Yoshida Miki, Saida Tsukasa, Mori Kensaku, Hoshiai Sodai, Sakai Masafumi, Amano Taishi, Shibuki Saki, Miyata Mariko, Sato Toyomi, Nakajima Takahito
Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan.
Department of Diagnostic and Interventional Radiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
Pol J Radiol. 2024 Jul 26;89:e358-e367. doi: 10.5114/pjr/189487. eCollection 2024.
To compare the diagnostic performance of virtual monoenergetic imaging (VMI), computed tomography (CT), and magnetic resonance imaging (MRI) in patients with endometrial cancer (EC).
This retrospective study analysed 45 EC patients (mean age: 62 years, range: 44-84 years) undergoing contrast-enhanced CT with dual-energy CT (DECT) and MRI between September 2021 and October 2022. Dual-energy CT generated conventional CT (C-CT) and 40 keV VMI. Quantitative analysis compared contrast-to-noise ratio (CNR) of tumour to myometrium between C-CT and VMI. Qualitative assessment by 5 radiologists compared C-CT, VMI, and MRI for myometrial invasion (MI), cervical invasion, and lymph node metastasis. Sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated and compared for each diagnostic parameter.
Virtual monoenergetic imaging showed significantly higher CNR than C-CT ( < 0.001) and a higher sensitivity for MI than C-CT ( = 0.027) and MRI ( = 0.011) but lower specificity than MRI ( = 0.018). C-CT had a higher sensitivity and AUC for cervical invasion than MRI ( = 0.018 and 0.004, respectively).
The study found no significant superiority of MRI over CT across all diagnostic parameters. VMI demonstrated heightened sensitivity for MI, and C-CT showed greater sensitivity and AUC for cervical invasion than MRI. This suggests that combining VMI with C-CT holds promise as a comprehensive preoperative staging tool for EC when MRI cannot be performed.
比较虚拟单能量成像（VMI）、计算机断层扫描（CT）和磁共振成像（MRI）在子宫内膜癌（EC）患者中的诊断性能。
这项回顾性研究分析了2021年9月至2022年10月期间接受双能量CT（DECT）增强CT和MRI检查的45例EC患者（平均年龄：62岁，范围：44 - 84岁）。双能量CT生成传统CT（C-CT）和40 keV的VMI。定量分析比较了C-CT和VMI之间肿瘤与子宫肌层的对比噪声比（CNR）。5名放射科医生进行定性评估，比较C-CT、VMI和MRI在子宫肌层浸润（MI）、宫颈浸润和淋巴结转移方面的情况。计算并比较每个诊断参数的敏感性、特异性、准确性和受试者操作特征曲线下面积（AUC）。
虚拟单能量成像显示CNR显著高于C-CT（<0.001），对MI的敏感性高于C-CT（=0.027）和MRI（=0.011），但特异性低于MRI（=0.018）。C-CT对宫颈浸润的敏感性和AUC高于MRI（分别为=0.018和0.004）。
该研究发现在所有诊断参数方面MRI并不显著优于CT。VMI对MI表现出更高的敏感性，C-CT对宫颈浸润的敏感性和AUC比MRI更高。这表明当无法进行MRI检查时，将VMI与C-CT结合有望成为一种用于EC的综合术前分期工具。
