陈苑,程敬亮,白洁,张勇,薛康康,张春艳.DWI及动态增强MRI鉴别诊断Ⅰa期子宫内膜癌与子宫内膜息肉[J].中国医学影像技术,2017,33(1):70~74
DWI及动态增强MRI鉴别诊断Ⅰa期子宫内膜癌与子宫内膜息肉
DWI and dynamic contrast-enhanced MRI in differential diagnosis of stage-Ⅰ a endometrial carcinomas and endometrial polyps
投稿时间:2016-07-08  修订日期:2016-11-29
DOI:10.13929/j.1003-3289.201607038
中文关键词:  子宫内膜肿瘤  磁共振成像  表观扩散系数  动态增强
英文关键词:Endometrial neoplasms  Magnetic resonance imaging  Apparent diffusion coefficient  Dynamic contrast-enhanced
基金项目:河南省科技厅重点攻关项目(112102310703)。
作者单位E-mail
陈苑 郑州大学第一附属医院磁共振科, 河南 郑州 450052  
程敬亮 郑州大学第一附属医院磁共振科, 河南 郑州 450052 cjr.chjl@vip.163.com 
白洁 郑州大学第一附属医院磁共振科, 河南 郑州 450052  
张勇 郑州大学第一附属医院磁共振科, 河南 郑州 450052  
薛康康 郑州大学第一附属医院磁共振科, 河南 郑州 450052  
张春艳 郑州大学第一附属医院磁共振科, 河南 郑州 450052  
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中文摘要:
      目的 探讨DWI及动态增强MRI(DCE-MRI)鉴别诊断Ⅰa期子宫内膜癌与子宫内膜息肉的价值。方法 回顾性分析经本院病理证实、并接受DWI及DCE-MRI检查的60例Ⅰa期子宫内膜癌和38例子宫内膜息肉患者资料。分析并比较病变的ADC、相对表观扩散系数(rADC)、达峰时间(TTP)、最大增强对比率(MCER)、90 s与60 s增强对比率差(ER90 s-60 s)和时间-信号强度曲线(TIC)类型。评价DWI和DCE-MRI鉴别Ⅰa期子宫内膜癌与子宫内膜息肉的效能。结果 Ⅰa期子宫内膜癌与子宫内膜息肉的ADC[(0.76±0.17)×10-3 mm2/s vs(1.33±0.20)×10-3 mm2/s]、rADC(0.58±0.07 vs 1.02±0.13)、TTP[(76.47±13.37)s vs(101.86±14.62)s]、MCER[(119.48±42.51)% vs(178.32±88.24)%]、ER90 s-60 s[(7.12±14.15)% vs(44.67±27.99)%]差异均有统计学意义(P均<0.05)。ROC曲线分析显示,鉴别Ⅰa期子宫内膜癌与子宫内膜息肉的ADC、rADC、TTP、MCER及ER90 s-60 s阈值分别为0.904×10-3 mm2/s、0.74、81.5 s、159.01%和19.25%,曲线下面积(AUC)分别为0.984、1.000、0.966、0.718和0.937。60例Ⅰa期子宫内膜癌中,Ⅰ型TIC 26例,Ⅱ型31例,Ⅲ型3例;38例子宫内膜息肉中,Ⅱ型TIC 9例,Ⅲ型29例,二者差异有统计学意义(χ2=57.167,P<0.001)。结论 DWI及DCE-MRI在Ⅰa期子宫内膜癌和子宫内膜息肉的鉴别诊断中具有重要价值,ADC、rADC、TTP、MCER、ER90 s-60 s可作为有效的定量指标。
英文摘要:
      Objective To explore the value of DWI and dynamic contrast-enhanced MRI (DCE-MRI) in differential diagnosis of stage-Ⅰ a endometrial carcinomas and endometrial polyps. Methods A total of 60 cases of stage-Ⅰ a endometrial carcinomas and 38 cases of endometrial polyps confirmed by pathology were analyzed retrospectively. All of patients underwent DWI and DCE-MRI. The ADC, relative ADC (rADC), time to peak (TTP), maximum contrast enhancement ratio (MCER), difference value of contrast enhancement ratio between 90 s and 60 s (ER90 s-60 s) and time-intensity curves (TIC) types were measured and compared between stage-Ⅰ a endometrial carcinomas and endometrial polyps. The diagnostic efficacy of DWI, DCE-MRI in distinguishing stage-Ⅰ a endometrial carcinomas and endometrial polyps were evaluated. Results The ADC value ([0.76±0.17]×10-3 mm2/s), rADC value (0.58±0.07), TTP ([76.47±13.37]s), MCER ([119.48±42.51]%) and ER90 s-60 s ([7.12±14.15]%) of stage-Ⅰa endometrial carcinomas were statistically different from the ADC value ([1.33±0.20]×10-3 mm2/s), rADC value (1.02±0.13), TTP ([101.86±14.62]s), MCER ([178.32±88.24]%) and ER90 s-60 s ([44.67±27.99]%) of endometrial polyps. The cut-off value of ADC, rADC, TTP, MCER and ER90 s-60 s were 0.904×10-3 mm2/s, 0.74, 81.5 s, 159.01% and 19.25% respectively in differential diagnosis of stage-Ⅰa endometrial carcinomas and endometrial polyps. The AUC were 0.984, 1.000, 0.966, 0.718 and 0.937 respectively. There were 26 typeⅠ, 31 typeⅡ and 3 type Ⅲ TICs in stage-Ⅰa endometrial carcinomas. There were 9 type Ⅱ and 29 type Ⅲ TICs in endometrial polyps. There was statistically significant difference between the two groups (χ2=57.167, P<0.001). Conclusion DWI and DCE-MRI are of high diagnostic value in differential diagnosis of stage-Ⅰ a endometrial carcinomas and endometrial polyps. The ADC, rADC, TTP, MCER, and ER90 s-60 s can be used as quantitative parameters effectively.
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