子宫内膜癌：扩散张量成像的评估及其与组织病理学发现的相关性。
Endometrial carcinoma: Evaluation using diffusion-tensor imaging and its correlation with histopathologic findings.
机构信息
Department of Diagnostic Radiology and Nuclear Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Comprehensive Reproductive Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
J Magn Reson Imaging. 2019 Jul;50(1):250-260. doi: 10.1002/jmri.26558. Epub 2018 Nov 19.
BACKGROUND
Although the prognosis of endometrial carcinoma (EMC) patients strictly depends on tumor invasion depth and its histologic grade, accurate preoperative assessment of these prognostic factors is often difficult.
PURPOSE
To determine the usefulness of diffusion-tensor imaging (DTI) as a noninvasive method for evaluating tumor invasion depth and its histologic grade in patients with EMC.
STUDY TYPE
Prospective.
POPULATION
Twenty-five consecutive patients with histologically confirmed EMC who were surgically treated at our institution.
FIELD STRENGTH/SEQUENCE: DTI was performed with a 1.5T MRI system using a single-shot echo-planar imaging sequence with b values of 0 and 1000 s/mm and motion-probing gradients in nine noncollinear directions.
ASSESSMENT
Fractional anisotropy (FA), mean diffusivity (MD), and axial diffusivity (AD) maps were analyzed by three observers and compared with histopathologic findings.
STATISTICAL TESTS
Dunnett's test, Spearman's rank correlation coefficient, and receiver operating characteristic (ROC) curve analyses.
RESULTS
FA maps from all patients distinctly identified the junctional zone as a high-FA zone (0.864 ± 0.037) that was significantly different from the endometrium and outer myometrium (0.251 ± 0.030 and 0.471 ± 0.091, respectively; P < 0.001). All EMCs were clearly depicted as hypointense areas on all DTI maps. AD maps provided the best tumor-to-uterus contrast, and EMCs (0.977 ± 0.120 × 10 mm /s) had significantly lower AD values than all other layers of the normal uterine wall (2.166 ± 0.408, 2.010 ± 0.289, and 2.655 ± 0.203 × 10 mm /s, respectively; P < 0.001). EMCs were clearly demarcated from the normal uterine wall, and DTI maps and histopathologic data yielded identical findings regarding tumor invasion depth. FA values showed a significant inverse correlation (r = -0.818; P < 0.001) with histologic grades 1, 2, and 3 of endometrioid adenocarcinomas.
DATA CONCLUSION
In patients with EMC, DTI may be useful for evaluating tumor invasion depth and its histologic grade.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:250-260.
背景
尽管子宫内膜癌（EMC）患者的预后严格取决于肿瘤侵袭深度和组织学分级，但准确的术前评估这些预后因素往往很困难。
目的
确定扩散张量成像（DTI）作为一种非侵入性方法，用于评估 EMC 患者的肿瘤侵袭深度和组织学分级。
研究类型
前瞻性。
人群
在我院接受手术治疗的 25 例经组织学证实的 EMC 连续患者。
场强/序列：使用单次激发回波平面成像序列在 1.5T MRI 系统上进行 DTI，b 值分别为 0 和 1000 s/mm，在九个非共线方向上使用运动探测梯度。
评估
三位观察者分析了各向异性分数（FA）、平均扩散系数（MD）和轴突扩散系数（AD）图，并与组织病理学结果进行比较。
统计检验
Dunnett 检验、Spearman 秩相关系数和接收者操作特征（ROC）曲线分析。
结果
所有患者的 FA 图均清晰地区分交界区为高 FA 区（0.864±0.037），与子宫内膜和外肌层明显不同（0.251±0.030 和 0.471±0.091，P<0.001）。所有 EMC 在所有 DTI 图上均清晰显示为低信号区。AD 图提供了最佳的肿瘤与子宫对比度，而 EMC（0.977±0.120×10mm/s）的 AD 值明显低于正常子宫壁的所有其他层（2.166±0.408、2.010±0.289 和 2.655±0.203×10mm/s，P<0.001）。EMC 与正常子宫壁明显分界，DTI 图和组织病理学数据在肿瘤侵袭深度方面得出相同的结果。FA 值与子宫内膜样腺癌 1、2 和 3 级呈显著负相关（r=-0.818；P<0.001）。
数据结论
在 EMC 患者中，DTI 可能有助于评估肿瘤侵袭深度和组织学分级。
证据水平
1 技术功效：2 级 J. Magn. Reson. Imaging 2019；50：250-260.
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