鉴别子宫癌肉瘤与子宫内膜样腺癌的临床及多参数MRI特征

Clinical and multiparametric MRI features for differentiating uterine carcinosarcoma from endometrioid adenocarcinoma.

作者信息

Chen Xiaodan, Guo Qingyong, Chen Xiaorong, Zheng Wanjing, Kang Yaqing, Cao Dairong

机构信息

Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, P.R. China.

Department of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.

出版信息

BMC Med Imaging. 2024 Feb 19;24(1):48. doi: 10.1186/s12880-024-01225-4.

DOI:10.1186/s12880-024-01225-4

PMID:38373912

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10877902/

Abstract

INTRODUCTION

The purpose of our study was to differentiate uterine carcinosarcoma (UCS) from endometrioid adenocarcinoma (EAC) by the multiparametric magnetic resonance imaging (MRI) features.

METHODS

We retrospectively evaluated clinical and MRI findings in 17 patients with UCS and 34 patients with EAC proven by histologically. The following clinical and pathological features were evaluated: post- or pre-menopausal, clinical presentation, invasion depth, FIGO stage, lymphaticmetastasis. The following MRI features were evaluated: tumor dimension, cystic degeneration or necrosis, hemorrhage, signal intensity (SI) on T2-weighted images (T2WI), relative SI of lesion to myometrium on T2WI, T1WI, DWI, ADCmax, ADCmin, ADCmean (RSI-T2, RSI-T1, RSI-DWI, RSI-ADCmax, RSI-ADCmin, RSI-ADCmean), ADCmax, ADCmin, ADCmean, the maximum, minimum and mean relative enhancement (RE) of lesion to myometrium on the arterial and venous phases (REAmax, REAmin, REAmean, REVmax, REVmin, REVmean). Receiver operating characteristic (ROC) analysis and the area under the curve (AUC) were used to evaluate prediction ability.

RESULTS

The mean age of UCS was higher than EAC. UCS occurred more often in the postmenopausal patients. UCS and EAC did not significantly differ in depth of myometrial invasion, FIGO stage and lymphatic metastasis. The anterior-posterior and transverse dimensions were significantly larger in UCS than EAC. Cystic degeneration or necrosis and hemorrhage were more likely occurred in UCS. The SI of tumor on T2WI was more heterogeneous in UCS. The RSI-T2, ADCmax, ADCmean, RSI-ADCmax and RSI-ADCmean of UCS were significantly higher than EAC. The REAmax, REAmin, REAmean, REVmax, REVmin and REVmean of UCS were all higher than EAC. The AUCs were 0.72, 0.71, 0.86, 0.96, 0.89, 0.84, 0.73, 0.97, 0.88, 0.94, 0.91, 0.69 and 0.80 for the anterior-posterior dimension, transverse dimension, RSI-T2, ADCmax, ADCmean, RSI-ADCmax, RSI-ADCmean, REAmax, REAmin, REAmean, REVmax, REVmin and REVmean, respectively. The AUC was 0.997 of the combined of ADCmax, REAmax and REVmax. Our study showed that ADCmax threshold value of 789.05 (10mm/s) can differentiate UCS from EAC with 100% sensitivity, 76.5% specificity, and 0.76 AUC, REAmax threshold value of 0.45 can differentiate UCS from EAC with 88.2% sensitivity, 100% specificity, and 0.88 AUC.

CONCLUSION

Multiparametric MRI features may be utilized as a biomarker to distinguish UCS from EAC.

摘要

引言

我们研究的目的是通过多参数磁共振成像（MRI）特征来鉴别子宫癌肉瘤（UCS）和子宫内膜样腺癌（EAC）。

方法

我们回顾性评估了17例经组织学证实的UCS患者和34例EAC患者的临床及MRI表现。评估了以下临床和病理特征：绝经后或绝经前、临床表现、浸润深度、国际妇产科联盟（FIGO）分期、淋巴转移。评估了以下MRI特征：肿瘤大小、囊性变或坏死、出血、T2加权像（T2WI）上的信号强度（SI）、T2WI上病变与肌层的相对SI、T1WI、扩散加权成像（DWI）、最大表观扩散系数（ADCmax）、最小表观扩散系数（ADCmin）、平均表观扩散系数（ADCmean）（RSI-T2、RSI-T1、RSI-DWI、RSI-ADCmax、RSI-ADCmin、RSI-ADCmean）、ADCmax、ADCmin、ADCmean，病变在动脉期和静脉期与肌层的最大、最小和平均相对强化（RE）（REAmax、REAmin、REAmean、REVmax、REVmin、REVmean）。采用受试者工作特征（ROC）分析和曲线下面积（AUC）来评估预测能力。

结果

UCS患者的平均年龄高于EAC患者。UCS更常发生于绝经后患者。UCS和EAC在肌层浸润深度、FIGO分期和淋巴转移方面无显著差异。UCS的前后径和横径显著大于EAC。UCS更易发生囊性变或坏死及出血。UCS肿瘤在T2WI上的SI更不均匀。UCS的RSI-T2、ADCmax、ADCmean、RSI-ADCmax和RSI-ADCmean显著高于EAC。UCS的REAmax、REAmin、REAmean、REVmax、REVmin和REVmean均高于EAC。前后径、横径、RSI-T2、ADCmax、ADCmean、RSI-ADCmax、RSI-ADCmean、REAmax、REAmin、REAmean、REVmax、REVmin和REVmean的AUC分别为0.72、0.71、0.86、0.96、0.89、0.84、0.73、0.97、0.88、0.94、0.91、0.69和0.80。ADCmax、REAmax和REVmax联合的AUC为0.997。我们的研究表明，ADCmax阈值为789.05（10⁻³mm²/s）可将UCS与EAC区分开来，灵敏度为100%，特异度为76.5%，AUC为0.76；REAmax阈值为0.45可将UCS与EAC区分开来，灵敏度为88.2%，特异度为100%，AUC为0.88。