多参数磁共振成像有助于在对子宫内膜癌进行保留生育力管理之前选择患者。
Multiparametric magnetic resonance imaging facilitates the selection of patients prior to fertility-sparing management of endometrial cancer.
机构信息
Department of Diagnostic Radiology and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
Abdom Radiol (NY). 2021 Sep;46(9):4410-4419. doi: 10.1007/s00261-021-03050-7. Epub 2021 Apr 7.
PURPOSE
To compare the diagnostic performance of biparametric magnetic resonance imaging (bpMRI) versus multiparametric MRI (mpMRI) for the staging of well-differentiated endometrioid endometrial cancer (EC) in potential candidates for fertility-sparing management.
METHODS
This multi-center retrospective study included 48 potential candidates for fertility-sparing management (age <46 years, grade 1 endometroid EC) who did not wish to undergo fertility-sparing management and thus underwent definitive surgery. Two readers (R1, R2) independently reviewed bpMRI (T1, T2, and diffusion-weighted imaging) and mpMRI (bpMRI and dynamic contrast-enhanced imaging, DCE) during two separate sessions spaced one month apart for the presence of myometrial invasion (MI), cervical stromal involvement (CSI), malignant adnexal disease (mAD), and pelvic lymphadenopathy (pLNM). Each reader also recorded maximum tumor diameter, tumor volume, and tumor-to-uterine volume ratio (TVR) on T2-weighted imaging. The diagnostic performance of bpMRI and mpMRI was determined for each reader with surgical pathology serving as a gold standard.
RESULTS
The area under the receiver operating curve (AUC) for bpMRI versus mpMRI was 0.76/0.78 (R1/R2) versus 0.84/0.83 for MI, 0.79/0.76 versus 0.99/0.80 for CSI, 0.84/0.84 versus 0.84/0.80 for mAD, and 0.82/0.82 for pLMN. The sensitivity and specificity of MRI for detecting tumor spread beyond the endometrium were 71%/77% and 71%/65% for bpMRI (R1/R2) vs. 84%/90% and 71%/65% for mpMRI (R1/R2), respectively. The AUC of maximum tumor diameter, tumor volume, and TVR for MI was 0.71/0.61, 0.73/0.75, and 0.75/0.77 for R1/R2, respectively.
CONCLUSION
MRI had moderate diagnostic performance across potential candidates for fertility-sparing treatment of EC. mpMRI outperformed bpMRI for detecting EC spreading beyond the endometrium.
目的
比较双参数磁共振成像（bpMRI）与多参数磁共振成像（mpMRI）在潜在生育保留管理候选者中对分化良好的子宫内膜样子宫内膜癌（EC）进行分期的诊断性能。
方法
这项多中心回顾性研究纳入了 48 名潜在的生育保留管理候选者（年龄<46 岁，G1 子宫内膜样 EC），他们不希望进行生育保留管理，因此接受了确定性手术。两位读者（R1、R2）分别在相隔一个月的两次会议上独立检查 bpMRI（T1、T2 和弥散加权成像）和 mpMRI（bpMRI 和动态对比增强成像，DCE），以评估是否存在子宫肌层侵犯（MI）、宫颈基质受累（CSI）、恶性附件疾病（mAD）和盆腔淋巴结病（pLNM）。每位读者还记录 T2 加权成像上的最大肿瘤直径、肿瘤体积和肿瘤与子宫体积比（TVR）。以手术病理为金标准，确定 bpMRI 和 mpMRI 的诊断性能。
结果
bpMRI 与 mpMRI 的受试者工作特征曲线下面积（AUC）分别为 0.76/0.78（R1/R2）和 0.84/0.83 用于 MI，0.79/0.76 用于 CSI，0.84/0.84 用于 mAD，0.82/0.82 用于 pLNM。MRI 检测肿瘤是否超出子宫内膜的敏感性和特异性分别为 71%/77%和 71%/65%的 bpMRI（R1/R2）与 84%/90%和 71%/65%的 mpMRI（R1/R2）。用于 MI 的最大肿瘤直径、肿瘤体积和 TVR 的 AUC 分别为 0.71/0.61、0.73/0.75 和 0.75/0.77，用于 R1/R2。
结论
MRI 在 EC 潜在生育保留治疗的候选者中具有中等的诊断性能。mpMRI 在检测 EC 超出子宫内膜的扩散方面优于 bpMRI。
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