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目的探讨表观扩散系数(ADC)在鉴别子宫内膜癌盆腔转移性及非转移性淋巴结中的价值。材料与方法本回顾性研究共纳入40例子宫内膜癌病人,所有病人均行MRI检查[T2加权,动态T1加权成像和体部背景信号抑制扩散加权成像(DWIBS),b值为0和1000s/mm2]、全子宫切除术及盆腔淋巴结清扫术。对DWIBS上可识别的淋巴结进行评估,分为6个淋巴结区域,由2名观察者分别对每个淋巴结的ADC值、长轴及短轴直径进行测量。将组织病理学结果及随访信息作为参考标准。结果转移区域(n=7)的平均ADC值(±标准差)及最小ADC值[(0.87±0.15)×10-3mm2/s和(0.74±0.07)×10-3mm2/s)]明显低于非转移区域的[n=89;(1.07±0.20)×10-3mm2/s和(1.02±0.20)×10-3mm2/s;P=0.010及0.0004]。转移性淋巴结的短轴直径平均值、短轴与长轴直径之比分别为7.47mm和0.68。使用最小ADC区域值且阈值为0.807×10-3mm2/s时,敏感度、特异度、阳性及阴性预测值和准确度分别为100%、98.3%、63.6%、100%和98.3%(观察者1)。结论子宫内膜癌盆腔转移性淋巴结较正常部位的淋巴结的平均及最小ADC区域值明显要小。要点①MR成像广泛应用于子宫内膜癌。②转移性淋巴结的ADC值小于正常淋巴结的。③与传统的大小标准相比ADC值具有更高的诊断价值。④最小ADC区域值较平均ADC区域值诊断价值高。⑤放射科医生能够为外科医生提示受侵的淋巴结。
Objective To investigate the value of apparent diffusion coefficient (ADC) in differentiating pelvic metastasis from non-metastatic lymph nodes in endometrial carcinoma. Materials and Methods This retrospective study enrolled 40 patients with endometrial cancer and performed MRI on all patients (T2 weighted, dynamic T1 weighted, and body background suppressed diffusion weighted imaging (DWIBS) with b values of 0 and 1000s / mm2], hysterectomy and pelvic lymph node dissection. The identifiable lymph nodes on DWIBS were evaluated and divided into six lymph node regions. Two observers measured the ADC value, major axis, and minor axis diameter of each lymph node, respectively. Histopathological findings and follow-up information as a reference standard. Results Mean ADC values (± standard deviation) and minimum ADC values [(0.87 ± 0.15) × 10-3 mm2 / s and (0.74 ± 0.07) × 10-3 mm2 / s) in the metastatic region (n = 7) [N = 89; (1.07 ± 0.20) × 10-3mm2 / s and (1.02 ± 0.20) × 10-3mm2 / s; P = 0.010 and 0.0004] for the non-metastatic region. The average short-axis diameter of metastatic lymph nodes, the ratio of the short axis to the long axis diameters were 7.47 mm and 0.68, respectively. Sensitivity, specificity, positive and negative predictive values, and accuracy were 100%, 98.3%, 63.6%, 100%, and 98.3%, respectively, using a minimum ADC area value of 0.807 x 10-3 mm2 / s 1). Conclusions The average and minimum ADC value of lymph node in pelvic metastatic lymph node of endometrial carcinoma is obviously smaller than normal. Points ① MR imaging is widely used in endometrial cancer. ② metastatic lymph node ADC value is less than normal lymph nodes. ③ Compared with the traditional size standard ADC value has a higher diagnostic value. ④ The minimum ADC area value is higher than the average ADC area value diagnosis value. Radiologists are able to prompt the surgeon for an affected lymph node.