3.0T MR弥散加权成像对子宫内膜病变的诊断价值

目的：探讨3.0TMR弥散加权成像及表观弥散系数（ADC）对子宫内膜病变的诊断价值。材料与方法：回顾性分析46例经手术病理证实的子宫内膜病变,其中35例为子宫内膜癌,11例为良性子宫内膜病变。所有患者在常规MRI检查（T1WI、T2WI、动态增强扫描-LAVA序列）的基础上均行弥散加权平面回波序列（DWI-EPI）,弥散敏感因子（b值）为0、600s/mm2。T2WI,LAVA序列观察子宫内膜癌及良性内膜病变表现,对子宫颈有无侵犯及盆腔内淋巴结转移的信号强度,在确定病灶的位置区域比较DWI的信号特点,测定子宫内膜癌及良性病变的ADC值,并与手术病理结果对照进行统计学分析。结果本组35例子宫内膜癌在DWI上32例显示为高信号影（91.4%）,3例病灶显示不清;子宫内膜癌宫颈浸润2例,盆腔淋巴结转移2例,均呈高信号影。11例良性病变包括子宫粘膜下肌瘤7例,子宫内膜息肉2例,内膜增生2例,DWI序列7例呈等信号,4例呈稍高信号影。在DWI、LAVA、DWI结合T2WI序列上判断肿瘤对子宫肌层浸润程度的准确性分别为62.9%（22/35）、74.3%（26/35）、82.9%（29/35）。子宫内膜癌的ADC平均值为1.02±0.23×10-3mm2/s,低于良性子宫内膜组1.49±0.21×10-3mm2/s,差别具有统计学意义（P〈0.01）。结论 ADC值对鉴别子宫良恶性病变有重要的价值。DWI结合常规MR序列检查对子宫内膜癌肌层浸润及盆腔淋巴结转移的诊断有较高的准确率,为子宫内膜癌的临床分期提供较重要信息。

Diagnostic Value of Diffusion-weighted Imaging for Endometrial Lesions

Objective：To investigate the diagnostic value of 3.0T MR diffusion-weighted imaging （DWI）sequence and apparent diffusion coefficient （ADC） measurement for endometrial lesions. Materials and Methods：Retrospective analysis of 46 patients with 35endometrial cancer patients and 11 benign lesions,all cases were confirmed by pathology. DWI sequence （b=0,600s/mm2） and FSE T2WI and LAVA were made on 3.0T MR Scanner. The signal features of the endometrial cancer and benign lesions were observed on DWI sequences. The features of the cervix infiltrated by cancer and lymph-node in pelvic were also observed. The accuracy of the depth of myometrial invasion by cancer were evaluated by DWI,LAVA,DWI combined T2WI respectively,Surgical pathology findings were the reference standard. The ADC values between two groups were analyzed. Results：In 35 patients of endometrial cancer,32 patients have high signal intensity on DWI （91.4%）,while 3 patients could not display. In 11 benign lesions（7cases of the submucosal leiomyoma,2 cases of endometrial hyperplasia,2cases of endometrial polyps）,7 cases have iso-intensity and 4 cases have high signal on DWI. 2 cases of the cervix infiltrated by cancer and 2 of lymph-node were high signal on DWI. The accuracy of the depth of myometrial invasion were 62.9%（22/35）,74.3%（26/35）,82.9%（29/35）respectively. The average ADC value of 32 cases of endometrial cancer were lower than benign lesions （1.02×10-3±0.23×10-3 mm2/s vs1.49×10-3±0.21×10-3 mm2/s,there was statistical significance between the groups（P0.01）. Conclusion：ADC value may play an important role in differentiating malignant from benign endometrial lesions,and DWI sequence combined with conventional MRI have high diagnostic accuracy for myometrial invasion and pelvic lymph-node metastasis of endometrial cancer.