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目的比较3.0 T MR动态增强扫描(DCE-MRI)与扩散加权成像(DWI)术前评估子宫内膜癌肌层浸润深度的准确性。方法回顾分析2011年5月至2012年8月38例经手术病理证实为子宫内膜癌患者的术前MRI资料。MRI扫描包括:T2WI、DWI(b值为0,1000 s/mm2)及DCE-MRI。评估不同成像方法的子宫内膜癌肌层浸润情况,并与术后病理结果对照。通过SPSS 17.0统计分析软件,运用诊断实验方法计算子宫内膜癌肌层浸润的敏感性、特异性、阳性预测值、阴性预测值和准确性,并采用配对卡方检验确切概率法比较不同成像方法对肌层浸润的准确性。而不同成像方法判断肌层浸润的影响因素分析采用Fisher’s确切概率法。结果 T2WI诊断子宫内膜癌肌层浸润的准确性为73.7%,DCE-MRI联合T2WI为84.2%,DWI联合T2WI为91.2%。DWI联合T2WI诊断肌层浸润的准确性要高于DCE-MRI联合T2WI和单独T2WI,其中DWI联合T2WI与单独T2WI之间差异具有统计学意义(P=0.014<0.05)。DWI评估肌层浸润时不受混杂因素的影响(P值均>0.05),而肿瘤浸润宫角是DCE-MRI诊断错误的唯一影响因素(P=0.007<0.05)。结论 DWI在评估子宫内膜癌肌层浸润时具有与DCE-MRI相当的准确性,应作为子宫内膜癌患者的常规检查序列。
Objective To compare the accuracy of 3.0 T MR dynamic contrast-enhanced scanning (DCE-MRI) and diffusion-weighted imaging (DWI) in assessing the depth of myometrial invasion before endometrial cancer. Methods A retrospective analysis was performed on 38 preoperative MRI data of 38 patients with endometrial carcinoma confirmed by surgery and pathology from May 2011 to August 2012. MRI scans included T2WI, DWI (b values of 0 and 1000 s / mm2), and DCE-MRI. Evaluation of different imaging methods of endometrial cancer, myometrial invasion, and postoperative pathological results. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the myometrial invasion in endometrial carcinoma were calculated by SPSS 17.0 statistical analysis software, and the diagnostic method was used to compare the different imaging methods with exact chi-square test The accuracy of myometrial invasion. The different imaging methods to determine the factors affecting myometrial invasion using Fisher’s exact test. Results The accuracy of T2WI in the diagnosis of endometrial carcinoma was 73.7%, that of DCE-MRI combined with T2WI was 84.2%, and that of DWI combined with T2WI was 91.2%. The accuracy of DWI and T2WI in the diagnosis of myometrial invasion was higher than that of DCE-MRI combined with T2WI and T2WI alone. The difference between DWI combined with T2WI and T2WI alone was statistically significant (P = 0.014 <0.05). DWI was not affected by confounding factors (P> 0.05), while tumor infiltration angle was the only influential factor of DCE-MRI diagnosis (P = 0.007 <0.05). Conclusion DWI has the same accuracy as DCE-MRI in evaluating myometrial invasion of endometrial carcinoma and should be used as a routine examination sequence for patients with endometrial cancer.