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：

子宮內膜腫瘤; 動態增強掃描; 磁共振成像

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【摘要】目的 探討MRI動態增強掃描在子宮內膜癌手術前診斷中的價值。方法回顧分析2008年2月-2010年3月38例經手術病理證實為子宮內膜癌患者的動態增強MRI檢查資料，判斷內膜癌子宮肌層和宮頸浸潤情況，與病理結果對照，計算T2WI及動態增強序列診斷肌層及宮頸浸潤的敏感度、特異度、準確度等，分析兩種序列診斷準確度有無差異；計算內膜癌組織與子宮肌層在動態增強各期的對比信噪比，并分析其在各期間有無差異。結果動態增強序列診斷內膜癌肌層和宮頸受侵的敏感度、特異度、陽性預測值、陰性預測值分別為96.8%、85.7%、96.8%、85.7%和85.7%、91.7%、85.7%、91.7%；動態增強序列診斷內膜癌深肌層浸潤的準確度為94.7%，顯著高于T2WI診斷深肌層浸潤的準確度78.9%（P lt;0.05）；平衡期內膜癌組織與子宮肌層的對比信噪比顯著高于動脈期和靜脈期（P lt;0.01）。結論 MRI動態增強掃描能夠在手術前準確的判斷內膜癌肌層及宮頸浸潤，有助于子宮內膜癌治療方式的選擇。
【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, 鄧開鴻. MRI 3D-VIBE在梗阻性膽道病變中的應用[J]. 華西醫學, 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. 紀瑞云, 高楠, 李揚, 等. 116例早期子宮內膜癌臨床分析[J]. 中國腫瘤臨床, 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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