Endometrial carcinoma: multisection dynamic MR imaging using a three-dimensional FLASH technique during breath holding.

PURPOSE: Our aim was to investigate the usefulness of multisection dynamic MR imaging using a 3D FLASH technique during breath holding in assessing myometrial invasion by endometrial carcinoma. MATERIALS AND METHODS: Twenty-eight endometrial carcinomas were evaluated with pathologic correlation. Dynamic MR imaging was performed using the 3D FLASH technique during breath holding. We compared accuracy in the assessment of myometrial invasion by endometrial carcinoma between T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MR images. RESULTS: The accuracy rates in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MR images were 64.3%, 67.8%, and 85.7%, respectively. Statistically significant differences were seen between dynamic MR images and both T2-weighted images and contrast-enhanced T1-weighted images. CONCLUSION: Multisection dynamic MR imaging using the 3D FLASH technique during breath holding is useful for the evaluation of myometrial invasion by endometrial carcinoma with polypoid growth or an unclear junctional zone on T2-weighted images.     

MR imaging of pelvic masses in women: contrast-enhanced vs unenhanced images.

OBJECTIVE. We compared the value of contrast-enhanced MR images with that of T2-weighted MR images in the diagnosis and staging of pelvic masses in women. MATERIALS AND METHODS. The findings on preoperative MR studies of 97 patients with a total of 124 surgically proved lesions were retrospectively analyzed. Unenhanced T1- and T2-weighted spin-echo images were compared with contrast-enhanced T1-weighted images. The final diagnosis included benign (36 patients), borderline (six patients), and malignant (15 patients) ovarian masses, fallopian tube masses (15 patients), endometrial tumors (seven patients), cervical carcinomas (32 patients), subserous leiomyomas (11 patients), and two masses of extragenital origin. RESULTS. In the depiction of pelvic lesions, the sensitivity of contrast-enhanced MR imaging (96%) was equal to that of unenhanced T2-weighted imaging (97%). Contrast-enhanced images were useful in the definition of intratumoral architecture and tumor borders of 72 adnexal masses, resulting in better determination of malignancy (accuracy, 95%) than on T2-weighted images (85%). Size of viable tumor, differentiation of tumor from retained fluid, and depth of myometrial invasion of six endometrial carcinomas were most reliably shown on contrast-enhanced images. In the evaluation of cervical carcinoma, overall staging accuracy of contrast-enhanced imaging (80%) was slightly inferior to that of T2-weighted imaging (83%). However, contrast-enhanced images improved assessment of parametrial and organ invasion in seven cases in which findings on T2-weighted MR images were equivocal. Administration of contrast material was not helpful in the evaluation of subserous leiomyomas or masses of extragenital origin. CONCLUSIONS. The findings suggest that when results of unenhanced T1- and T2-weighted MR imaging of pelvic masses are equivocal, contrast-enhanced MR images should be used as supportive and complementary pulse sequences to (1) improve definition of intratumoral architecture and prediction of malignancy in adnexal tumors, (2) stage endometrial carcinoma, and (3) determine tumor extension in cervical carcinoma.     

Cervical carcinoma with full-thickness stromal invasion: efficacy of dynamic MR imaging in the assessment of parametrial involvement

The purpose of this study was to investigate the efficacy of dynamic MR imaging in the assessment of parametrial involvement by cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images. Dynamic MR images of 24 patients with cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images were evaluated with pathologic correlation. Dynamic MR imaging was performed using a turboFLASH, 3D-FISP, or 2D-FLASH technique. The imaging planes of dynamic MR imaging were oblique axial planes of the uterine cervix. Dynamic MR imaging was performed twice, once for the early phase (40 to 60 sec after the administration of contrast media) and once for the late phase (5 min). Contrast enhancement of the tumor was divided into six types. Type I, cervical stroma with low signal intensity surrounding a tumor with high signal intensity, was seen in the early phase of dynamic MR imaging; type II-RR, the hyperintense rim was seen from the early phase to the late phase; type II-RO, the hyperintense rim was seen in the early phase only; type II-OR, the hyperintense rim was seen in the late phase only; type II-O, the hyperintense rim was not seen at all; and type III, tumor invasion with high signal intensities was seen beyond the cervical stroma in the early phase of dynamic MR imaging. The numbers for each type of cervical carcinoma on dynamic MR images were as follows: type I, four parametrial sites; type II-RR, 0; type II-RO, 0; type II-OR, 13; type II-O, 14; and type III, one. Three-dimensional diameters (transverse, craniocaudal, and anteroposterior) of the primary tumor were measured using dividers. All parametrial sites of type I and type II-OR showed no parametrial involvement. One parametrial site of type III and three parametrial sites of type II-O showed parametrial involvement, and 11 of type II-O showed no parametrial involvement. None of the patients showed type I-RR or type II-RO. When type I and type II-OR were categorized as criteria of no parametrial involvement and type III and transverse diameters of 3.5 cm or over classified as type II-O were categorized as criteria of parametrial involvement, the rate of diagnostic accuracy was 95.8%. Dynamic MR imaging is considered to be substantially useful in the assessment of parametrial involvement with cervical carcinoma with full-thickness stromal invasion by thin-section oblique axial T2-weighted images.     

Irradiated carcinoma of the tongue: correlation of MR imaging findings with pathology

OBJECTIVE: MR imaging was prospectively correlated with pathologic findings to study whether MR imaging can differentiate viable from nonviable tumor tissue in the irradiated carcinoma of the tongue. SUBJECTS AND METHODS: MR examinations were performed after radiation therapy in 21 patients with carcinoma of the tongue. All patients underwent either a total glossectomy or hemiglossectomy after radiation therapy. Specimens were examined microscopically. Radiation changes were histologically graded into four groups (I, minimal cellular changes; II, presence of cellular changes and partial destruction of the tumor; III, only nonviable tumor cells; IV, no tumor cells). MR examinations included T2-weighted imaging, unenhanced T1-weighted imaging, dynamic contrast-enhanced imaging, and contrast-enhanced T1-weighted imaging. RESULTS: On unenhanced T1-weighted images, the lesion was hypointense, except for two patients with histologic grade III. On T2-weighted images, the lesion appeared hyperintense in 12 of 14 patients with viable tumor cells (grades I and II); however, the lesion was hypointense in four, and isointense in two of seven patients with nonviable tumor cells (grades III or IV). Contrast-enhanced T1-weighted images showed that the degree of contrast enhancement of the lesion was equal to or lower than that of a normal salivary gland in 18 of 21 patients. For the time of maximal enhancement of the lesion on dynamic imaging, there was no substantial difference between viable (grades I and II) and nonviable (grades III and IV) tumor tissue. CONCLUSION: The present study shows that T2-weighted imaging is feasible for differentiating viable from nonviable tumor tissue in irradiated carcinoma of the tongue.     

Dynamic MR imaging of recurrent postoperative cervical cancer

The value of dynamic-contrast enhanced MR imaging using FLASH technique was studied in 13 patients with postoperative recurrent cervical cancer verified histopathology and in 9 patients without recurrence. Dynamic FLASH imaging and conventional spin-echo T1- and T2-weighted sequences were compared in a prospective fashion with regard to accuracy of the diagnosis of recurrent tumor using biopsy results as the gold standard. The contrast between the recurrent tumor and the surrounding pelvic tissues was also analyzed. The accuracy of depicting recurrent tumor on dynamic images (82%) was superior to that of pre- and postcontrast T1-weighted images and T2-weighted images (64%, 68%, and 64%, respectively). The contrast between the recurrent tumor and pelvic fat was greater on precontrast T1-weighted and dynamic images than on T2-weighted and postcontrast T1-weighted images. The dynamic images clearly showed involvement of the surrounding pelvic organs, because enhancement was observed exclusively in the tumor in the early dynamic phase. Accuracy regarding involvement of the urinary bladder or rectal wall on pre- and postcontrast T1-weighted images and T2-weighted images was lower than that on the dynamic images. Dynamic MR imaging has potential for use in the detection and evaluation of the extent of recurrent postoperative cervical cancer.     

Assessment of depth of myometrial invasion by endometrial carcinoma: comparison of T2-weighted SE and contrast-enhanced dynamic GRE MR imaging

A prospective study was undertaken to assess the value of both T2-weighted spin-echo (SE) and contrast-enhanced dynamic gradient-echo (GRE) sequences using MR imaging in differentiating the deep myometrial invasion from lower stages produced by endometrial carcinoma. For the correlation of MR findings with the histopathologic findings, patients who had no myometrial invasion (stage 1 a) and patients in whom tumors were confined to the superficial myometrium (stage 1 b) at pathologic examination were combined as lower stages. Twenty patients with endometrial carcinoma were studied using both techniques. The absence of any detectable tumor (stage 1 a) or the presence of a tumor confined to inner half of myometrium (stage 1 b) and extention of tumor to the outer half of myometrium (stage 1 c) were used as the diagnostic criteria. In pathologic examination of excised specimens, deep myometrial invasion was detected in 9 of 20 patients. The sensitivity, specificity, accuracy, positive predictive values (PPV) and negative predictive values (NPV) of T2-weighted SE in differentiating deep myometrial invasion from combined lower stages were 88, 91, 90, 88, and 91 %, respectively, whereas corresponding values for contrast-enhanced dynamic GRE sequences were 78, 100, 90, 100, and 85 %. Statistical difference between two sequences did not reach a significant level. We conclude that in cases of absence of visible junctional zone with SE sequence, contrast-enhanced dynamic GRE MR imaging may be helpful. Received 13 December 1996; Revision received 1 July 1997; Accepted 4 July 1997     

肝细胞癌射频治疗后的磁共振表现

目的：评价MRI平扫及Gd-DTPA动态增强对射频治疗肝细胞癌疗效随访的价值。材料和方法：回顾性分析了55例RF术前及术后的MRI表现,并与活检及长期随访结果进行对照。结果：RF术前病灶在T1加权上多呈相对低信号、T2加权像上呈相对高信号,RF术后病灶转变成T1加权较高信号、T2加权均匀一致的等低信号,残存的癌结节表现为病灶周围包膜不规整或周边小结节并在动态增强时呈单峰型“快进快出”强化表现,活检提示癌灶残存。结论：MR平扫评价RF的疗效基本可靠,动态增强能进一步提高评价信心及准确率。RF术后定期MR随访具有重要意义。     

Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images

OBJECTIVE: The aim of our study was to compare T2-weighted and contrast-enhanced dynamic T1-weighted images with histologic findings in assessing the depth of myometrial invasion by endometrial carcinoma in adenomyosis. MATERIALS AND METHODS: We retrospectively reviewed the MRIs of 11 patients who had a total of 12 lesions of endometrial carcinoma within adenomyosis. T2-weighted and contrast-enhanced dynamic T1-weighted images were compared with the histologic findings separately. We assessed the extent of myometrial invasion by endometrial carcinomas. The depth of myometrial invasion seen on MRI was classified as stage S (superficial invasion), stage D (deep invasion), or undetectable. The staging accuracies of each sequence were assessed. The tumor-myometrium contrast-to-noise ratios were calculated for each sequence. RESULTS: The histologic specimens revealed that myometrial invasion was deep in seven of 12 lesions and superficial in five. On T2-weighted images the depth of invasion was underestimated in two lesions and impossible to determine in five lesions. On dynamic T1-weighted images the depth of invasion was overestimated in one lesion and underestimated in one lesion. The staging accuracy on dynamic T1-weighted images (83%) was significantly higher than that on T2-weighted images (42%). The contrast-to-noise ratio was significantly higher on dynamic T1-weighted studies during the early phase (mean +/- SD, 2.68 +/- 0.94) than it was on T2-weighted studies (1.74 +/- 1.05) and during the delayed phase (2.01 +/- 0.86). CONCLUSION: When adenomyosis coexists with endometrial cancer at the same site on T2-weighted images, contrast-enhanced dynamic T1-weighted imaging improves the accuracy of staging.     

Preliminary experience with gadolinium-enhanced dynamic MR imaging for uterine neoplasms.

Usefulness of gadopentetate dimeglumine in magnetic resonance (MR) imaging of uterine neoplasms was evaluated in 53 patients with endometrial carcinoma and 15 patients with cervical carcinoma. T1- and T2-weighted MR images were obtained before the contrast material was administered. After a bolus injection of gadopentetate dimeglumine, dynamic MR images were acquired, followed by static T1-weighted images. Gadolinium-enhanced MR images revealed relatively small endometrial carcinomas in the uterine cavity as high signal intensity in four cases and invasion of the myometrium as low signal intensity in 20 cases. In eight cases, endometrial tumors showed irregular, early enhancement compared with that of the myometrium on dynamic images; these cases were associated with poor prognosis. Tumor extension into the lower part of the uterus, parametrium, and paracervical fat was well seen on enhanced images in cases of cervical carcinoma. The authors believe that gadolinium-enhanced MR imaging will prove helpful in the staging of uterine neoplasms.     

Differentiation of the various lesions causing an abnormality of the endometrial cavity using MR imaging: emphasis on enhancement patterns on dynamic studies and late contrast-enhanced T1-weighted images

The objectives of this study were to determine the usefulness of magnetic resonance (MR) imaging in the differentiation of various lesions causing an abnormality of the endometrial cavity by evaluating the imaging features on dynamic contrast-enhanced study and late contrast-enhanced T1-weighted images (T1WI). Contrast-enhanced MR imaging of 59 pathologically proven lesions that showed an abnormality of the endometrial cavity, including 32 endometrial cancers, five sarcomas, nine hyperplastic polyps, nine submucosal myomas, three hyperplasia, and one adenomyoma, were retrospectively reviewed. The enhancement degree and patterns on dynamic contrast-enhanced study and late contrast-enhanced T1WI were compared among different pathologies. On dynamic contrast-enhanced study, 72% (23/32) of endometrial cancers showed early peak enhancement to be reached within 1 min following intravenous administration of contrast material. On late-contrast-enhanced T1WI, lesions showed weak enhancement with gradual washout. Ninety-five percent (21/22) of benign lesions and 100% (5/5) of sarcomas showed late peak enhancement to be reached in 2–3 min following intravenous administration of contrast material. On late contrast-enhanced T1WI, both of these lesions showed persistent strong enhancement. Different enhancement patterns on dynamic contrast-enhanced MR imaging and late contrast-enhanced T1WI can provide a useful clue in the differentiation of various lesions causing an abnormality of the endometrial cavity.     

Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging

OBJECTIVE: To compare the efficacy of dynamic contrast-enhanced MR imaging and spin-echo T1-weighted with and without fat-saturated MR imaging in the detection and staging of pancreatic adenocarcinoma. METHODS AND MATERIAL: Spin-echo T1-weighted, fat-saturated T1-weighted and dynamic breath-hold 2D-FLASH MR imaging were performed in 25 patients with pancreatic adenocarcinoma. MR images were analysed by calculating the CNR between tumor and normal portion of the pancreas. The CNRs calculated at each sequences were compared. A total of 16 out of 25 patients underwent surgery. Preoperative staging according to TNM classification was also done in patients undergoing surgery. RESULTS: The CNR was significantly different (P<0.05) in the arterial phase of dynamic MR images. The accuracy of 'T' staging was 75% for SE T1-W, fat-saturated T1-W and arterial phase of dynamic MR images. CONCLUSION: The CNRs between pancreatic carcinoma and normal pancreas is significantly higher in dynamic MR sequences than the SE T1-W, fat-saturated T1-W sequences. However, the accuracy of tumor staging according to TNM is equivocal to SE T1-W and fat-saturated T1-W images.     

Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging

BACKGROUND AND PURPOSE: Morphologic assessment by conventional imaging methods of lymph node metastases in patients with squamous cell carcinoma of the head and neck is, at best, insensitive. Doppler sonography has shown that lymph node metastases exhibit alterations in the number of vessels and blood flow. We assessed the ability of dynamic contrast-enhanced MR imaging to differentiate normal from diseased nodes in this patient population. METHODS: Twenty-one patients with newly diagnosed squamous cell carcinoma and no previous treatment were studied with the use of a head and neck phased array surface coil. Anatomic imaging included high resolution T1-weighted, fat-saturated fast spin-echo T2-weighted, and contrast-enhanced T1-weighted imaging (0.99-1.32 mm(3) voxels). The dynamic contrast-enhanced MR imaging was performed by using a 2D fast spoiled gradient recalled sequence with single dose bolus injection of contrast agent. Calculated values included time to peak, peak enhancement, maximum slope, and washout slope for the enhancement. All patients underwent neck dissection as part of their indicated treatment, and imaging results were correlated with pathologic findings. RESULTS: Dynamic contrast-enhanced MR imaging and pathology comparisons were obtained for 68 nodes. There was significantly longer time to peak (P <.001), lower peak enhancement (P <.05), lower maximum slope (P <.01), and slower washout slope (P <.05) in the tumor-involved nodes compared with the normal nodes. CONCLUSION: Analysis of dynamic contrast-enhanced MR imaging can differentiate normal from diseased lymph nodes in patients with squamous cell carcinoma of the head and neck.     

Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager

OBJECTIVE: To assess the feasibility of MR (magnetic resonance)-guided bone biopsies. DESIGN AND PATIENTS: Thirty-six consecutive patients with known or suspected benign or malignant bone lesions underwent comprehensive MR imaging. A dynamic contrast-enhanced sequence followed by stationary T1-weighted sequences were obtained and MR-guided bone biopsy of the tumor at the site with fastest enhancement was performed using an open 0.23 T MR imager. RESULTS: All MR-guided bone biopsies samples were estimated to be sufficient by the pathologists. The biopsy specimens were diagnostic in 34 of 36 cases. CONCLUSION: MR-guided bone biopsies combined with dynamic contrast-enhanced imaging are feasible and safe for the diagnostic investigation of equivocal bone lesions.     

Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging.

A prospective study was designed to determine the sensitivity and specificity of nonenhanced T2-weighted and contrast material-enhanced T1-weighted magnetic resonance (MR) imaging in assessing the depth of myometrial invasion in patients with proved endometrial cancer. In 56 consecutive patients with clinically determined early-stage disease, findings of the two MR imaging techniques were compared with results of histologic examination of surgical specimens. Myometrial invasion was classified as absent (stage IA), superficial (stage IB), or deep (stage IC). In the assessment of each tumor stage, the sensitivity and specificity of contrast-enhanced T1-weighted MR imaging were higher than those of non-enhanced T2-weighted MR imaging. In determining the degree of myometrial tumor invasion, the overall sensitivity of enhanced T1-weighted MR imaging was 87.5%, whereas that of nonenhanced T2-weighted MR imaging was 71.4% (P less than .05). The use of contrast material may improve the ability to assess, with MR imaging, the depth of myometrial invasion by endometrial cancer.     

黄色肉芽肿性女性生殖道炎症影像学表现并文献复习

目的 报道1例宫颈黄色肉芽肿性炎(XGI)并复习文献,提高对该病的认识.方法 回顾性分析1例XGI宫颈炎合并弥漫大B细胞淋巴瘤患者的影像学表现,总结文献报道中XGI女性生殖道炎症的影像学特点.结果 子宫内膜XGI,MRI示子宫增大,内膜增厚,T1WI脂肪抑制序列低信号,T2WI高信号.累及附件者单侧、多房囊性病变多见,...     

Ovarian carcinoma in patients with endometriosis: MR imaging findings

OBJECTIVE: Various types of malignancy can develop in patients with endometriosis. Enhancing mural nodules have been reported as an imaging characteristic of malignant transformations. We evaluated contrast-enhanced MR imaging to determine the optimum sequence to reveal mural nodules and other characteristics of malignant transformations. MATERIALS AND METHODS: We examined 10 patients with pathologically proven ovarian adenocarcinoma in endometriosis and 10 patients (the control group) with ovarian endometrioma suggestive of malignant transformation on the basis of sonographic findings. We analyzed the size and nature of the endometriomas in each patient. We compared four types of contrast-enhanced MR imaging to determine which sequence best revealed mural nodules. RESULTS: In the malignant and control groups, 80% of the cysts with findings suggestive of malignant transformation showed unilateral disease or larger endometrial cysts on the suggestive side than on the contralateral side. High signal intensity on T1-weighted images and low signal intensity on T2-weighted images relative to the myometrium were observed only in two of 10 malignant endometrial cysts and in all control cysts. All malignant endometriomas had small mural nodules with low signal intensity on T1-weighted contrast-enhanced images. Only three benign endometriomas had mural nodules and none of them enhanced. The enhancement of mural nodules was easily seen on dynamic subtraction imaging. CONCLUSION: On the basis of our findings, endometrial cysts with malignant transformation rarely show low signal intensity on T2-weighted images and usually have enhancing mural nodules. Because the enhancement of mural nodules is often difficult to evaluate on conventional T1-weighted images, dynamic subtraction imaging can be valuable.     

Small hepatocellular carcinoma treated with percutaneous RF ablation: MR imaging follow-up.

OBJECTIVE: The purpose of our study was to determine the usefulness of MR imaging in the follow-up evaluation of small hepatocellular carcinoma lesions treated with RF ablation. SUBJECTS AND METHODS: The study group included 37 patients with a single hepatocellular carcinoma lesion less than 3 cm in diameter. A strict protocol required follow-up MR imaging every 6 months after RF treatment. At each follow-up visit, the findings on unenhanced and dynamic gadolinium-enhanced MR images were correlated with those on contrast-enhanced CT images and with results of fine-needle aspiration biopsy. In five patients who underwent surgical resection after the 6-month follow-up examination, comparison with histologic findings of surgical specimens was also performed. RESULTS: Correct diagnosis of complete or partial tumor necrosis was made in 32 (86%) of the 37 patients with the use of unenhanced and dynamic gadolinium-enhanced MR images. Hypointensity on T2-weighted images and loss of enhancement on dynamic MR images corresponded to completely necrotic lesions in all patients. Conversely, intratumoral regions of hyperintensity on T2-weighted images and enhancement on dynamic MR images did not always correlate to residual viable tumor. MR imaging and CT findings agreed in the evaluation of therapeutic response in all patients. CONCLUSION: Our experience confirms that MR imaging is useful for evaluating the effectiveness of RF therapy in achieving tumor regression.     

MR diagnosis of adenomyomatosis of the gallbladder and differentiation from gallbladder carcinoma: importance of showing Rokitansky-Aschoff sinuses.

OBJECTIVE: We evaluated the MR imaging features of adenomyomatosis of the gallbladder with particular emphasis on Rokitansky-Aschoff sinuses. MATERIALS AND METHODS: MR images of 17 patients with histologically proven adenomyomatosis were retrospectively reviewed. The presence of Rokitansky-Aschoff sinuses was evaluated and analyzed; four T2-weighted (fast spin-echo with a surface coil, with or without breath-holding, fast spin-echo with a phased-array coil with breath-holding, and half-Fourier rapid acquisition with relaxation enhancement with breath-holding) and two contrast-enhanced dynamic pulse sequences were studied. These six pulse sequences were separately rated on a 5-point scale by two radiologists for comparison. Interobserver differences were evaluated. Other MR findings were also analyzed. RESULTS: Among the six pulse sequences studied, three T2-weighted with breath-holding sequences were found to be superior to the other three sequences in showing Rokitansky-Aschoff sinuses. In particular, the half-Fourier rapid acquisition with relaxation enhancement was scored the highest by the two observers and received the highest kappa coefficient in our statistical analysis of the scoring. Diffuse-type adenomyomatosis typically showed early mucosal and subsequent serosal enhancement. Localized adenomyomatosis exhibited homogeneous enhancement, showing smooth continuity with the surrounding gallbladder epithelium. CONCLUSION: MR imaging may be able to provide important information in the diagnosis of adenomyomatosis.     

联合应用MR动态增强及T_2WI对Ⅰ、Ⅱ期子宫内膜癌的诊断价值

目的:评价MR动态增强、T2WI二者结合对Ⅰ、Ⅱ期子宫内膜癌的诊断价值。方法:回顾性分析36例经手术病理证实的子宫内膜癌的T1WI、T2WI和动态增强图像,将MRI判断肌层和宫颈侵犯结果与手术病理比较。结果:MRI动态增强及T2WI二者结合判断子宫内膜癌浸润深度诊断符合率为80.6%,对Ⅰa期的敏感性、特异性,阳性预测值、阴性预测值分别为85.7%、93.1%、75%、96.4%;Ⅰb期的敏感性、特异性,阳性预测值、阴性预测值分别为76.5%、84.2%、81.3%、80%;Ⅰc期的敏感性、特异性,阳性预测值、阴性预测值分别为83.3%、91.7%、83.3%、91.7%;Ⅱ期的敏感度为80%,特异度为96.8%,诊断符合率为94.4%。结论:联合应用MRI动态增强及T2WI判断子宫内膜癌侵犯肌层的深度、范围有很高的临床价值,能够指导临床治疗方式的选择。     

Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging

PURPOSE: To prospectively determine the accuracies of T2-weighted magnetic resonance (MR) imaging, dynamic contrast material-enhanced MR imaging, and quantitative three-dimensional (3D) proton MR spectroscopic imaging of the entire prostate for prostate cancer localization, with whole-mount histopathologic section findings as the reference standard. MATERIALS AND METHODS: This study was approved by the institutional review board, and informed consent was obtained from all patients. Thirty-four consecutive men with a mean age of 60 years and a mean prostate-specific antigen level of 8 ng/mL were examined. The median biopsy Gleason score was 6. T2-weighted MR imaging, dynamic contrast-enhanced MR imaging, and 3D MR spectroscopic imaging were performed, and on the basis of the image data, two readers with different levels of experience recorded the location of the suspicious peripheral zone and central gland tumor nodules on each of 14 standardized regions of interest (ROIs) in the prostate. The degree of diagnostic confidence for each ROI was recorded on a five-point scale. Localization accuracy and ROI-based receiver operating characteristic (ROC) curves were calculated. RESULTS: For both readers, areas under the ROC curve for T2-weighted MR, dynamic contrast-enhanced MR, and 3D MR spectroscopic imaging were 0.68, 0.91, and 0.80, respectively. Reader accuracy in tumor localization with dynamic contrast-enhanced imaging was significantly better than that with quantitative spectroscopic imaging (P < .01). Reader accuracy in tumor localization with both dynamic contrast-enhanced imaging and spectroscopic imaging was significantly better than that with T2-weighted imaging (P < .01). CONCLUSION: Compared with use of T2-weighted MR imaging, use of dynamic contrast-enhanced MR imaging and 3D MR spectroscopic imaging facilitated significantly improved accuracy in prostate cancer localization.