Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, No.139 Renmin Road, Changsha, Hunan, 410011, PR China.
Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China.
Cancer Imaging. 2020 Sep 21;20(1):66. doi: 10.1186/s40644-020-00346-7.
We assessed the image quality of endometrial cancer lesions by readout segmentation of long variable echo-trains (RESOLVE) diffusion-weighted imaging (DWI) compared with that by single-shot echo-planar imaging (SS-EPI) DWI, aimed to explore the value of RESOLVE DWI for determining myometrial invasion and clinical stage in endometrial cancer.
From April 2017 to March 2018, a total of 30 endometrial cancer patients (mean age 52.8 ± 9.0 years), who had undergone RESOLVE DWI and SS-EPI DWI, were included in the study. The image quality of endometrial carcinoma by two kinds of DWI scanning methods was compared qualitatively and quantitatively. The Spearman rank correlation test was used to assess the correlation of qualitative image quality scores between two readers. The accuracy of two DWI methods in detecting myometrial invasion and staging of endometrial carcinoma was calculated according to postoperative pathological results. The indexes were analyzed including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV).
The qualitative score of RESOLVE DWI group was superior to SS-EPI DWI group in every aspect of five aspects (all P < 0.001). Interobserver agreement of depiction was good or excellent in two DWI sequences. Signal to noise ratio and contrast to noise ratio values in RESOLVE DWI group were both higher than those in SS-EPI DWI group (P<0.001). No statistical difference of apparent diffusion coefficient value was observed between two DWI groups (P = 0.261). The specificity, accuracy, PPV, and NPV of estimating myometrial invasion by RESOLVE DWI in three cases (intramucosal lesion, <50% superficial invasion and ≥ 50% deep invasion) were all higher than those by SS-EPI DWI for endometrial carcinoma. Especially RESOLVE DWI was valuable in judging <50% superficial invasion (95%CI:0.586, 0.970). No significant difference in accuracy staging was between the two DWI groups (P = 0.125).
RESOLVE DWI can provide higher quality images of endometrial carcinoma than SS-EPI DWI. The high-quality images are helpful for precise assessment of myometrial invasion in endometrial cancer.
我们通过读取分段长变量回波序列（RESOLVE）弥散加权成像（DWI）与单次激发回波平面成像（SS-EPI）DWI 评估子宫内膜癌病变的图像质量，旨在探索 RESOLVE DWI 对确定子宫内膜癌肌层浸润和临床分期的价值。
2017 年 4 月至 2018 年 3 月，共纳入 30 例子宫内膜癌患者（平均年龄 52.8±9.0 岁），均行 RESOLVE DWI 和 SS-EPI DWI 检查。对两种 DWI 扫描方法对子宫内膜癌的图像质量进行定性和定量比较。采用 Spearman 秩相关检验评估两位观察者之间定性图像质量评分的相关性。根据术后病理结果计算两种 DWI 方法在检测子宫内膜癌肌层浸润和分期中的准确性。分析的指标包括灵敏度、特异度、准确性、阳性预测值（PPV）和阴性预测值（NPV）。
在五个方面，RESOLVE DWI 组的定性评分均优于 SS-EPI DWI 组（均 P<0.001）。两种 DWI 序列的观察者间评估具有良好或极好的一致性。RESOLVE DWI 组的信噪比和对比噪声比均高于 SS-EPI DWI 组（均 P<0.001）。两种 DWI 组的表观弥散系数值无统计学差异（P=0.261）。RESOLVE DWI 对三种情况（黏膜内病变、<50%浅层浸润和≥50%深层浸润）估计子宫内膜癌肌层浸润的特异性、准确性、PPV 和 NPV 均高于 SS-EPI DWI。特别是 RESOLVE DWI 对<50%浅层浸润的评估有价值（95%CI：0.586，0.970）。两种 DWI 组的分期准确性无显著差异（P=0.125）。
RESOLVE DWI 可提供比 SS-EPI DWI 更高质量的子宫内膜癌图像。高质量图像有助于精确评估子宫内膜癌的肌层浸润。
