MR I测量子宫结合带厚度对预测子宫内膜异位症的价值

目的：探讨 MRI测量子宫结合带(JZ)厚度在子宫内膜异位症(内异症)诊断中的价值。方法回顾分析42例卵巢良性肿瘤患者的临床资料,根据术中所见和/或病理检查结果将其分为内异症组(21例)和非内异症组(21例),并依照改良的美国生殖医学协会内异症(r-AFS)分期系统进一步将内异症组分为轻中度(Ⅰ~Ⅲ期)内异症组(10例)和重度(Ⅳ期)内异症组(11例)。测量所有患者 MRI图像上各 JZ 数据,包括最大 JZ 厚度(JZmax)、最小 JZ 厚度(JZmin)、JZmax 径线上总肌层厚度(JZmaxM)、JZmax-JZmin(JZdif)、JZmax/JZmin、JZmax/JZmaxM和JZmin/JZmaxM。采用t检验比较内异症组与非内异症组,轻中度内异症组与重度内异症组之间各JZ数据的差异；采用受试者工作特征曲线(ROC)分析术前 MRI结果和各JZ数据对内异症的诊断效能。结果内异症组JZmax(P<0.05)、JZdif和JZmax/JZmin(P 值均<0.01)显著高于非内异症组；轻中度内异症组和重度内异症组间各JZ数据无统计学差异；在内异症诊断中,术前 MRI结果的敏感度61.9%,特异度90.5%；JZdif界值点取4.50时,敏感度89.5%,特异度71.4%,JZmax/JZmin界值点取2.42时,敏感度90.5%,特异度71.4%。结论 MRI图像上JZ 增厚可提示内异症,不能预示内异症严重程度；当JZdif≥4.5 mm或JZmax/JZmin≥2.42时手术医生需注意筛查内异症。

Value of uterine j unctional zone thickness in diagnosing of endometriosis:an MRI study

Objective To investigate the value of uterine junctional zone (JZ)thickness in diagnosing endometriosis (EMS)by MRI.Methods A total of 42 female patients with benign ovarian tumors were analyzed retrospectively.Based on the laparoscopic and/or pathological examination results,the patients were divided into the EMS group (2 1 cases)and non-EMS group (2 1 cases), then the EMS group was further divided into the mild to moderate (stage Ⅰ-Ⅲ)EMS group (10 cases)and the severe (stage Ⅳ) EMS group (1 1 cases)based on the revised American Fertility Society (r-AFS)classification.Using MRI,all of the JZ values,in-cluding the maximum and minimum JZ thickness (JZmax,JZmin),total myometrial thickness of JZmax (JZmaxM),difference between JZmax and JZmin (JZdif),JZmax/JZmin,JZmax/JZmaxM and JZmin/JZmaxM were measured.T-test was used to analyze all the JZ values between the EMS group and non-EMS group,as well as the mild to moderate EMS group and the severe EMS group.The receiver operating characteristic (ROC)curve was used to assess the preoperative MRI results and the JZ values diagnosing EMS. Results The values of JZmax (P<0.05),JZdif and JZmax/JZmin (P<0.01,respectively)were significantly higher in the EMS group than those in the non-EMS group.No JZ values showed any difference between the mild to moderate EMS group and the severe EMS group.The sensitivity and specificity of preoperative MRI results were 61.9% and 90.5%,respectively.Using JZdif and JZmax/JZmin of 4.50 and 2.42 respectively as the ROC cut-off points,the diagnostic sensitivities were 89.5% and 90.5%,respectively,and the specificities were both 7 1 .4%.Conclusion The thickened JZ on MRI image is associated with EMS,irrelevant to the severity of EMS. If JZdif≥4.5 mm or JZmax/JZmin≥2.42,the surgeons should be aware of EMS in laparoscopy.