Bakir Vuslat Lale, Bakir Baris, Sanli Sükrü, Yildiz Sevda Ozel, Iyibozkurt Ahmet Cem, Kartal Merve Gülbiz, Yavuz Ekrem
1 Department of Obstetrics and Gynecology, Haseki Women and Children Diseases Education and Research Hospital, Istanbul, Turkey.
2 Department of Radiology, Istanbul University, Istanbul Medical School, Istanbul, Turkey.
Acta Radiol. 2017 Jun;58(6):758-767. doi: 10.1177/0284185116669873. Epub 2016 Sep 23.
Background Many publications have examined the relationship between apparent diffusion coefficient (ADC) values and tumor grade in endometrial cancer. Nevertheless, none were designed to evaluate according to the histopathological type of endometrioid and non-endometrioid tumors. Purpose To evaluate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of endometrioid and non-endometrioid cancer of the uterus, by comparing them with contrast-enhanced magnetic resonance imaging (MRI) findings. Material and Methods Institutional review board approval and informed consent were obtained. The MRI findings of 63 patients with endometrial cancer were retrospectively evaluated and divided into four groups: Grades I, II, and III endometrioid tumors, and non-endometrioid tumors. ADC values, DWI quotients ( b = 1000 s/mm), and post-contrast signal intensities between lesions and the myometrium (b1000q-Cq values) were evaluated. The one-way-ANOVA, student's t-test, Kruskal-Wallis test, and receiver operating characteristic (ROC) analysis were used for statistical evaluation. Results Mean ADC values were 0.86 ± 0.14 in Grade I, 0.80 ± 0.7 in Grade II, 0.71 ± 0.14 in Grade III for endometrioid tumors, and 0.70 ± 0.12 in non-endometrioid tumors. There was a significant difference in ADC values between Grade I and Grade III ( P = 0.006), and non-endometrioid tumors ( P = 0.003). The difference was also significant between Grades I + II and Grade III ( P = 0.009), and non-endometrioid tumors ( P = 0.004). Besides, there was a significant difference between endometrioid and non-endometrioid tumors ( P = 0.022). However, when considering b1000q (F = 0.640, P = 0.593) and Cq (χ= 6.233; P = 0.101), no significant difference was detected among the groups. Conclusion The difference in ADC values between the endometrioid and non-endometrioid tumors was statistically significant. However, the difference in DWI and contrast-enhancement findings were not statistically significant. Furthermore, the mean ADC values had an inverse relationship with tumor grade in the endometrioid cancer group.
许多出版物研究了子宫内膜癌中表观扩散系数（ADC）值与肿瘤分级之间的关系。然而，尚无研究根据子宫内膜样和非子宫内膜样肿瘤的组织病理学类型进行评估。目的：通过将扩散加权成像（DWI）与对比增强磁共振成像（MRI）结果进行比较，评估其在子宫子宫内膜样癌和非子宫内膜样癌鉴别诊断中的作用。材料与方法：获得机构审查委员会批准并取得知情同意。回顾性评估63例子宫内膜癌患者的MRI表现，并分为四组：I级、II级和III级子宫内膜样肿瘤，以及非子宫内膜样肿瘤。评估ADC值、DWI商数（b = 1000 s/mm²）以及病变与子宫肌层之间的对比后信号强度（b1000q-Cq值）。采用单因素方差分析、学生t检验、Kruskal-Wallis检验和受试者操作特征（ROC）分析进行统计学评估。结果：子宫内膜样肿瘤I级的平均ADC值为0.86±0.14，II级为0.80±0.7，III级为0.71±0.14，非子宫内膜样肿瘤为0.70±0.1第十二。I级与III级（P = 0.006）以及与非子宫内膜样肿瘤（P = 0.003）之间的ADC值存在显著差异。I + II级与III级（P = 0.009）以及与非子宫内膜样肿瘤（P = 0.004）之间的差异也具有统计学意义。此外，子宫内膜样肿瘤与非子宫内膜样肿瘤之间存在显著差异（P = 0.022）。然而，在考虑b1000q（F = 0.640，P = 0.593）和Cq（χ²= 6.233；P = 0.101）时，各组之间未检测到显著差异。结论：子宫内膜样肿瘤与非子宫内膜样肿瘤之间的ADC值差异具有统计学意义。然而，DWI和对比增强表现的差异无统计学意义。此外，在子宫内膜样癌组中，平均ADC值与肿瘤分级呈负相关。
