扩散加权成像和半定量动态对比增强磁共振成像在预测醋酸甲羟孕酮治疗非典型子宫内膜增生和子宫内膜癌疗效中的价值
The value of diffusion-weighted imaging and semi-quantitative dynamic contrast-enhanced MRI in predicting the efficacy of medroxyprogesterone acetate treatment for atypical endometrial hyperplasia and endometrial carcinoma.
作者信息
Liu Mingming, Zheng Xingzheng, Mo Na, Liu Yang, Jin Erhu, Liang Yuting
机构信息
Department of Radiology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, NO. 17, Qihelou Street, Dongcheng District, Beijing, 100006, China.
Beijing Maternal and Child Health Care Hospital, NO. 17, Qihelou Street, Dongcheng District, Beijing, 100006, China.
出版信息
BMC Med Imaging. 2025 Jul 1;25(1):210. doi: 10.1186/s12880-025-01754-6.
BACKGROUND
It will be important to noninvasively evaluate the efficacy of treatment for patients with atypical endometrial hyperplasia (AEH) and endometrial carcinoma (EC) who wish to have children. The study aimed to explore the feasibility of diffusion-weighted imaging (DWI) and semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the efficacy of medroxyprogesterone acetate treatment for AEH and EC.
METHODS
A retrospective analysis was conducted on the clinical-pathological data of 6 patients with AEH and 6 patients with EC. The treatment effects of medroxyprogesterone acetate were pathologically evaluated. Additionally, MRI examination was conducted at each follow-up at the 3rd and 6th month after treatment. Repeated measures variance analysis was used to compare statistically significant differences in the apparent diffusion coefficient (ADC) values and maximum signal difference (MSD) of the lesion and corresponding endometrial site before treatment, and at the 3rd and 6th month after treatment. Endometrial thickness was analyzed utilizing the Friedman test. Furthermore, Fisher's exact probability method was used to determine if there was a significant difference in the time-intensity curve (TIC).
RESULTS
There was a statistically significant difference in endometrial thickness before treatment, and at the 3rd and 6th month after treatment for EC and AEH (P < 0.017). There was a statistically significant difference in the ADC values before treatment, and at the 3rd or 6th month after treatment for EC (P < 0.017). There was also a statistically significant difference in the type of TIC curve before and after treatment for EC (P < 0.001). However, the difference in MSD values was insignificant for EC and AEH before and after treatment (P > 0.05). No significant differences were noted in the ADC values, and type of TIC curve before and after treatment for AEH (P > 0.05).
CONCLUSIONS
Endometrial thickness can be imaging markers for predicting complete remission of EC and AEH with medroxyprogesterone acetate treatment. ADC values and TIC curve types can be imaging markers for predicting complete remission of EC.
背景
对于希望生育的非典型子宫内膜增生（AEH）和子宫内膜癌（EC）患者，无创评估治疗效果具有重要意义。本研究旨在探讨扩散加权成像（DWI）和半定量动态对比增强磁共振成像（DCE-MRI）在预测醋酸甲羟孕酮治疗AEH和EC疗效方面的可行性。
方法
对6例AEH患者和6例EC患者的临床病理资料进行回顾性分析。对醋酸甲羟孕酮的治疗效果进行病理评估。此外，在治疗后第3个月和第6个月的每次随访时进行MRI检查。采用重复测量方差分析比较治疗前、治疗后第3个月和第6个月病变及相应子宫内膜部位的表观扩散系数（ADC）值和最大信号差值（MSD）的统计学显著差异。利用Friedman检验分析子宫内膜厚度。此外，采用Fisher精确概率法确定时间-强度曲线（TIC）是否存在显著差异。
结果
EC和AEH治疗前、治疗后第3个月和第6个月的子宫内膜厚度存在统计学显著差异（P < 0.017）。EC治疗前、治疗后第3个月或第6个月的ADC值存在统计学显著差异（P < 0.017）。EC治疗前后TIC曲线类型也存在统计学显著差异（P < 0.001）。然而，EC和AEH治疗前后MSD值的差异不显著（P > 0.05）。AEH治疗前后的ADC值和TIC曲线类型无显著差异（P > 0.05）。
结论
子宫内膜厚度可作为预测醋酸甲羟孕酮治疗EC和AEH完全缓解的影像学标志物。ADC值和TIC曲线类型可作为预测EC完全缓解的影像学标志物。
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