磁共振成像在子宫内膜癌分期中的应用价值研究

目的 :探讨MRI在子宫内膜癌分期和判断子宫肌层浸润深度中的价值。方法 :经诊断性刮宫病理学证实的子宫内膜癌 30例经MRI检查后行手术治疗 ,依据FIGO分期原则 ,将MRI分期与手术后病理检查结果进行比较。MRI检查采取矢状位和轴位SE序列T1WI和T2 WI及T1和T2 频谱预饱和翻转恢复序列 (T1/SPIR和T2 /SPIR) ,其中 18例行增强后T1WI扫描。结果 :MRI分期准确率为 86 .6 % ,判断子宫肌层浸润深度的准确率为 85 .6 %。结论 :MRI对子宫内膜癌术前分期和子宫肌层浸润定位具有较高的价值。     

磁共振成像对子宫内膜癌术前分期及肌层浸润的价值探讨

目的 :回顾性分析了子宫内膜癌的磁共振成像 (MRI)表现和手术病理结果 ,探讨MRI在子宫内膜癌的术前分期和肌层浸润中的诊断价值。方法 :1 9例子宫内膜癌的诊断和分期均经手术和病理检查确诊 ,术前MRI检查采取横断位和矢状位的T1W和T2W成像 ,子宫内膜癌MRI分期按 1 988年FIGO分期原则。结果 :MRI分期的准确率达 78 9% ,其中对Ⅰ期的准确率为 92 .8% ,Ⅱ期的准确率为 1 0 0 % ,Ⅰ期和Ⅱ期的总准确率为 93 .7% ;对肌层浸润定位的准确率为85 .7%。结论 :MRI是子宫内膜癌术前分期和肌层浸润定位的一种优越方法。     

磁共振成像在子宫畸形诊断中的价值

目的:评价磁共振成像(MRI)在不孕症患者先天性子宫畸形诊断中的价值。方法:对临床怀疑有子宫畸形可能的66名不孕患者进行MRI检查,并将三维容积成像序列(Cube序列)所得图像信息进行重建。结果:66名患者中,MRI检测出55例先天性子宫畸形,包括先天性无子宫2例、幼稚子宫1例、单角子宫4例、残角子宫4例、双子宫8例、纵隔子宫30例、弓形子宫5例、双角子宫1例,MRI的后期重建能清晰显示子宫宫体和宫颈、宫腔内外各结构。结论:MRI检查对先天性子宫畸形的诊断准确性为100%,能为临床诊疗提供帮助。     

磁共振成像在子宫内膜癌诊断和分期中的价值

应用磁共振成像对４３例临床可疑子宫内膜癌患者和７例正常妇女进行了对照研究，以观察ＭＲＩ在子宫内膜癌诊断、估计肌层浸润深度和分期中的应用价值。４３例患者，ＭＲＩ测得内膜厚度均超过正常标准。     

磁共振在子宫内膜癌诊治中的应用

子宫内膜癌是最常见的女性生殖系统三大恶性肿瘤之一,严重威胁女性健康。磁共振(MRI)具有良好的软组织分辨率,能多方位、多序列成像,在子宫内膜癌术前诊断和分期中起着重要的作用。常规序列在子宫内膜癌的诊断中具有重要价值,但也存在局限性,以扩散加权成像和动态增强MRI为代表的功能成像在子宫内膜癌的诊断和分期方面有着巨大的潜能。文章就MRI的常规扫描技术、功能成像技术以及子宫内膜癌MRI诊断的现状展开讨论。     

MRI对判断Ⅰ期子宫内膜癌肌层浸润深度的价值

子宫内膜癌又称子宫体癌,是指原发于子宫内膜的上皮性恶性肿瘤,是女性生殖系统最常见的恶性肿瘤之一.诊断性刮宫是临床诊断子宫内膜癌的主要方法,但是无法判断肿瘤是否浸润肌层、浸润范围及有无转移.术前影像学检查可了解肿瘤的部位、大小、侵犯范围以及有无淋巴结转移.肿瘤对肌层的浸润深度与淋巴结转移几率关系密切,影响到手术方式的选择.治疗前准确估计分期、病理分级、淋巴结转移有助于合理选择治疗方案及判断预后[1].     

子宫内膜癌术前MRI及PET的诊断价值

目的 回顾性分析子宫内膜癌的术前磁共振显像(MRI)和正电子发射计算机断层显像(PET)表现与术后病理，探讨MRI及PET对其术前分期的价值。方法 30例子宫内膜癌患者均经术后病理确定分期，其中术前有16例患者行MRI检查，14例患者行PET检查。MRI分期按1988年FICO分期原则，PET以出现^18F-FDG聚集病灶为阳性。结果 MRI对Ⅰ期准确率为88．9％，Ⅱ期准确率为75％，Ⅰ期和Ⅱ期总的准确率为84．6％；PET均出现^18F-FDG聚集病灶。结论 MRI利于子宫内膜癌术前分期；而PET利于发现病灶，但对于术前分期的诊断欠佳。     

磁共振成像检查对早期宫颈癌分期价值研究

目的探讨磁共振成像(MRI)在评估早期宫颈癌患者宫旁浸润、阴道受侵、淋巴结转移方面的价值。方法选取2010-10-01至2013-01-31辽宁省肿瘤医院收治的48例因宫颈癌为病因首次就诊患者,以术后病理结果为金标准比较MRI、术前妇科三合诊、术中探查和剖视标本3种诊断方法在宫旁浸润、阴道受侵、淋巴结转移3个方面的价值,并以手术-病理分期为金标准对MRI分期及术前临床分期的准确度进行对比。结果 MRI在早期宫颈癌术前淋巴结转移诊断方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为65%、94%、85%、83%、83%,在宫旁浸润方面分别为50%、91%、33%、95%、88%,在阴道受侵方面分别为50%、78%、43%、82%、71%。妇科三合诊在早期宫颈癌宫旁浸润方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为0、100%、0、92%、92%、阴道受侵方面分别为75%、100%、100%、92%、94%。临床分期的整体准确度为81%,MRI分期的整体准确度为67%,临床-MRI分期的整体准确度为92%。结论 MRI在早期宫颈癌术前淋巴结转移诊断方面有良好的价值;在宫旁浸润、阴道受侵方面有较好的阴性预测值和特异度;将临床-MRI结合所得分期较单独运用两种诊断方法分期准确度有所提高。     

超声和磁共振成像在早期子宫内膜癌诊断中的价值分析

目的 探讨经阴道超声和磁共振成像（MRI）对子宫内膜癌（EC）的深部（≥50%）肌层浸润（DMI）和宫颈间质浸润（CSI）的诊断准确度。方法 选取53例绝经后阴道出血或服用激素替代疗法期间不定期阴道失血的妇女为研究对象,其中病理结果作为EC诊断的金标准,比较经阴道超声和MRI评估DMI和CSI诊断结果。结果 53例EC患者病理结果中,子宫内膜样组织学类型占比75%(40/53),其中良好至中度分化（1级或2级）占比95%(38/40);DMI发生率为43%(53/53)、CSI发生率为17%(9/53),FIGO 1或2期为77%(41/53)。经阴道超声与MRI诊断DMI及CSI的特异度、敏感度、准确度、阴性预测值、阳性预测值,差异均无统计学意义（P>0.05）。经阴道超声和MRI术前诊断DMI与病理结果一致性评价：其中经阴道超声术前诊断DMI Kappa值为0.438,经MRI术前诊断DMI Kappa值为0.584;经阴道超声和MRI术前诊断CSI与病理结果一致性评价：其中经阴道超声术前诊断CSI Kappa值为0.769,经MRI术前诊断CSI Kappa值为0.790。...     

磁共振成像在子宫内膜癌FIGO2009新分期改动中的应用及误判分析

目的 评估增强磁共振成像（MRI）对子宫内膜癌肌层和宫颈浸润及盆腔淋巴结转移的诊断价值并分析误判的相关因素。方法 收集2009年3月至2013年3月天津医科大学总医院妇科收治的167例子宫内膜癌患者临床、增强MRI及病理资料进行回顾,将MRI分期与病理分期结果进行对照,并对肌层和宫颈浸润深度及淋巴结转移误判的相关因素进行分析。结果 （1）MRI诊断准确率随期别升高而降低,随子宫内膜样腺癌分化程度的降低而降低,差异有统计学意义（P<0.05）;MRI诊断子宫内膜样腺癌和特殊病理类型患者的准确率为79.74%和64.29%,差异有统计学意义(P<0.05)。（2）MRI诊断肿瘤浅肌层浸润的敏感度、特异度、准确率、阳性预测值（PPV）、阴性预测值（NPV）及与病理结果一致性的手捣直鹞?91.79%、90.91%、91.62%、97.62%、73.17%和0.758;深肌层浸润率分别为90.91%、91.79%、91.62%、73.17%、97.62%和0.758;宫颈浸润率分别为84.21%、95.95%、94.61%、72.73%、97.93%和0.750;盆腔淋巴结转移率分别为45.00%、91.16%、85.63%、40.91%、92.41%和0.347。（3）MRI错误评估肌层浸润、宫颈浸润及盆腔淋巴结转移,与患者分娩次数少、合并肌瘤、宫角部位病变、深肌层浸润、肿瘤体积大（包括肿瘤占宫腔面积≥1/2及肿瘤最大径较大）、子宫内膜样腺癌低分化及特殊病理类型正相关（P<0.05）。结论 增强MRI对术前子宫内膜癌深肌层浸润、宫颈浸润和盆腔淋巴结转移评估具有较高的准确率和阴性预测值。当患者合并肌瘤、宫角部位病变、肿瘤体积较大、特殊病理类型和子宫内膜样腺癌低分化等因素时较易误诊。     

The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer

ObjectiveTo evaluate the accuracy of preoperative magnetic resonance imaging (MRI) to detect deep myometrial invasion in patients with endometrial cancer.Materials and MethodsWe retrospectively reviewed 66 cases of women with endometrial cancer, who underwent preoperative MRI assessment and surgical staging between January 2006 and October 2010. The MRI findings were then compared with the pathology results. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI in detecting deep myometrium invasion were evaluated.ResultsThe sensitivity, specificity, accuracy, PPV, and NPV results of MRI for the detection of deep myometrium invasion were 92.52%, 74.35%, 81.81%,71.42%, and 93.54%, respectively, with a kappa of 0.64. In the postmenopausal group, the values were 100%, 55.5%, 74.19%, 61.9%, and 100%. In the premenopausal women, they improved to 85.7%, 90.47%, 88.57%, 88.71%, and 90.47%. The sensitivity (100%) was better than the specificity (55.56%) in the postmenopausal women. The predictive value was markedly higher in the premenopausal women than the postmenopausal women (85.7% vs. 61.9%).ConclusionIn patients with endometrial cancer, a preoperative MRI contributes to accurate staging, allowing planning for the scale of surgery and preoperative counseling. In our study, the pretreatment identification of myometrium invasion provided the opportunity for small-scale surgery in the premenopausal women with early endometrial cancer. However, for the postmenopausal patients, the standard surgical procedure is indicated even if the degree of myometrium invasion is low.     

Magnetic resonance imaging in the preoperative staging of endometrial carcinoma

PURPOSE OF INVESTIGATION: Magnetic resonance imaging (MRI) has emerged as an important imaging modality in the evaluation of the extension of endometrial carcinoma which is essential in planning treatment and predicting prognosis. This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma. METHODS: We included in this study 162 patients with a histological diagnosis of endometrial carcinoma who underwent MRI pelvic imaging and surgical staging. MRI images were compared with pathological findings to measure MRI's sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in what concerns myometrial, cervical and lymph node invasion. RESULTS: MRI differentiation of deep myometrial invasion from superficial disease agreed with pathological findings in 77% of cases, with a sensitivity of 83%, a specificity of 72% and a diagnostic accuracy of 77%. Concerning cervical invasion, MRI had a sensitivity, specificity and diagnostic accuracy of 42%, 92%, 81% respectively. In assessing lymph node invasion, MRI presented a sensitivity of just 17%, a specificity of 99% and a diagnostic accuracy of 89%. CONCLUSION: Our study confirmed the high accuracy of MRI imaging in assessing myometrial and cervical invasion in endometrial carcinoma. When evaluating lymph node invasion, micrometastases are responsible for the low sensitivy of MRI.     

Evaluation of endometrial carcinoma on magnetic resonance imaging

Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy.     

Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinoma

Aims: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion.
Methods: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results.
Results: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764.
Conclusion: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.     

Magnetic resonance imaging in endometrial carcinoma staging

Correct evaluation of myometrial infiltration is essential in patients with stage I and II endometrial cancer who are candidates for hysterectomy without lymphadenectomy, if extensive infiltration of the myometrium is not present. The aim of this study was to evaluate the use of magnetic resonance imaging (MRI) to improve staging of patients with endometrial cancer. Thirty patients with histological diagnosis of endometrial cancer were studied with MRI at 1.5 T and subsequently underwent abdominal hysterectomy. The MRI results were compared with those of the histological tests. MRI was performed with a 1.5-T magnet and spin-echo (SE) technique [repetition time/echo time (msec) = 2.000/35-90]. Contiguous 4-mm sections of were obtained from the sagittal plane. Clinical staging was not confirmed in two patients who presented with cervical extension of the tumor. The overall accuracy of MRI in determining the grade of myometrial and cervical invasion was 86 and 90%, respectively.     

Clinical utility of magnetic resonance imaging and the preoperative identification of low risk endometrial cancer

BACKGROUND: Magnetic resonance imaging (MRI) is reported to offer the best imaging of local disease in endometrial cancer. We audited MRI scans to identify their clinical utility, particularly in the preoperative identification of 'low risk' endometrial cancer (grade one or two endometrioid tumours confined to the inner half of the myometrium). AIM: To correlate histological and MRI findings and to establish our ability to preoperatively identify women with 'low risk' tumours. STUDY DESIGN: A retrospective audit of MRI scans in women with a new diagnosis of endometrial cancer from July 1998 to November 2002. Radiology and pathology reports and surgical staging data were extracted. Independently a team of radiologists reviewed MRI films and the findings were compared to pathology. RESULTS: Thirty-nine patients were included. Only 10% of original reports contained all the clinically relevant information. On review, the sensitivity for the detection of myometrial invasion was 90%, specificity 71%, positive predictive value (PPV) 93% and negative predictive value (NPV) 63%. For the detection of deep invasion, sensitivity was 56%, specificity 77%, PPV 64% and NPV 71%. All women with grade one or two tumours having no invasion or grade one having superficial invasion detected on MRI had pathological 'low risk' disease. CONCLUSIONS: Magnetic resonance imaging scans as reported offered limited clinical benefit. Attention needs to be given to MRI sequencing and reporting protocols. If the review results can be confirmed by prospective studies, MRI offers significant clinical utility in the identification of low risk patients and their surgical treatment planning.     

Magnetic resonance (MR) in endometrial carcinoma preoperative evaluation

BACKGROUND: Myometrial invasion of endometrial carcinoma is an important prognostic factor because the degree of myometrial invasion is correlated with the rate of lymphnode metastases and of recurrences. The aim of the study was a preoperative evaluation of endometrial carcinoma by Magnetic Resonance (MR). METHODS: The authors present a prospective study performed on 54 cases of endometrial carcinoma collected at the Department of Gynecology and Obstetrics of the University of Trieste (Italy). All the patients were considered as Stage I after hysteroscopy and endocervical curettage. Prior to surgery all the patients underwent MR at the Department of Radiology of the University of Trieste (Italy) in order to evaluate the depth of myometrial invasion. The surgical procedure included total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and lomboaortic lymphadenectomy in high risk cases. Statistical evaluation was performed by Fischer's exact test. RESULTS: Statistically significant positive correlation was found (p<0.001) between MR staging and surgical staging. The sensitivity reported in our series for distinguishing between superficial disease (Stage IA and IB) and deep myometrial invasion (Stage IC) was 92%. CONCLUSIONS: Preoperative MR is helpful in selecting patients at high risk of nodal involvement and it is suggested that, although MR is considered an expensive examination, its use should be always considered before surgical treatment of patients with high surgical risk.     

Magnetic resonance imaging in stage I endometrial carcinoma

A prospective study was conducted on 50 consecutive patients with stage I endometrial cancer who had primary surgical treatment. The purpose of the study was to assess the value of magnetic resonance imaging (MRI) for accurate staging of early disease and determination of myometrial invasion. Features identified by MRI were correlated with surgical pathology. Preliminary MRI results provided additional valuable information. All but one of 18 patients with histologically proven deep myometrial invasion were predicted preoperatively by MRI. Of 17 patients with detached fragments of malignant tissue in the endocervical curettage (ECC) but with results inconclusive for actual cervical invasion, MRI revealed all three patients with true cervical tissue involvement. Magnetic resonance imaging detected all six patients with gross extrauterine spread and also precisely measured uterine enlargement by myomata. The extent and location of tumor growth in the uterus could be mapped out in the majority of cases. Based on these findings, a pretreatment MRI scan of the pelvis in presumably stage I endometrial carcinoma resulted in an advance in staging in 18% of the patients, and accurately predicted deep myometrial invasion in 94% of the cases. Inclusion of MRI in the routine work-up in stage I endometrial carcinoma should be considered for proper clinical staging, particularly in patients with a positive but nondiagnostic ECC, uterine papillary serous carcinoma, or grade 3 tumor.     

Accuracy of magnetic resonance imaging for diagnosis and preoperative assessment of deeply infiltrating endometriosis

Objective

To evaluate the accuracy of preoperative magnetic resonance imaging (MRI) findings relative to surgical presence of deeply infiltrating endometriosis (DIE).

Methods

This prospective study included 92 women with clinical suspicion of DIE. The MR images were compared with laparoscopy and pathology findings. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for diagnosis of DIE were assessed.

Results

DIE was confirmed at histopathology in 77 of the 92 patients (83.7%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI to diagnose DIE at each of the specific sites evaluated were as follows: retrocervical space (89.4%, 92.3%, 96.7%, 77.4%, 90.2%); rectosigmoid (86.0%, 92.9%, 93.5%, 84.8%, 89.1%); bladder (23.1%, 100%, 100%, 88.8%, 89.1%); ureters (50.0%, 100%, 95.5%, 95.7%); and vagina (72.7%, 100%, 100%, 96.4%, 96.7%).

Conclusion

MRI demonstrates high accuracy in diagnosing DIE in the retrocervical region, rectosigmoid, bladder, ureters, and vagina.