Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul Metropolitan Government, Seoul National University Boramae Medical Center, Seoul, Korea.
Korean J Radiol. 2019 Mar;20(3):378-384. doi: 10.3348/kjr.2018.0248.
To directly compare the diagnostic performance of true and oblique axial T2-weighted imaging (T2WI) for assessing parametrial invasion (PMI) in cervical cancer.
This retrospective study included 71 women with treatment-naive cervical cancer who underwent MRI that included both oblique and true axial T2WI, followed by radical hysterectomy. Two blinded radiologists (Radiologist 1 and Radiologist 2) independently assessed the presence of PMI on both sequences using a 5-point Likert scale. Receiver operating characteristic (ROC) curve analysis was performed, with a subgroup analysis for tumors sized > 2.5 cm and ≤ 2.5 cm in diameter. Inter-reader agreement was assessed with kappa (k) statistics.
At hysterectomy, 15 patients (21.1%) had PMI. For Radiologist 1, the area under the ROC curve (AUC) was greater for oblique axial than for true axial T2WI {0.941 (95% confidence interval [CI] = 0.858-0.983) vs. 0.917 (95% CI = 0.827-0.969), = 0.027}. The difference was not significant for Radiologist 2 (0.879 [95% CI = 0.779-0.944] vs. 0.827 [95% CI = 0.719-0.906], = 0.153). For tumors > 2.5 cm, AUC was greater with oblique than with true axial T2WI (0.906 vs. 0.860, = 0.046 for Radiologist 1 and 0.839 vs. 0.765, = 0.086 for Radiologist 2). Agreement between the radiologists was almost perfect for oblique axial T2WI (k = 0.810) and was substantial for true axial T2WI (k = 0.704).
Oblique axial T2WI potentially provides greater diagnostic performance than true axial T2WI for determining PMI, particularly for tumors > 2.5 cm. The inter-reader agreement was greater with oblique axial T2WI.
直接比较真实轴和斜轴 T2 加权成像（T2WI）在评估宫颈癌旁肌层浸润（PMI）中的诊断性能。
本回顾性研究纳入了 71 例未经治疗的宫颈癌患者，这些患者均接受了包括斜轴和真实轴 T2WI 的 MRI 检查，随后进行根治性子宫切除术。两名盲法阅片医生（阅片医生 1 和阅片医生 2）分别使用 5 分制 Likert 量表独立评估两种序列上 PMI 的存在情况。进行了受试者工作特征（ROC）曲线分析，并对直径>2.5cm 和≤2.5cm 的肿瘤进行了亚组分析。采用kappa（k）统计评估读者间的一致性。
在子宫切除术中，15 例患者（21.1%）存在 PMI。对于阅片医生 1，斜轴 T2WI 的 ROC 曲线下面积（AUC）大于真实轴 T2WI{0.941（95%置信区间 [CI] = 0.858-0.983）与 0.917（95% CI = 0.827-0.969），=0.027}。对于阅片医生 2，两者之间的差异无统计学意义（0.879（95% CI = 0.779-0.944）与 0.827（95% CI = 0.719-0.906），=0.153）。对于直径>2.5cm 的肿瘤，斜轴 T2WI 的 AUC 大于真实轴 T2WI（0.906 与 0.860，=0.046 对于阅片医生 1 和 0.839 与 0.765，=0.086 对于阅片医生 2）。斜轴 T2WI 两位阅片医生之间的一致性近乎完美（k=0.810），而真实轴 T2WI 的一致性较高（k=0.704）。
对于确定 PMI，斜轴 T2WI 可能比真实轴 T2WI 提供更好的诊断性能，尤其是对于直径>2.5cm 的肿瘤。斜轴 T2WI 的读者间一致性更高。
