and 97.2 %/94.4 %. The diagnostic performance of DW MR imaging (Reader 1: areas under the receiver operating characteristic curve (AUC) = 0.98; Reader 2: AUC = 0.97) was significantly higher than that of DCE MR imaging (p = 0.009 for Reader 2) or T2-weighted MR imaging (Reader 1: p = 0.006; Reader 2: p = 0.013). Patients with cervical stromal invasion showed a significantly greater canal width (p < 0.0001) and myometrial invasion extent (p = 0.006).
DW MR imaging has superior diagnostic performance compared with DCE MR imaging in the detection of cervical stromal invasion.
• DWI demonstrates a higher accuracy than DCE in detecting cervical stromal invasion. • Tumour ADC values are similar between patients without or with cervical invasion. • Canal widening causes false-negativity on DCE and T2W but not on DWI.
比较扩散加权（DW）磁共振成像（MRI）和动态对比增强（DCE）MRI在检测子宫内膜癌宫颈基质浸润方面的诊断准确性。
83例连续的子宫内膜癌女性患者在3-T设备上进行术前评估，包括T2加权、DW（b = 0和1000 s/mm²）及DCE MRI检查。两名放射科医生独立评估宫颈基质浸润情况，以组织病理学结果作为金标准。
对于评估宫颈基质浸润，读者1/读者2的诊断准确性、敏感性和特异性分别如下：DW MRI分别为95.2%/91.6%、91.7%/100%和95.8%/90.1%；DCE MRI分别为91.6%/88%、58.3%/50%和97.2%/94.4%。DW MRI的诊断性能（读者1：受试者操作特征曲线下面积（AUC）= 0.98；读者2：AUC = 0.97）显著高于DCE MRI（读者2，p = 0.009）或T2加权MRI（读者1：p = 0.006；读者2：p = 0.013）。有宫颈基质浸润的患者宫颈管宽度（p < 0.0001）和肌层浸润程度（p = 0.006）明显更大。
在检测宫颈基质浸润方面，DW MRI比DCE MRI具有更高的诊断性能。
• 在检测宫颈基质浸润方面，DWI的准确性高于DCE。• 有无宫颈浸润患者的肿瘤表观扩散系数（ADC）值相似。• 宫颈管增宽会导致DCE和T2加权成像出现假阴性，但不会导致DWI出现假阴性。
