利用无创性 MRI T2 映射对子宫内膜纤维化进行定量评估：初步发现。
Quantification of Endometrial Fibrosis Using Noninvasive MRI T2 Mapping: Initial Findings.
机构信息
Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
出版信息
J Magn Reson Imaging. 2023 Dec;58(6):1703-1713. doi: 10.1002/jmri.28746. Epub 2023 Apr 19.
BACKGROUND
Endometrial fibrosis may cause infertility. Accurate evaluation of endometrial fibrosis helps clinicians to schedule timely therapy.
PURPOSE
To explore T2 mapping for assessing endometrial fibrosis.
STUDY TYPE
Prospective.
POPULATION
Ninety-seven women with severe endometrial fibrosis (SEF) and 21 patients with mild to moderate endometrial fibrosis (MMEF), diagnosed by hysteroscopy, and 37 healthy women.
FIELD STRENGTH/SEQUENCE: 3T, T2-weighted turbo spin echo (T2-weighted imaging) and multi-echo turbo spin echo (T2 mapping) sequences.
ASSESSMENT
Endometrial MRI parameters (T2, thickness [ET], area [EA], and volume [EV]) were measured by N.Z. and Q.H. (9- and 4-years' experience in pelvic MRI) and compared between the three subgroups. A multivariable model including MRI parameters and clinical variables (including age and body mass index [BMI]) was developed to predict endometrial fibrosis assessed by hysteroscopy.
STATISTICAL TESTS
Kruskal-Wallis; ANOVA; Spearman's correlation coefficient (rho); area under the receiver operating characteristic curve (AUC); binary logistic regression; intraclass correlation coefficient (ICC). P value <0.05 for statistical significance.
RESULTS
Endometrial T2, ET, EA, and EV of MMEF patients (185 msec, 8.2 mm, 168 mm , and 2181 mm ) and SEF patients (164 msec, 6.7 mm, 120 mm , and 1762 mm ) were significantly lower than those of healthy women (222 msec, 11.7 mm, 316 mm , and 3960 mm ). Endometrial T2 and ET of SEF patients were significantly lower than those of MMEF patients. Endometrial T2, ET, EA, and EV were significantly correlated to the degree of endometrial fibrosis (rho = -0.623, -0.695, -0.694, -0.595). There were significant strong correlations between ET, EA, and EV in healthy women and MMEF patients (rho = 0.850-0.908). Endometrial MRI parameters and the multivariable model accurately distinguished MMEF or SEF from normal endometrium (AUCs >0.800). Age, BMI, and MRI parameters in univariable analysis and age and T2 in multivariable analysis significantly predicted endometrial fibrosis. The reproducibility of MRI parameters was excellent (ICC, 0.859-0.980).
DATA CONCLUSION
T2 mapping has potential to noninvasively and quantitatively evaluate the degree of endometrial fibrosis.
EVIDENCE LEVEL
2 Technical Efficacy: Stage 2.
背景
子宫内膜纤维化可能导致不孕。准确评估子宫内膜纤维化有助于临床医生及时安排治疗。
目的
探讨 T2 映射在评估子宫内膜纤维化中的应用。
研究类型
前瞻性。
人群
97 例经宫腔镜诊断为重度子宫内膜纤维化（SEF）和 21 例轻度至中度子宫内膜纤维化（MMEF）的患者，以及 37 例健康女性。
磁场强度/序列：3T，T2 加权涡轮自旋回波（T2WI）和多回波涡轮自旋回波（T2 映射）序列。
评估
子宫内膜 MRI 参数（T2、厚度[ET]、面积[EA]和体积[EV]）由 N.Z. 和 Q.H.（9 年和 4 年盆腔 MRI 经验）测量，并在三组亚组之间进行比较。建立了一个包含 MRI 参数和临床变量（包括年龄和体重指数[BMI]）的多变量模型，以预测宫腔镜评估的子宫内膜纤维化。
统计学检验
Kruskal-Wallis；方差分析；Spearman 相关系数（rho）；接收者操作特征曲线下面积（AUC）；二元逻辑回归；组内相关系数（ICC）。P 值<0.05 表示有统计学意义。
结果
MMEF 患者（185msec，8.2mm，168mm，2181mm）和 SEF 患者（164msec，6.7mm，120mm，1762mm）的子宫内膜 T2、ET、EA 和 EV 明显低于健康女性（222msec，11.7mm，316mm，3960mm）。SEF 患者的子宫内膜 T2 和 ET 明显低于 MMEF 患者。子宫内膜 T2、ET、EA 和 EV 与子宫内膜纤维化程度呈显著负相关（rho=-0.623、-0.695、-0.694、-0.595）。在健康女性和 MMEF 患者中，ET、EA 和 EV 之间存在显著的强相关性（rho=0.850-0.908）。在健康女性和 MMEF 患者中，子宫内膜 MRI 参数和多变量模型能够准确地区分 MMEF 或 SEF 与正常子宫内膜（AUC>0.800）。单变量分析中的年龄、BMI、MRI 参数和多变量分析中的年龄和 T2 显著预测了子宫内膜纤维化。MRI 参数的可重复性极好（ICC，0.859-0.980）。
数据结论
T2 映射具有无创性和定量评估子宫内膜纤维化程度的潜力。
证据水平
2 级技术疗效。
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