磁共振成像对子宫内膜癌浸润深度诊断价值的研究
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摘要
目的:探讨磁共振(MRI)在评估子宫内膜癌浸润深度方面的应用价值。方法:回顾性分析术前行MRI检查,术后经病理证实的子宫内膜癌患者46例。应用SPSS 13.0统计学软件分析:1)MRI对子宫内膜癌不同浸润深度的敏感性、特异性、准确性;2)结合带完整和部分中断对评价肌层有无浸润的价值。结果:1)MRI观察子宫内膜癌浸润深度:局限于内膜8例,浸润浅肌层19例,浸润深肌层12例,突破浆膜7例。与病理结果对照,MRI对肿瘤局限于内膜的敏感性、特异性、准确性分别为75%、94.7%和91.3%,浸润浅肌层的敏感性、特异性、准确性分别为80%、88.5%和84.8%,浸润深肌层的敏感性、特异性、准确性分别为81.8%、91.4%和89.1%,突破浆膜的敏感性、特异性、准确性分别为71.4%、94.9%和91.3%;2)以MRI检查T2WI中结合带完整作为肿瘤局限于内膜的标准,与相应的病理结果对照,其敏感性为75%、特异性92. 6%、准确性88.6%、阳性预测值75%、阴性预测值92.6%;3)结合带部分中断作为肿瘤浸润肌层的标准,与相应的病理结果对照,其敏感性、特异性、准确性、阳性预测值、阴性预测值分别为92.6%、75%、88.6%、92.6%、75%。结论:MRI对子宫内膜癌浸润深度的判定具有很高的价值,有助于准确临床分期,从而更好地指导临床医师选择合适的治疗方案。
Objective:To evaluate the value of MR imaging in the assessment of invasion in endometrial carcinoma.Methods:The data of 46 patients with endometrial carcinoma proved by postoperative pathology were retrospectively reviewed.all patients underwent conventional MRI examination Preoperatively .Compared with the results of pathology, The sensitivity, specificity and accuracy respectively of MRI in evaluation the invasion in endometrial carcinoma determined by MRI were analyzed .Result:1)Based on MR image, the tumor was confined to the endometrium in 8 patients, superficial myomentrial invasion in19, deep-myometrial invasion in 12 and having penetrated the serosa in 7.Compared with postoperative pathology results, the incidence of sensitivity, specificity and accuracy of MRI assessment for tumor confined to endometrial was 75%?94.7%and 91.3%, respectively.to superficial myometrial invasion:80%?88.5%and 84.8%, respectively.to deep-myometrial invasion: 81.8% ? 91.4%and 89.1%, respectively.to tumor having penetrated the serosa: 71.4%?94.9%and 91.3% respectively.2)Based on intact junctional zone as the criterion of tumor confined to endometrium, the sensitivity, specificity, accuracy, positive and negative predictive value was 75%?92.6%?88.6%?75%?92.6%, respectively .3)Based on the interruption of junctional zone as the criterion of tumor having involved the myometrium, the sensitivity, specificity, accuracy, positive and negative predictive value was 92.6% ? 75% ? 88.6% ? 92.6% ? 75%, respectively Conclusion:MRI is one of valuable methods in the assessment of the invasion in endometrial carcinoma, and could plays an important role for the clinical in selecting proper therapy.
Objective:To evaluate the value of MR imaging in the assessment of invasion in endometrial carcinoma.Methods:The data of 46 patients with endometrial carcinoma proved by postoperative pathology were retrospectively reviewed.all patients underwent conventional MRI examination Preoperatively .Compared with the results of pathology, The sensitivity, specificity and accuracy respectively of MRI in evaluation the invasion in endometrial carcinoma determined by MRI were analyzed .Result:1)Based on MR image, the tumor was confined to the endometrium in 8 patients, superficial myomentrial invasion in19, deep-myometrial invasion in 12 and having penetrated the serosa in 7.Compared with postoperative pathology results, the incidence of sensitivity, specificity and accuracy of MRI assessment for tumor confined to endometrial was 75%?94.7%and 91.3%, respectively.to superficial myometrial invasion:80%?88.5%and 84.8%, respectively.to deep-myometrial invasion: 81.8% ? 91.4%and 89.1%, respectively.to tumor having penetrated the serosa: 71.4%?94.9%and 91.3% respectively.2)Based on intact junctional zone as the criterion of tumor confined to endometrium, the sensitivity, specificity, accuracy, positive and negative predictive value was 75%?92.6%?88.6%?75%?92.6%, respectively .3)Based on the interruption of junctional zone as the criterion of tumor having involved the myometrium, the sensitivity, specificity, accuracy, positive and negative predictive value was 92.6% ? 75% ? 88.6% ? 92.6% ? 75%, respectively Conclusion:MRI is one of valuable methods in the assessment of the invasion in endometrial carcinoma, and could plays an important role for the clinical in selecting proper therapy.
引文
[1]张继斌,许建铭等?子宫内膜癌的MRI诊断及分期研究[J].临床放射学杂志, 2004, 23:135-137?
[2]隋邦森,吴恩惠,陈雁冰,主编.磁共振诊断学[M].北京:人民卫生出版社, 2004, 27
[3]张逊.子宫内膜癌的现状及发展趋势[J].中华肿瘤杂志, 2004, 26(11): 641-644
[4]汤钊猷,主编.现代肿瘤学[M].上海:上海医科大学出版社, 2006, 660
[5] Sivridis, Buckley CH, Fox H. type I and type II estropen and progesterone binding sites in endometrial carcinomas: their value in predicting survival. int [J]. Gynecol Cancer. 2003, 3(2):80-88
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[7] Liapi E, Kamel IR, Bluemke DA, et al. Assessment of response of uterine fibroids and myometrium to embolization using diffusion weighted echo planar MR imaging [J]. J Comput Assist Tomogr 2005, 29 (1) :83-86
[8]王立侠,欧阳汉.磁共振成像在子宫内膜癌诊断和分期中的应用[J].中国医学影像技术, 2004, 20 (6) :967-970
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[10] Palter SF, Oliver DL. Uterine cancer. Berek JS, ed. Novak’s, gynecology [M]. 12 th ed. Baltimore, Md : Williams & wilkins, 2006: 1057 - 1085.
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[14] Noguchi K, Ogawa T, Inugami A, et al. Acute subarachnoid hemorrhage: MR imaging with fluid2attenuated inversion recovery pulse sequence[J]. Radiology, 2005, 196 :773
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[23] Scoutt LM, McCarthy SM, Flynn SD, et al. Clinical stage I endometrial carcinoma :pitfalls in preoperative assessment with MR imaging : work in progress[J]. Radiology, 2005, 194:567~572
[24] Sugahara T, Korogi Y, Kochi M, et al. Usefulness of diffusion weighted MRI with echo planar technique in the evaluation of ceularity in gliomas [J]. Magn Reson Imaging, 2004, 9 (1) :532-602
[1]张继斌,许建铭等?子宫内膜癌的MRI诊断及分期研究[J].临床放射学杂志, 2004, 23:135-137?
[2]霍福涛,颜小琼.子宫内膜癌的诊断[J].国外医学放射学分册, 2005, 18:325-327.
[3] Klingele CJ, Ellerkmann M. Advanced diagnostic testing for pelvic floor function[J]. Pelvic Medicine Surgery, 2004, 10 :139 -154
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[5] Fielding F R, Practical MR. imaging of female pelvic floor weakness[J]. Radio graphs, 2002, 22 :295-304
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[2]隋邦森,吴恩惠,陈雁冰,主编.磁共振诊断学[M].北京:人民卫生出版社, 2004, 27
[3]张逊.子宫内膜癌的现状及发展趋势[J].中华肿瘤杂志, 2004, 26(11): 641-644
[4]汤钊猷,主编.现代肿瘤学[M].上海:上海医科大学出版社, 2006, 660
[5] Sivridis, Buckley CH, Fox H. type I and type II estropen and progesterone binding sites in endometrial carcinomas: their value in predicting survival. int [J]. Gynecol Cancer. 2003, 3(2):80-88
[6] Moteki T, Ishizaka H. Diffusion2weighted EPI of cystic ovarian le sions : evaluation of cystic content s using apparent diffusion coefficient [J]. J Magn Reson Imaging, 2006, 12 (6) :1014-1019
[7] Liapi E, Kamel IR, Bluemke DA, et al. Assessment of response of uterine fibroids and myometrium to embolization using diffusion weighted echo planar MR imaging [J]. J Comput Assist Tomogr 2005, 29 (1) :83-86
[8]王立侠,欧阳汉.磁共振成像在子宫内膜癌诊断和分期中的应用[J].中国医学影像技术, 2004, 20 (6) :967-970
[9] Brown HK, Stoll BS, Nicosia SV, et al. Uterine junctional zone : correlation between histologic findings and MR imaging[J]. Radi ology, 2005, 179 (2) :409-413
[10] Palter SF, Oliver DL. Uterine cancer. Berek JS, ed. Novak’s, gynecology [M]. 12 th ed. Baltimore, Md : Williams & wilkins, 2006: 1057 - 1085.
[11] Goodman A. premalignant and malignant disorders of the uterine corpus. in Decherneny AH, pernoll ML[M]. ed. current obstetric and gynecologic diagnosis and treatment, 8th ed. norwalk, ct: Appleton & lange, 2007. 937-953.
[12]陈亦乐,王静等?子宫内膜癌疗效分析[J].中华肿瘤杂志, 1997, 19:292?
[13] Hardesty LA, Sumkin JH, Hakim C, et al. The ability of CT to pre operatively stage endometrial carcinoma [J]. AJR Am J Roentagenol, 2006, 176:603—606.
[14] Noguchi K, Ogawa T, Inugami A, et al. Acute subarachnoid hemorrhage: MR imaging with fluid2attenuated inversion recovery pulse sequence[J]. Radiology, 2005, 196 :773
[15] Yazigi R, Cohen J, Munoz AK, et al. Magnetic resonance imaging determination of myometrial invasion in endometrial carcinoma[J]. Gynecol Oncol, 2005, 34:94~97
[16] Chen S, Ikawa F, Kurisu K. Quantitative MR evaluation of int racranial epidermoid tumors by fast fluid2attenuated inversion re covery imaging and echo planar diffusion weighted imaging[J]. Am J Neuroradiol, 2004, 22 (6) :1089-1096
[17] Rosal J.女性生殖道病理学[M].回允中译.北京:北京大学医学出版社, 2005: 241-264
[18] Brown HK, Stoll BS, Nieosia SV, et a1. Uterine junctional zone: correlation between histology findings and MR imaging[J]. Radiology, 2001, 179(2):409—413
[19] Seki H, Takano T, Sakai K. Value of dynamic MR imaging in assessment endometrial carcinoma involvement of the cervix[J]. AJR, 2000, 175(1):171—176
[20] Savci G, Ozyaman T, Tutar M, et al. Assessment of depth of myometrial invasion by endometrial carcinoma : comparison of T2~weighted SE and contrast~enhanced dynamic GRE MR imaging [J]. Eur Radiology, 2006, 8:218~223
[21] Yamashita Y, Tang Y, Takahashi M, et al. Ultra fast MR imaging of the abdomen: echo planar imaging and diffusion weighted imaging [J]. Magn Reson Imaging, 2004, 8 ( 2) : 367- 374
[22] Pruessmann K P, Weiger M, Scheidegger M B, et al. SENSE: sensitivity encoding for fast MRI [J]. Magn Reson Med, 2001, 42( 5) : 952- 962.
[23] Scoutt LM, McCarthy SM, Flynn SD, et al. Clinical stage I endometrial carcinoma :pitfalls in preoperative assessment with MR imaging : work in progress[J]. Radiology, 2005, 194:567~572
[24] Sugahara T, Korogi Y, Kochi M, et al. Usefulness of diffusion weighted MRI with echo planar technique in the evaluation of ceularity in gliomas [J]. Magn Reson Imaging, 2004, 9 (1) :532-602
[1]张继斌,许建铭等?子宫内膜癌的MRI诊断及分期研究[J].临床放射学杂志, 2004, 23:135-137?
[2]霍福涛,颜小琼.子宫内膜癌的诊断[J].国外医学放射学分册, 2005, 18:325-327.
[3] Klingele CJ, Ellerkmann M. Advanced diagnostic testing for pelvic floor function[J]. Pelvic Medicine Surgery, 2004, 10 :139 -154
[4] Corton MM. Anatomy of the pelvis :how the pelvis is built for support Berstchinger[J] Clinical Obstetrics and Gynecology, 2005, 48 :611-626
[5] Fielding F R, Practical MR. imaging of female pelvic floor weakness[J]. Radio graphs, 2002, 22 :295-304
[6] Dealmeida FG, Rodriguez LV, Raz S. Magnetic resonance imaging in diagnosis of pelvic floor disorders[J]. International Radiology, 2002, 28 :553-559
[7] Berstchinger KM, Hetzer FH, Roos JE, et al. Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patients up in closed-magnet unit[J]. Radiology, 2007, 223 :501-508.
[8] Sivridise, Buckley CH, Fox H. type I and type II estropen and progesterone binding sites in endometrial carcinomas: their value in predicting survival[J]. int J Gynecol Cancer. 2003, 3(2):80-88
[9] Mathis JM. Percutenous vertebroplasty:complication avoidance and technique optimization[J]. AJNR, 2003, 24(8):1697-1706
[10] Miklos JR, Moore RD, Kohli N. Laparoscopic surgery for pelvic support defects[J]. Current Opinion in Obstetric sand Gyn ecology, 2006, 14 :387-395
[11] Hyslop W B, Semelka R C. Future directions in body magnetic resonance imaging[J]. Top Imaging, 2003, 14 :387-395
[12]包如迪,吴爱如,欧阳汉,等.磁共振成像在子宫内膜癌诊断和分期中的作用[J].中华妇产科杂志, 1995, 30 4 :215-217
[13] Kinkel k, kaji Y, Yu KK, et al. Radiologic staging in patients with endometrial cancer :a meta-analysis[J]. Radiology, 2004, 212(3):711 -718.
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