MR弥散加权成像在子宫内膜良恶性病变中的鉴别价值

目的 探讨MR弥散加权成像(DWI)及其表观弥散系数(ADC)在子宫内膜良恶性病变中的鉴别价值.方法 回顾性分析55例经病理证实的子宫内膜病变,其中良性组14例(6例内膜增生、8例内膜息肉),恶性组41例(39例内膜癌、2例癌肉瘤).所有病例行常规MRI平扫和增强检查,以及DWI(弥散敏感因子b值为0、1000s/mm2),分析病变的DWI信号特点和测定ADC值.结果 良性组DWI图12例表现为稍高信号、2例表现为等信号、平均ADC值为(1.34±0.19)×103mm2/s;恶性组DWI图34例表现为明显高信号,余下7例表现为稍高信号,平均ADC值为(0.84±0.14)×103 mm2/s；恶性组ADC值明显小于良性组(P=0.042),以1.07×103 mm2/s为临界值诊断子宫内膜良恶性病变的敏感性、特异性、准确性高达92.9％、97.6％、96.4％.结论 DWI及ADC值测定有助于子宫内膜良恶性病变的鉴别诊断.

Differential value of MR diffusion weighted imaging in the evaluation between benign and malignant endometrial lesion

Objective To evaluate differences in application value of diffusion-weighted imaging （DWI） and apparent dif- fusion coefficient （ADC） values for benign versus malignant endometrial lesion. Methods The endometrial lesion of 55 pa- tients confirmed by pathology were analyzed retrospectively, in which benign group was 11 cases （6 cases of endometrial hyperplasia, 8 cases of endometrial polyp）, the malignant group was 41 cases （39 cases of endometrial cancer, 2 cases of sarcocarcinoma）. All cases were performed conventional MRI, the enhancement scan, and DWI with b values of 0 and 1000 s/mm2. We then analyzed the signal characteristic of the disease on DWI map, measured ADC values. Results The DWI map of 12 cases in benign group showed slightly high signal, the other 2 cases showed equal signal, the mean ADC value was （1.34±0.19）×10^3mm2/s. The DWI map of 34 cases in malignant group showed obviously high signal, the other 7 cases showed slightly high signal, the mean ADC value was （0.84±0.14） ×10^3mm2/s. Mean ADC values of ma- lignant group were significantly lower than those of the benign group （ P =0. 042）. A cutoff ADC value of 1.07 ×10^3mm2/s for differenting benign versus malignat endometrial lesion was associated with 92.9 % sensibility, 97.6 % specificity and 96.4% accuracy. Conclusion DWI and ADC values for differenting benign versus malignant endometrial lesion were found to be significantly useful.