不同月经状态女性正常子宫动态增强MRI定量参数变化特性及其临床意义

目的 探讨不同月经状态女性正常子宫动态增强MRI定量参数值的特点及其临床意义。方法 收集我院46例不同月经状态女性资料，均行动态增强MR检查，测量子宫内膜、结合带及肌层定量参数值，包括体积转运常数（K^trans）、速率转运常数（K_ep）及体积分数（V_e）。根据不同月经状态将受试者分为绝经前和绝经后（n=14）。采用单因素方差或秩和检验比较子宫不同层面、不同月经状态的定量参数。结果 相同子宫层面，不同月经状态子宫内膜K^trans、K_ep值及子宫结合带V_e值总体比较差异有统计学意义（P均<0.05）；子宫内膜绝经后K^trans、K_ep值与分泌期和增殖期、分泌期K_ep值与增殖期差异均有统计学意义（P均<0.05）；结合带增殖期V_e值与绝经后间差异有统计学意义（P<0.05）。相同的月经状态，子宫内膜、结合带及肌层的K^trans值、K_ep值及V_e值差异均有统计学意义（P均<0.05）；子宫各层面分泌期K^trans值两两比较差异均有统计学意义（P均<0.05），子宫结合带和肌层的增殖期和绝经后K^trans值与子宫内膜同一月经状态差异有统计学意义（P均<0.05）；除绝经后结合带与肌层间K_ep值差异无统计学意义，子宫各层面同一月经状态K_ep值两两比较差异均有统计学意义（P<0.05）。结论 采用动态增强MRI定量参数评判子宫疾病时应考虑不同月经状态下K^trans、K_ep和V_e的变化。

Changes of quantitative parameters of dynamic contrast-enhanced MRI in normal uterus of women with different menstrual states and clinical significance

Objective To investigate the changes and clinical significance of quantitative parameters of dynamic contrast-enhanced MRI in normal uterus of women during different menstrual states. Methods Totally 46 women with different menstrual states who underwent dynamic contrast-enhanced MRI were divided into premenopausal phase (proliferative phasen=16], secretory phasen=16]) and postmenopausal phase (n=14) according to different menstrual states. The quantitative parameters (K^trans, K_ep and V_e) of endometrium, junctional zone and myometrium were measured. One-way ANOVA or rank sum test was used to compare the quantitative parameters with different uterus structures and menstrual states. Results The K^trans value and K_ep value of endometrium between the same menstrual states were statistically significant (all P<0.05). There were significant differences of K^trans, K_ep, in secretory phase, proliferative phase and postmenopausal phase, K_ep in secretory phase and proliferative phase (P<0.05). There was statistically significant difference of V_e in junctional zone between proliferative phase and postmenopausal phase (P<0.05). There were significant differences in K^trans, K_ep and V_e among endometrium, junctional zone and myometrium under the same menstrual state (all P<0.05). The K^trans was statistically significant during the secretory phase (all P<0.05). There was no significant difference in K_ep between the junctional zone and the myometrium except postmenopausal phase, and the K_ep were statistically significant between the structures in different menstrual states (P<0.05). Conclusion The changes of K^trans, K_ep and V_e in different menstrual states should be considered when using the quantitative parameters of dynamic enhanced MRI to evaluate uterine diseases.