Dynamic Enhanced MRI in the Diagnosis of Endometrial Carcinoma_West China Medical Journal

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Department of Radiology, Sichuan Cancer Hospital, Chengdu, Sichuan 610041, P.R.China;

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Keywords：

子宫内膜肿瘤; 动态增强扫描; 磁共振成像

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【摘要】目的 探讨MRI动态增强扫描在子宫内膜癌手术前诊断中的价值。方法回顾分析2008年2月-2010年3月38例经手术病理证实为子宫内膜癌患者的动态增强MRI检查资料，判断内膜癌子宫肌层和宫颈浸润情况，与病理结果对照，计算T2WI及动态增强序列诊断肌层及宫颈浸润的敏感度、特异度、准确度等，分析两种序列诊断准确度有无差异；计算内膜癌组织与子宫肌层在动态增强各期的对比信噪比，并分析其在各期间有无差异。结果动态增强序列诊断内膜癌肌层和宫颈受侵的敏感度、特异度、阳性预测值、阴性预测值分别为96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；动态增强序列诊断内膜癌深肌层浸润的准确度为94.7%，显著高于T2WI诊断深肌层浸润的准确度78.9%（P lt;0.05）；平衡期内膜癌组织与子宫肌层的对比信噪比显著高于动脉期和静脉期（P lt;0.01）。结论 MRI动态增强扫描能够在手术前准确的判断内膜癌肌层及宫颈浸润，有助于子宫内膜癌治疗方式的选择。
【Abstract】 Objective To investigate the role of dynamic-enhanced MRI in the diagnosis of endometrial carcinoma. Methods Thirty-eight patients with endometrial carcinoma confirmed by surgicopathology undergone dynamic-enhanced MRI scans were analyzed retrospectively. The invasion in myometrium and uterine cervix were analyzed. The tumor and myometrium contrast-to-noise ratios during different phases of dynamic imaging were calculated. MR imaging findings were compared with pathologic findings. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values of MR imaging in depicting myometrial and cervical infiltration were calculated. Results Respective sensitivity, specificity, and positive and negative predictive values in assessing myometrial infiltration were 968%,85.7%,96.8%,85.7%;those for cervical infiltration were 85.7%,91.7%,85.7%,91.7%,respectively. The diagnostic accuracy (94.7%) of dynamic imaging in depicting deep myometrial infiltration were significantly higher than that of T2WI (78.9%) (P lt;0.05).There was a significant improvement in tumor and myometrium contrast-to-noise ratios during the equilibrium phase compared with the arterial and venous phases (P lt;0.01). Conclusion Dynamic-enhanced MRI is highly accurate in preoperative diagnosis of endometrial carcinoma, which will benefit for the treat of endometrial carcinoma.

Citation： CHEN Jinxiu,REN Jing,WANG Min,LIU Jin,DONG Xiaolei,ZUO Jiaming. Dynamic Enhanced MRI in the Diagnosis of Endometrial Carcinoma. West China Medical Journal, 2010, 25(9): 1676-1679. doi: Copy

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13.	Frei KA, Kinkel K, Bonel HM, et al. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta analysis and Bayesian analysis[J]. Radiology, 2000, 216(2): 444-449.
14.	Manfredi R, Mirk P, Maresca G, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning[J]. Radiology, 2004, 231(2): 372-378.
15.	Seki H, Kimura M, Sakai K. Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images[J]. Clin Radiol, 1997, 52(1): 18-23.
16.	Yamashita Y, Harada M, Sawada T, et al. Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging[J]. Radiology, 1993, 186(2): 495-501.
17.	Nakao Y, Yokoyama M, Hara K, et al. MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion[J]. Gynecol Oncol, 2006, 102(2): 343-347.
18.	Sala E, Crawford R, Senior E, et al. Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma[J]. Int J Gynecol Cancer, 2009, 19(1): 141-146.
19.	Seki H, Takano T, Sakai K. Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix [J]. Am J Roentgenol, 2000, 175(1): 171-176.
20.	Nagar H, Dobbs S, Mc Clelland HR, et al. The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer [J]. Gynecol Oncol, 2006, 103(2): 431-434.

1. Jemal A, Siegel R, Ward E, et al. Cancer statistics 2007[J]. CA Cancer J Clin, 2007, 57(1): 43-66.
2. Frei KA, Kinkel K. Staging endometrial cancer: role of magnetic resonance imaging[J]. J Magn Reson Imaging, 2001, 13(6): 850-855.
3. Zuurendonk LD, Smit RA, Mol BW, et al. Routine pelvic lymphadenectomy in apparently early stage endometrial cancer[J]. Eur J Surg Oncol, 2006, 32(4): 450-454.
4. 印隆林, 宋彬, 邓开鸿. MRI 3D-VIBE在梗阻性胆道病变中的应用[J]. 华西医学, 2005, 20(4): 784-785.
5. Akaeda T, Isaka K, Takayama M, et al. Myometrial invasion and cervical invasion by endometrial carcinoma: evaluation by CO2-volumetric interpolated breathhold examination (VIBE)[J]. J Magn Reson Imaging, 2005, 21(2): 166-171.
6. Barwick TD, Rockall AG, Barton DP, et al. Imaging of endometrial adenocarcinoma[J]. Clin Radiol, 2006, 61(7): 545-555.
7. Boronow RC, Morrow CP, Creasman WT, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study[J]. Obstet Gynecol, 1984, 63(6): 825-832.
8. Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer: a gynecologic oncology group study[J]. Cancer, 1987, 60 (Suppl 8): 2035-2041.
9. Kitchner H, Redman CW, Swart AW, et al. A study in the treatment of endometrial carcinoma: a randomised trial of lymphadenectomy in the treatment of endometrial carcinoma[J]. Gynecol Oncol, 2006, 101(Suppl): 21-22.
10. 纪瑞云, 高楠, 李扬, 等. 116例早期子宫内膜癌临床分析[J]. 中国肿瘤临床, 2009, 36(16): 917-919.
11. Eltabbakh GH, Shamonki MI, Moody JM, et al. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma[J]. Cancer, 2001, 91(2): 378-387.
12. Kinkel K, Kaji Y, Yu KK, et al. Radiologic staging in patients with endometrial cancer: a meta-analysis[J]. Radiology, 1999, 212(3): 711-718.
13. Frei KA, Kinkel K, Bonel HM, et al. Prediction of deep myometrial invasion in patients with endometrial cancer: clinical utility of contrast-enhanced MR imaging-a meta analysis and Bayesian analysis[J]. Radiology, 2000, 216(2): 444-449.
14. Manfredi R, Mirk P, Maresca G, et al. Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning[J]. Radiology, 2004, 231(2): 372-378.
15. Seki H, Kimura M, Sakai K. Myometrial invasion of endometrial carcinoma: assessment with dynamic MR and contrast-enhanced T1-weighted images[J]. Clin Radiol, 1997, 52(1): 18-23.
16. Yamashita Y, Harada M, Sawada T, et al. Normal uterus and FIGO stage I endometrial carcinoma: dynamic gadolinium-enhanced MR imaging[J]. Radiology, 1993, 186(2): 495-501.
17. Nakao Y, Yokoyama M, Hara K, et al. MR imaging in endometrial carcinoma as a diagnostic tool for the absence of myometrial invasion[J]. Gynecol Oncol, 2006, 102(2): 343-347.
18. Sala E, Crawford R, Senior E, et al. Added value of dynamic contrast-enhanced magnetic resonance imaging in predicting advanced stage disease in patients with endometrial carcinoma[J]. Int J Gynecol Cancer, 2009, 19(1): 141-146.
19. Seki H, Takano T, Sakai K. Value of dynamic MR imaging in assessing endometrial carcinoma involvement of the cervix [J]. Am J Roentgenol, 2000, 175(1): 171-176.
20. Nagar H, Dobbs S, Mc Clelland HR, et al. The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer [J]. Gynecol Oncol, 2006, 103(2): 431-434.

West China Medical Journal

Dynamic Enhanced MRI in the Diagnosis of Endometrial Carcinoma

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