Diagnostic value of T2 and diffusion-weighted imaging (DWI) in local staging of endometrial cancer

BackgroundEndometrial cancer (EC) is the eighth most prevalent cancer globally. T2-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) help anatomical localization and local staging of lesions. The present study was performed to assess the diagnostic value of the simultaneous use of T2 and DWI techniques in EC evaluation.MethodsSeventy-eight histopathological-proven EC cases were included in this study. Patients were assessed using a complete MRI exam, including T2 and DWI. The myometrial invasion, cervical, serosal or adnexal, vaginal or parametrial, and pelvic lymph node involvements and accuracy, sensitivity, specificity, and positive and negative predictive values were evaluated in each sequence distinctly and was compared with the pathology findings and full standard protocol using post-contrast multiphasic contrast-enhanced series.ResultsDeep myometrial invasion in EC cases was detected in 38.5% by T2-DWI and 37.2% by pathology. The pathology diagnosed cervical, serosal, and vaginal involvements and pelvic lymph node metastases in 20.5%, 7.7%, 6.4% and 11.5% of cases respectively, while the numbers for T2-DWI were 26.9%, 7.7%, 7.7%, and 15.4%, respectively. The accuracy, sensitivity, specificity, PPV, and NPV of T2-DWI in the diagnosis of myometrial invasion were 93.5%, 93.1%, 93.8%, 90%, and 93.8%, respectively. A slightly higher Kappa coefficient of DWI (0.973) in the diagnosis of myometrial invasion was identified compared to T2 (0.946). The T2-DWI technique had a 52.6% intraclass correlation coefficient in the diagnosis of IA stage.ConclusionThe simultaneous consideration of T2 and DWI technique may signify a noninvasive, rapid, safe, and accurate approach for precisely assessing myometrial invasion and EC staging. Elimination of intravenous contrast material result in prevention of contrast related side effects beside significant cost reduction for health care systems and patients with a comparable result to contrast enhanced MRI.     

Endometrial cancer: magnetic resonance imaging

Carcinoma of the endometrium is the most common invasive gynecologic malignancy of the female genital tract. Clinically, patients with endometrial carcinoma present with abnormal uterine bleeding. The role of magnetic resonance imaging (MRI) in endometrial carcinoma is disease staging and treatment planning. MRI has been shown to be the most valuable imaging mod-ality in this task, compared with endovaginal ultrasound and computed tomography, because of its intrinsic contrast resolution and multiplanar capability. MRI protocol includes axial T1-weighted images; axial, sagittal, and coronal T2-weighted images; and dynamic gadolinium-enhanced T1-weighted imaging. MR examination is usually performed in the supine position with a phased array multicoil using a four-coil configuration. Endometrial carcinoma is isointense with the normal endometrium and myometrium on noncontrast T1-weighted images and has a variable appearance on T2-weighted images demonstrating heterogeneous signal intensity. The appearance of noninvasive endometrial carcinoma on MRI is characterized by a normal or thickened endometrium, with an intact junctional zone and a sharp tumor-myometrium interface. Invasive endometrial carcinoma is characterized disruption or irregularity of the junctional zone by intermediate signal intensity mass on T2-weighted images. Invasion of the cervical stroma is diagnosed when the low signal intensity cervical stroma is disrupted by the higher signal intensity endometrial carcinoma. MRI in endometrial carcinoma performs better than other imaging modalities in disease staging and treatment planning. Further, the accuracy and the cost of MRI are equivalent to those of surgical staging.     

Endometrial carcinoma: efficacy of thin-section oblique axial MR images for evaluating cervical invasion

BACKGROUND: To investigate the efficacy of thin-section oblique axial magnetic resonance (MR) images in evaluating cervical invasion by endometrial carcinoma. METHODS: Sixty-seven patients with endometrial carcinoma were evaluated with pathologic correlation. We compared the accuracy in the assessment of cervical invasion by endometrial carcinoma between parasagittal MR images and thin-section oblique axial MR images by using T2-weighted and contrast-enhanced T1-weighted pulse sequences. RESULTS: Cervical invasion by endometrial carcinoma was confirmed by pathologic examination. Cervical invasion was seen in 16 patients. The accuracy rates of parasagittal T2-weighted images, thin-section oblique axial T2-weighted images, parasagittal contrast-enhanced T1-weighted images, and thin-section oblique axial contrast-enhanced T1-weighted images were 74.7%, 89.5%, 82.0%, and 95.5%, respectively. Statistically significant differences were seen between parasagittal T2-weighted images and thin-section oblique axial T2-weighted images (p = 0.002) and between parasagittal contrast-enhanced T1-weighted images and thin-section oblique axial contrast-enhanced T1-weighted images (p = 0.003). CONCLUSION: Thin-section oblique axial MR images are considered to be useful for the assessment of cervical invasion by endometrial carcinoma.     

MRI动态增强扫描在子宫内膜癌术前诊断中的应用

目的探讨MRI动态增强扫描在子宫内膜癌手术前诊断中的价值。方法回顾分析2008年2月2010年3月38例经手术病理证实为子宫内膜癌患者的动态增强MRI检查资料,判断内膜癌子宫肌层和宫颈浸润情况,与病理结果对照,计算T2WI及动态增强序列诊断肌层及宫颈浸润的敏感度、特异度、准确度等,分析两种序列诊断准确度有无差异;计算内膜癌组织与子宫肌层在动态增强各期的对比信噪比,并分析其在各期间有无差异。结果动态增强序列诊断内膜癌肌层和宫颈受侵的敏感度、特异度、阳性预测值、阴性预测值分别为96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%;动态增强序列诊断内膜癌深肌层浸润的准确度为94.7%,显著高于T2WI诊断深肌层浸润的准确度78.9%（P〈0.05）;平衡期内膜癌组织与子宫肌层的对比信噪比显著高于动脉期和静脉期（P〈0.01）。结论 MRI动态增强扫描能够在手术前准确的判断内膜癌肌层及宫颈浸润,有助于子宫内膜癌治疗方式的选择。     

16排螺旋CT重建技术在宫颈癌诊断及分期中的应用

目的探讨16排螺旋CT重建技术在宫颈癌诊断及分期中的应用价值。方法经活检病理证实的23例患者均行16排螺旋CT容积增强扫描；图像经后处理获得宫颈癌多平面图像。结果矢状面图像可以全面显示宫颈肿块生长趋势；轴位图像、冠状面图像可以显示宫颈旁侵犯程度及淋巴结转移情况；任意旋转位图像可以显示宫颈肿块最大截面，与周围脏器组织之间关系，淋巴结侵犯情况。结论16排螺旋CT重建技术可以全面显示宫颈肿块生长及侵犯特征，对临床分期及指导治疗有重要价值。     

磁共振弥散加权成像在宫颈癌诊断和分期中的价值

目的 探讨磁共振弥散加权成像(DWI)及表观弥散系数(ADC)值对于宫颈癌检测的敏感性及分期的准确性.方法 对经病理证实的67例宫颈癌患者(宫颈癌组)、20名女性健康志愿者(对照组)行常规MRI及DWI检查;比较DWI结合MR常规序列与单纯MR常规序列对宫颈癌分期诊断的差异;分析正常志愿者宫颈三层(颈管内膜、结合带、肌层)与宫颈癌的ADC值差异.结果 DWI结合MRI常规序列检出全部病例,单纯MRI常规序列检测出64例,漏诊3例,准确率为95.52%.对于各期宫颈癌及全部病例分期诊断中,DWI结合MRI常规序列与单纯MRI常规序列之间差异均无统计学意义.对照组宫颈三层平均ADC值分别为颈管内膜(1.54±0.15)×10-3 mm2/s,结合带(1.56±0.16)×10-3 mm2/s,肌层(1.81±0.16)×10-3 mm2/s;宫颈内膜与结合带间差异无统计学意义,二者与肌层之间差异有统计学意义;颈管癌平均ADC值为(1.05±0.20)×10-3 mm2/s,正常颈管内膜与宫颈癌之间差异有统计学意义.结论 相对于MRI常规序列,DWI结合常规MRI序列对于检测宫颈癌更敏感;DWI对于区分正常宫颈与宫颈癌有重要价值.     

B超在宫颈癌诊断中的临床价值

目的探讨B超在宫颈癌诊断中的临床价值及宫颈癌的声像图表现.方法对51例经手术病理证实为宫颈癌患者的声像图作回顾性分析.结果子宫、宫颈、双侧附件未见异常声像(假阴性)7例;宫颈段异常声像14例;合并宫腔、宫体异常12例;合并宫旁或盆腔异常8例;合并膀胱、直肠、盆腔淋巴结、泌尿系受侵犯10例.51例中术后复发2例.结论 B超在宫颈癌诊断的术前分期、鉴别诊断、术后复发、放疗前后观察等方面起重要辅助作用.     

Applications of magnetic resonance imaging to gynecology

The advent of MRI has improved the ability of the diagnostic radiologist to provide useful clinical information to the practicing gynecologist. Although US remains the screening procedure of choice for evaluation of the uterus and adnexa because of its relative safety and low cost, MRI is now considered the next imaging step. In a woman with pelvic pain, MRI can accurately identify adenomyosis, enumerate and localize uterine fibroids, and provide more accurate identification of endometriosis and cystic teratomas of the ovary than US. Although MRI should not be used as a screening procedure for diagnosing endometrial or cervical carcinoma, it can aid in patient management by determining the extent of myometrial or cervical invasion by endometrial carcinoma and can be used to calculate tumor volume in patients with cervical carcinoma. Early studies suggest that MRI may be helpful in distinguishing between long-term radiation fibrosis and tumor recurrence in such patients. MRI findings may be highly indicative of the presence of ovarian malignancy, but the procedure adds little to CT or US findings. Nevertheless, MRI is superior in the localization of pelvic masses and is often indicated in clarifying the origin of a mass as uterine or ovarian.     

磁共振成像在喉癌诊断中的应用价值

目的：探讨磁共振成像（MRI）在喉癌诊断中的应用价值。方法回顾性分析26例喉癌患者的MRI表现。结果26例喉癌中声门型l5例（57.7％）,声门上型7例（26.9％）,跨声门型4例（15.4％）,无声门下型。MRI表现为声带局部侵润、增厚,喉内软组织肿块、贯穿声门及周围组织浸润,颈部淋巴结转移。结论 MRI检查在诊断喉癌过程中能清晰准确并直观的反应癌肿侵犯的范围与邻近扩散情况,对于喉癌的早期诊断、分期及治疗具有重要意义。     

探讨子宫颈癌的临床病理特征和影响盆腔淋巴结转移的Logistic危险因素分析

目的探究与分析子宫颈癌的临床病理特征和影响盆腔淋巴结转移的Logistic危险因素分析结果。方法回顾性分析本院自2017年12月至2019年12月收治的65例子宫颈癌患者的临床以及术后病理资料,按照是否发生淋巴结转移分为淋巴结转移组(n=19例)及淋巴结未转移组(n=46例),采用单因素以及多因素的Logistic回归分析该组子宫颈癌临床病理特征以及影响盆腔淋巴结的转移危险因素。结果行Logistic分析可见,影响子宫颈癌合并发生盆腔淋巴结转移的危险因素包括了肿瘤直径≥2cm、肿瘤浸润深度>1/2子宫颈全层、存在宫旁浸润、肿瘤累及子宫下段(P<0.05)。结论影响子宫颈癌合并发生盆腔淋巴结转移的危险因素包括了肿瘤直径≥2cm、肿瘤浸润深度>1/2子宫颈全层、存在宫旁浸润、肿瘤累及子宫下段等,妇科工作者需要根据盆腔淋巴结转移情况实施规范性的盆腔淋巴结切除术等其他措施,以达到促进预后的目的。     

Lymph node staging

Cancers of the head and neck (HNC) include cancers of the larynx, nasal passages/nose, oral cavity, pharynx, salivary glands, buccal regions, and thyroid. In these cancers, lymph node staging and localization of pathological lymph nodes are necessary to decide on either (neo) adjuvant or surgical therapy and are a major factor for the prognosis in HNC patients. Cervical node metastases have different incidence, and their presence is associated with a decrease in global survival to roughly half and with higher recurrence rates. The node metastases can be categorized in the following 2 groups: overt (clinical) or nonovert (occult). The latter can be subcategorized as metastases detectable by traditional methods (eg, staining) or "submicroscopic" metastases, only evident with immunohistochemical or molecular analysis. Compared with clinical invasive and laboratory examinations, which may have complications and are expensive, radiology plays an important role in lymph node staging. Mainly, the overt node metastases are the field of radiological imaging, and second, the detection of nonovert metastases is important and holds promise for the future because many patients of those initially classified as cN0 have, in fact, occult metastatic disease (pN1). Vice versa, radiological imaging has to avoid false-positive results that can lead to an elective or radical neck dissection, which are associated with increased morbidity and mortality and thus overshadow the improvement in survival. Radiological imaging plays a role not only as an initial staging of N+ but also in the case of N0 due to the continuing controversy for the treatment of N0 patients. A close observation of the patient may reveal a positive node in the follow-up. The imaging modalities used for the node staging in HNC patients include ultrasound, contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging (MRI), and positron emission tomography scans. None of the above-mentioned methods reaches a 100% sensitivity or specificity, and the accuracy of the exact number of metastases or levels involved has not been studied; thus, neck dissection with subsequent pathological examination remains the gold standard for node staging. Among the described cross-sectional imaging modalities, MRI presents a lot of advantages mainly due to the increased soft tissue contrast and the ability to obtain tissue characteristics in different sequences, including diffusion- and perfusion-weighted sequences and proton spectroscopy imaging. The lack of the radiation burden makes MRI suitable for a close follow-up of the patient, and the imaging with the use of new intravenous contrast material (such as ultrasmall iron oxide particles) seems superior to the conventional. In this article, we will focus on the lymph node MRI staging in HNC patients and the MR anatomy of the nodes, the necessary diagnostic workup, and the advantages of the method over computed tomography. The possibilities of the new imaging sequences and the treatment implications will be addressed as well.     

MRI动态增强在判断子宫内膜癌肌层浸润中的应用价值

目的:探讨MRI动态增强在判断子宫内膜癌肌层浸润中的应用价值。材料与方法:回顾性分析33例经手术病理证实的子宫内膜癌的MR动态增强表现,观察肿瘤的强化特点、内膜下强化带的显示及肌层内表面情况,将MR动态增强判断肌层浸润的结果与病理比较。结果:动态增强延迟期31例子宫内膜癌呈轻至中等强化,与肌层信号比较,呈相对低信号,2例子宫内膜癌明显强化;动态增强早期显示子宫内膜下强化带22例,不出现内膜下强化带者,肌层内表面不规则10例,光滑1例。以手术病理为准,MRI动态增强扫描判断肌层浸润的诊断符合率为90·9%。结论:MRI动态增强对判断子宫内膜癌肌层浸润有较高的价值,应列为术前MRI检查常规序列。     

Magnetic resonance imaging of uterine malignancies

Magnetic Resonance Imaging (MRI) is the criterion standard in the assessment and staging of uterine cancer because of the high tissue contrast between glandular lining and inner and outer muscle layers of the uterine corpus and cervix on T2-weighted scans. It is also an essential tool in monitoring treatment response and in assessing disease recurrence in these patients. The key to a successful examination lies in good patient preparation, use of antiperistaltic agents, and a meticulous scanning technique. Endometrial carcinomas are the most common uterine malignancy, occurring in a primarily postmenopausal population. Dynamic contrast-enhanced scans may be required in addition to T2-weighted images to assess the presence of myometrial invasion in this age group. Cervical cancers occur in a younger population and are readily assessed with T2-weighted imaging. Use of an endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful when assessing patients for fertility-sparing procedures such as trachelectomy. Uterine sarcomas are 1% to 3% of all uterine malignancies and usually arise from a mixture of homologous and heterologous elements. Rarely, lymphoma, small cell carcinoma and metastatic deposits involve the uterus. This review summarizes the optimal scanning techniques for demonstrating uterine malignancy and discusses the role of imaging and the MRI appearances of uterine tumors.     

MRI及彩超对子宫内膜癌的诊断价值

目的:探讨子宫内膜癌的MRI及彩超表现,评价MRI及彩超对子宫内膜癌的诊断及术前分期的价值。材料和方法:回顾性分析24例经病理证实的子宫内膜癌患者MRI及彩超征象,对18例行手术治疗者术前通过MRI及彩超对肿瘤进行分期,并与术后病理结果相对照。结果:子宫内膜癌MRI表现:T2WI表现为子宫内膜增宽,癌灶信号高于肌层,但略低于邻近尚残留的内膜和腔内黏液。分期准确度为77.8%,对肌层浸润深度判断的准确度为87.5%。子宫内膜癌彩超表现:肿瘤内彩色血流信号丰富,呈现低阻力血流,RI=0.35±0.05, 彩超分期准确度77.8%,对肌层浸润深度判断的准确度为75%。结论:MRI及彩超能多方位清晰显示子宫内膜癌癌灶及侵犯范围;对子宫内膜癌的术前分期有很高的价值。经阴道彩色多普勒超声(TVCDS)对肌层浸润深度及邻近盆腔有无转移结节病变显示不如MRI清晰、直观,综合分析判断将大大提高子宫内膜癌的诊断及术前分期的准确性。     

子宫内膜癌临床病理特征与盆腔淋巴结转移的相关性研究

【目的】探讨子宫内膜癌患者盆腔淋巴结转移的相关病理因素。【方法】回顾性分析经手术治疗的68例子宫内膜癌患者的临床病理资料,探讨患者临床病理特征与腹膜后盆腔淋巴结转移的关系。【结果168例子宫内膜癌患者中,淋巴结转移13例。组织类型、肿瘤分级、肌层浸润、宫颈受累和脉管浸润与淋巴结转移显著相关（P〈0．05）;而年龄、绝经状态、有无附件受累与淋巴结转移无明显相关（P〉0．05）。【结论】非子宫内膜样癌、肿瘤低分化、肌层浸润深、宫颈受累和脉管浸润对判断淋巴结转移和预后有指导意义。     

CT、MRI及与PET融合显像评价宫颈癌分期及淋巴结转移中的应用进展

传统影像学检查方法(CT、MRI)在宫颈癌分期及淋巴结转移的诊断方面应用较为广泛,对制定治疗方案、改善预后和降低死亡率有重要的作用。近年来,随着分子影像技术的发展,多模态分子影像技术(PET/CT及PET/MR)被逐渐应用于宫颈癌的诊断并指导治疗。本文对CT、MRI及与PET融合显像技术在宫颈癌分期及淋巴结转移评价中的临床应用进行综述。     

CT指数及MR成像对盆腔淋巴结转移诊断价值的研究

目的探讨CT指数及MR成像对盆腔淋巴结转移诊断价值。材料与方法 2011年9月到2015年2月选择在湖北省十堰市房县人民医院肿瘤科就诊的56例宫颈癌初诊患者,都进行CT指数及MRI成像检测与对比,并且进行了病理分析。结果在56例患者中,手术病理判断为淋巴结转移38例,转移阳性率为67.9%。CT检测显示淋巴结转移阳性患者的淋巴结多为原型、中心有坏死、多合并存在包膜外侵,并且大小明显高于淋巴结转移阴性患者(P0.05)。MRI DWI图像显示淋巴结转移阳性患者的ADC值明显低于淋巴结转移阴性患者(P0.05),而eADC值明显高于淋巴结转移阴性患者(P0.05)。与手术病理结果对比,CT与MR诊断淋巴结转移的敏感性为97.4%和100.0%,特异性都为100.0%,对比差异都无统计学意义(P0.05)。结论宫颈癌盆腔淋巴结转移在临床上比较常见,可导致CT影像图特征的变化与MR成像参数的改变,CT指数及MRI成像对盆腔淋巴结转移都是非常敏感与特异的检测手段,值得在临床上推广应用。     

MRI在子宫内膜癌术前分期诊断中的应用价值

目的:探究MRI对子宫内膜癌术前分期的诊断价值.方法:搜集2018年1月～2021年10月我院诊治的EC患者33例作为研究对象,所有患者术前均应用MRI检查并进行分期,与术后病理分期对照.结果:MRI对子宫内膜癌的肌层侵犯深度、宫颈浸润及宫旁侵犯与病理诊断有高度一致性.结论:术前MRI在子宫内膜癌检查,能够有效准确的对...     

108例子宫内膜癌临床病理分析

目的 :阐明子宫内膜癌的临床病理特点 ,肿瘤的生物学行为 ,为临床早期诊断和选择合适手术提供参考。方法 :回顾性分析 1998年 2 0 0 2年门诊和住院手术的子宫内膜癌 10 8例 ,观察患者的发病年龄 ,症状特点 ,尤对 90例手术病例的病理特点、肿瘤的浸润转移情况作详细观察。结果 :发病年龄比以往文献报道略宽 ,阴道不规则出血占 97.2 % ,≤ 45岁确诊前平均流血时间 3 8.1个月 ,>45岁者为 7.8个月。就子宫颈受累情况而言 ,诊刮结果与全子宫切除标本符合率为 61.90 % ,假阳性率 3 9.71% ,假阴性率 3 1.3 %。浆乳癌和透明细胞癌子宫旁浸润率为 10 0 % ,卵巢、肠道、大网膜、盆腔淋巴结的转移率均为 66.7% ,明显高于内膜样腺癌 ,P <0 .0 5。腺鳞癌的淋巴结转移率高于普通内膜样腺癌 ,P <0 .0 5 ,病理分级越高 ,深肌层浸润率和淋巴结转移率越高 ,G3明显高于G1和G2 ,P <0 .0 5和P <0 .0 1。结论 :重视阴道不规则出血 ,及时诊断性刮宫是子宫内膜癌早发现、早诊断、早治疗的前提。颈管诊刮的假阳性率和假阴性均较高 ,是今后医疗工作中需注意的问题。子宫内膜癌旁浸润和卵巢转移率较高 ,术中须注意子宫旁组织和卵巢的处理。浆乳癌和透明细胞癌生物学行为最为恶劣 ,易子宫外浸润和盆外转移 ,手术范围宜广、宜彻底。     

颈部增强CT在甲状腺癌发生颈部淋巴结转移患者中的诊断效果

  目的  分析颈部增强CT对甲状腺癌颈部淋巴结转移的诊断效能。  方法  回顾性分析76例甲状腺乳头状癌患者的临床资料。以病理诊断结果为金标准,分析增强CT检查对甲状腺癌颈部淋巴结转移的诊断价值。  结果  病理学检查确诊本组患者颈部淋巴结转移153枚,未转移533枚,中央区淋巴结转60.13%;以病理诊断结果为金标准,增强CT诊断颈部中央区淋巴结转移准确率为83.61%,诊断颈侧区淋巴结转移准确率为89.26%;增强CT显示本组患者颈部转移淋巴结平均短径高于未转移淋巴结（8.91±2.62 mm vs 8.02±2.51 mm）,转移与未转移淋巴结短径>10 mm、明显增强、明显不均匀强化、囊变、病灶内钙化及周围组织侵犯数目的差异有统计学意义（P < 0.05）。  结论  增强CT对甲状腺癌颈部中央区淋巴结转移的诊断效能低于颈侧区淋巴结,建议结合超声或MRI检查综合评估。