Bazot Marc, Beldjord Selma, Jarboui Lamia, Ferrier Clement, Bendifallah Sofiane, Daraï Emile
Department of Radiology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
Groupe de Recherche Clinique (GRC-6), Centre Expert En Endométriose (C3E), Assistance Publique Des Hôpitaux de Paris, Tenon University Hospital, Sorbonne Université, Paris, France.
Front Surg. 2020 Dec 18;7:614989. doi: 10.3389/fsurg.2020.614989. eCollection 2020.
The aim of the study was to evaluate three-dimensional (3D) T2 MRI before and after vaginal opacification (VO) by gel (3DT2VO) and the additional value of 3DT1 with fat-suppression (3DT1FS) MRI in the diagnosis of vaginal endometriosis. In this study conducted from 2010 to 2013, 51 patients scheduled for surgical treatment of endometriosis underwent MRI 1 day before surgery. Three readers (novice, intermediate, expert) were asked to retrospectively diagnose vaginal endometriosis independently and blindly using four different readings (i.e., 3DT2, 3DT2VO, 3DT2 with 3DT1FS, 3DT2VO with 3DT1FS). Vaginal endometriosis diagnosis was positive on observation of a thickening of vaginal walls on 3DT2 with or without high-signal-intensity spots on 3DT2 and/or 3DT1FS. The reference standard was surgery and histology. Descriptive analysis, Chi-square test, and ROC curves were used for statistical analysis. For all readers, the combination of 3DT2 and 3DT1FS significantly improved the diagnosis of vaginal endometriosis compared with 3DT2 ( = 0.002, = 0.02, and = 0.003). 3DT2VO significantly improved diagnosis for the intermediate reader ( = 0.01). High-signal-intensity spots on 3DT1FS had a sensitivity of 50-63.6%, specificity of 86.2-96.6%, and high positive likelihood ratios (14.5-Inf). 3DT2 in association with 3DT1FS appears to be the best 3D MRI protocol for the diagnosis of vaginal endometriosis, whatever the level of experience of readers. The additional value of 3DT2VO is variable among the readers.
本研究旨在评估凝胶阴道显影（VO）前后的三维（3D）T2磁共振成像（3DT2VO）以及3D脂肪抑制T1加权成像（3DT1FS）磁共振成像在阴道子宫内膜异位症诊断中的附加价值。在这项于2010年至2013年开展的研究中，51例计划接受子宫内膜异位症手术治疗的患者在手术前1天接受了磁共振成像检查。三名阅片者（新手、中级、专家）被要求使用四种不同的阅片方式（即3DT2、3DT2VO、3DT2联合3DT1FS、3DT2VO联合3DT1FS）独立且盲法地对阴道子宫内膜异位症进行回顾性诊断。当在3DT2上观察到阴道壁增厚，且在3DT2和/或3DT1FS上有或无高信号灶时，阴道子宫内膜异位症诊断为阳性。参考标准为手术及组织学检查。采用描述性分析、卡方检验和ROC曲线进行统计分析。对于所有阅片者，与3DT2相比，3DT2联合3DT1FS显著提高了阴道子宫内膜异位症的诊断率（P = 0.002、P = 0.02和P = 0.003）。3DT2VO对中级阅片者的诊断有显著改善（P = 0.01）。3DT1FS上的高信号灶敏感性为50 - 63.6%，特异性为86.2 - 96.6%，阳性似然比高（14.5 - 无穷大）。无论阅片者的经验水平如何，3DT2联合3DT1FS似乎是诊断阴道子宫内膜异位症的最佳3D磁共振成像方案。3DT2VO的附加价值在阅片者之间存在差异。
