MRI三维动态增强与扩散加权成像在子宫内膜癌分期与分级中的应用

目的 探讨3.0T MR三维肝脏容积加速采集(LAVA)动态增强检查在子宫内膜癌分期中的价值,分析不同病理级别内膜癌表观扩散系数(ADC)的差异.资料与方法 回顾性分析73例经手术病理证实为Ⅰ、Ⅱ期子宫内膜癌术前MR资料,评估LAVA增强检查分期各期(2009年FIGO分期标准)肿瘤的敏感性、特异性和准确性；比较各病理级别肿瘤间ADC值的差异.结果 以手术病理为标准,LAVA增强检查判断内膜癌Ⅰa、Ⅰb、Ⅱ期的敏感性、特异性、准确性分别为93.2％、77.8％、100.0％,83.3％、93.6％、100.0％,91.1％、91.1％、100.0％.G1、G2、G3级内膜癌平均ADC值分别为(0.78±0.14)× 10-3mm2/s、(0.64±0.06)×10-3mm2/s、(0.40±0.09)×10-3mm2/s,三者间两两比较差异均有统计学意义(P＜0 01).结论 3.0TMR 3DLAVA动态增强检查对Ⅰ、Ⅱ期子宫内膜癌的分期有较高的价值；测量ADC值对鉴别不同病理级别内膜癌有潜在价值,级别越高,ADC值趋于越低.

Evaluation of Pathological Stage and Grade of Endometrial Carcinoma Using MRI Three-dimensional Dynamic Contrast-enhanced and Diffusion Weighted Imaging

Purpose To investigate the value of 3.0T MR three-dimensional (3D) liver acquisition with volume acceleration (LAVA) dynamic contrast-enhanced imaging in evaluating the pathological stage of endometrial carcinoma,and to analyze apparent diffusion coefficient (ADC) values of endometrial carcinoma at different pathological grades.Materials and Methods MR images of 73 patients with endometrial carcinoma at stage Ⅰand Ⅱ proved pathologically were retrospectively reviewed.The sensitivity,specificity and accuracy of LAVA contrastenhanced imaging in staging carcinoma at stage Ⅰa,Ⅰb and Ⅱ (2009 FIGO staging standard) were evaluated respectively.The ADC values of endometrial carcinoma among groups at different pathological grades were also compared.Results On the basis of postoperative pathology results,the sensitivity,specificity and accuracy of LAVA contrast-enhanced imaging in staging carcinoma at stageⅠa,Ⅰb and Ⅱ were 93.2%,77.8%,100.0%;83.3%,93.6%,100.0%;91.1%,91.1%,100.0%,respectively.The mean ADC values of endometrial carcinoma in G1,G2 and G3 were (0.78±0.14)×10-3 mm 2 /s,(0.64±0.06)×10-3 mm 2 /s,(0.40±0.09)×10-3 mm 2 /s,respectively.There were statistical difference in ADC values among the groups at different pathological grades (P < 0.01).Conclusion 3.0T MR 3D LAVA dynamic contrast-enhanced imaging has considerable value in endometrial carcinoma at stage Ⅰand Ⅱ.Measuring ADC values has a potential ability to differentiate pathological grades.ADC value of high grade tumor tends to be lower.