Yamashita Y, Mizutani H, Torashima M, Takahashi M, Miyazaki K, Okamura H, Ushijima H, Ohtake H, Tokunaga T
Department of Radiology, Kumamoto University School of Medicine, Japan.
AJR Am J Roentgenol. 1993 Sep;161(3):595-9. doi: 10.2214/ajr.161.3.8352114.
A prospective study was designed to compare transvaginal sonography with contrast-enhanced MR imaging to determine preoperatively the depth of myometrial invasion in patients with early-stage endometrial carcinoma.
In 40 patients, findings on transvaginal sonograms, unenhanced T2-weighted MR images, and contrast-enhanced T1-weighted Mr images were compared with histologic findings. The depth of myometrial invasion was classified as stage E (tumor limited to endometrium, n = 12), stage S (superficial invasion: tumor invades up to 50% of the myometrium, n = 15), or stage D (deep invasion: tumor invades more than 50% of the myometrium, n = 13).
Findings on transvaginal sonograms were accurate in 27 of 40 patients (accuracy, 68%); the depth of invasion was overestimated in five patients and underestimated in eight patients. The results of unenhanced T2-weighted MR images were accurate in 27 patients (accuracy, 68%), with four overestimations and nine underestimations. The results of contrast-enhanced T1-weighted MR images were accurate in 34 patients (accuracy, 85%), with five underestimations and one overestimation. In the assessment of each stage of myometrial invasion, the sensitivity and specificity of contrast-enhanced T1-weighted imaging were higher than those of T2-weighted MR imaging and transvaginal sonography. The false-positive diagnoses based on transvaginal sonograms and T2-weighted images, respectively, involved polypoid tumors (n = 4 and 2), distension of the endometrial cavity by pyometra (n = 2 and 1), the presence of myoma (n = 2 and 1), atrophy of the myometrium (n = 1 and 0), and poor tumor/myometrium contrast (n = 0 and 2). On contrast-enhanced MR images, accuracy was influenced only in a case of polypoid tumor, because tumor, endometrial cavity, and myometrium were clearly distinguished and residual myometrium was clearly visualized. With all imaging techniques, false-negative diagnoses were caused mainly by tumors with superficially spreading growth or microscopic invasion. With transvaginal sonography, infiltrative tumor also tended to be understaged (n = 3).
Contrast-enhanced MR imaging is significantly superior to transvaginal sonography and unenhanced T2-weighted MR imaging for detecting myometrial invasion.
设计一项前瞻性研究，比较经阴道超声检查与对比增强磁共振成像，以术前确定早期子宫内膜癌患者的肌层浸润深度。
对40例患者的经阴道超声检查结果、未增强的T2加权磁共振图像以及对比增强的T1加权磁共振图像与组织学检查结果进行比较。肌层浸润深度分为E期（肿瘤局限于子宫内膜，n = 12）、S期（浅表浸润：肿瘤浸润达肌层的50%，n = 15）或D期（深部浸润：肿瘤浸润超过肌层的50%，n = 13）。
40例患者中，经阴道超声检查结果在27例中准确（准确率68%）；5例浸润深度被高估，8例被低估。未增强的T2加权磁共振图像结果在27例中准确（准确率68%），4例被高估，9例被低估。对比增强的T1加权磁共振图像结果在34例中准确（准确率85%），5例被低估，1例被高估。在评估肌层浸润的各个阶段时，对比增强的T1加权成像的敏感性和特异性高于T2加权磁共振成像和经阴道超声检查。经阴道超声检查和T2加权图像的假阳性诊断分别涉及息肉样肿瘤（n = 4和2）、宫腔积脓导致的宫腔扩张（n = 2和1）、肌瘤的存在（n = 2和1）、肌层萎缩（n = 1和0）以及肿瘤/肌层对比度差（n = 0和2）。在对比增强磁共振图像上，仅在息肉样肿瘤的情况下准确性受到影响，因为肿瘤、宫腔和肌层能够清晰区分，残余肌层也能清晰显示。对于所有成像技术，假阴性诊断主要由表面扩散生长或微小浸润的肿瘤引起。经阴道超声检查时，浸润性肿瘤也往往分期过低（n = 3）。
在检测肌层浸润方面，对比增强磁共振成像明显优于经阴道超声检查和未增强的T2加权磁共振成像。
