T2 及弥散加权成像（DWI）在子宫内膜癌局部分期中的诊断价值。
Diagnostic value of T2 and diffusion-weighted imaging (DWI) in local staging of endometrial cancer.
机构信息
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.
Erfan Niyaesh Hospital.
出版信息
J Med Imaging Radiat Sci. 2023 Jun;54(2):265-272. doi: 10.1016/j.jmir.2023.01.002. Epub 2023 Jan 30.
BACKGROUND
Endometrial cancer (EC) is the eighth most prevalent cancer globally. T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) help anatomical localization and local staging of lesions. The present study was performed to assess the diagnostic value of the simultaneous use of T2 and DWI techniques in EC evaluation.
METHODS
Seventy-eight histopathological-proven EC cases were included in this study. Patients were assessed using a complete MRI exam, including T2 and DWI. The myometrial invasion, cervical, serosal or adnexal, vaginal or parametrial, and pelvic lymph node involvements and accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated in each sequence distinctly and was compared with the pathology findings and full standard protocol using post-contrast multiphasic contrast-enhanced series.
RESULTS
Deep myometrial invasion in EC cases was detected in 38.5% by T2-DWI and 37.2% by pathology. The pathology diagnosed cervical, serosal, and vaginal involvements and pelvic lymph node metastases in 20.5%, 7.7%, 6.4% and 11.5% of cases respectively, while the numbers for T2-DWI were 26.9%, 7.7%, 7.7%, and 15.4%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of T2-DWI in the diagnosis of myometrial invasion were 93.5%, 93.1%, 93.8%, 90%, and 93.8%, respectively. A slightly higher Kappa coefficient of DWI (0.973) in the diagnosis of myometrial invasion was identified compared to T2 (0.946). The T2-DWI technique had a 52.6% intraclass correlation coefficient in the diagnosis of IA stage.
CONCLUSION
The simultaneous consideration of T2 and DWI technique may signify a noninvasive, rapid, safe, and accurate approach for precisely assessing myometrial invasion and EC staging. Elimination of intravenous contrast material result in prevention of contrast related side effects beside significant cost reduction for health care systems and patients with a comparable result to contrast enhanced MRI.
背景
子宫内膜癌（EC）是全球第八大常见癌症。T2 加权磁共振成像（MRI）和弥散加权成像（DWI）有助于病变的解剖定位和局部分期。本研究旨在评估 T2 和 DWI 技术联合应用于 EC 评估的诊断价值。
方法
本研究纳入 78 例经组织病理学证实的 EC 病例。对患者进行完整的 MRI 检查，包括 T2 和 DWI。在每个序列中分别评估肌层浸润、宫颈、浆膜或附件、阴道或宫旁、盆腔淋巴结累及情况及其准确性、敏感度、特异度、阳性和阴性预测值，并与病理结果和使用多相对比增强系列的完整标准方案进行比较。
结果
T2-DWI 在 EC 病例中检测到深肌层浸润的比例为 38.5%，而病理结果为 37.2%。病理诊断宫颈、浆膜和阴道受累及盆腔淋巴结转移的比例分别为 20.5%、7.7%、6.4%和 11.5%，而 T2-DWI 的比例分别为 26.9%、7.7%、7.7%和 15.4%。T2-DWI 诊断肌层浸润的准确性、敏感度、特异度、PPV 和 NPV 分别为 93.5%、93.1%、93.8%、90%和 93.8%。DWI 在诊断肌层浸润方面的 Kappa 系数（0.973）略高于 T2（0.946）。T2-DWI 技术在诊断 IA 期的内类相关系数为 52.6%。
结论
同时考虑 T2 和 DWI 技术可能是一种无创、快速、安全、准确的方法，可精确评估肌层浸润和 EC 分期。消除静脉内造影剂的使用除了可以预防造影剂相关的副作用外，还可以为医疗保健系统和患者显著降低成本，并且结果与对比增强 MRI 相当。
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