宫颈多房性黏液性囊腺癌与良性多房性病变的比较：多参数 MRI 特征。
Multicystic mucinous adenocarcinoma of the uterine cervix compared with benign multicystic lesions: Multiparametric MR features.
机构信息
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Obstetrics & Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
出版信息
J Magn Reson Imaging. 2018 Nov;48(5):1336-1343. doi: 10.1002/jmri.26038. Epub 2018 Apr 6.
BACKGROUND
Multicystic mucinous adenocarcinoma is rarely recognized and has a high misdiagnosis rate.
PURPOSE
To distinguish malignant multicystic mucinous adenocarcinomas from benign multicystic lesions in the uterine cervix using multiparametric MR.
STUDY TYPE
Retrospective.
POPULATION
Forty patients with seven cystic mucinous adenocarcinomas and 33 benign multicystic lesions.
FIELD STRENGTH/SEQUENCE: 3.0T. Diffusion-weighted images (DWI) and dynamic contrast-enhanced (DCE) images.
ASSESSMENT
Lesion size, intracystic hemorrhage, solid component, and heterogeneous enhancement were subjectively assessed, and apparent diffusion coefficient (ADC) values, K , K , and V parameters were compared.
STATISTICAL ANALYSIS
Student's t-test was used to compare age, tumor size, ADC values, and DCE parameters. Pearson's chi-square test was used to compare intracystic hemorrhage, solid component, and heterogeneous enhancement. Receiver-operating-characteristic (ROC) analysis of ADC values, tumor size, and K were performed.
RESULTS
The size of mucinous adenocarcinomas was larger than benign multicystic lesions (4.09 ± 2.09 vs. 2.23 ± 0.58 cm, P < 0.001); the area under the curve (AUC) for tumor size was 0.859 with a sensitivity of 71.4% and specificity of 90.9%. Stromal ADC value was lower for mucinous adenocarcinomas (1.19 ± 0.22 vs. 1.68 ± 0.22 × 10 mm /s, P < 0.001); AUC for stromal ADC value was 0.970, with a sensitivity of 86.4% and specificity of 100.0%. Among quantitative DCE parameters, only k offered a discriminative value (1.72 ± 1.42 vs. 0.69 ± 0.30 min , P = 0.031); the AUC for k was 0.831 with a sensitivity of 71.4% and specificity of 97.0%. Intracystic hemorrhage (3/7), solid component (5/7), and heterogeneous enhancement (4/7) were only found in mucinous adenocarcinomas. Five patients (71.4%) had lymphovascular space invasion and three (42.9%) had lymph node metastasis. The 1-year tumor recurrence or metastasis rate was 28.5% (2/7).
DATA CONCLUSION
Awareness of multiparametric MR features can assist in the differentiation of mucinous adenocarcinomas from benign multicystic lesions.
LEVEL OF EVIDENCE
4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1336-1343.
背景
多房性黏液性囊腺癌很少被认识，误诊率很高。
目的
利用多参数磁共振成像（MR）对宫颈多房性黏液性囊腺癌与良性多房性病变进行鉴别诊断。
研究类型
回顾性研究。
人群
40 例患者，其中 7 例为囊性腺癌，33 例为良性多房性病变。
磁场强度/序列：3.0T。弥散加权成像（DWI）和动态对比增强（DCE）图像。
评估
主观评估病变大小、囊内出血、实性成分和不均匀增强，并比较表观扩散系数（ADC）值、K、K和 V 参数。
统计学分析
采用 Student's t 检验比较年龄、肿瘤大小、ADC 值和 DCE 参数。采用 Pearson 卡方检验比较囊内出血、实性成分和不均匀增强。对 ADC 值、肿瘤大小和 K 进行受试者工作特征（ROC）分析。
结果
黏液性腺癌的大小大于良性多房性病变（4.09±2.09 vs. 2.23±0.58 cm，P<0.001）；肿瘤大小的曲线下面积（AUC）为 0.859，灵敏度为 71.4%，特异性为 90.9%。黏液性腺癌的间质 ADC 值较低（1.19±0.22 vs. 1.68±0.22×10 mm/s，P<0.001）；间质 ADC 值的 AUC 为 0.970，灵敏度为 86.4%，特异性为 100.0%。在定量 DCE 参数中，只有 k 具有鉴别价值（1.72±1.42 vs. 0.69±0.30 min，P=0.031）；k 的 AUC 为 0.831，灵敏度为 71.4%，特异性为 97.0%。囊内出血（3/7）、实性成分（5/7）和不均匀增强（4/7）仅见于黏液性腺癌。5 例（71.4%）患者有脉管侵犯，3 例（42.9%）患者有淋巴结转移。1 年肿瘤复发或转移率为 28.5%（2/7）。
数据结论
对多参数 MR 特征的认识有助于鉴别黏液性腺癌与良性多房性病变。
证据水平
4 级技术效果：阶段 2 J. 磁共振成像 2018；47：1336-1343。
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