3.0T MRI联合带厚度指标对子宫腺肌症的诊断价值及ROC曲线分析
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摘要
目的利用ROC曲线分析3.0T MRI联合带(the junctional zone,JZ)厚度指标在子宫腺肌症的应用价值。方法回顾性分析经病理或临床综合证实的51例子宫腺肌症患者与80例正常对照者的3.0T MRI子宫联合带厚度及信号特点。2组均于T2WI压脂矢状位上,测出JZ厚度的最大值(JZmax)和最小值(JZmin),并通过ROC曲线分析评估3.0T MRI诊断子宫腺肌症的最佳JZ厚度截点。结果 51例腺肌症患者,JZ弥漫或局限性增厚,JZ厚度测量最大值(JZmax)及测量最小值(JZmin)均大于正常对照组,差异有统计学意义(P<0.01)。利用ROC曲线分析,JZ厚度测量最大值(JZmax)及最小值(JZmin)在诊断子宫腺肌症均有较高价值,曲线下面积分别为0.997、0.838,且JZmax较JZmin诊断价值高,曲线下面积有统计学差别(P<0.01)。JZmax区分正常与腺肌症的最佳厚度截点为10.4 mm,其敏感度、特异度、阳性预测值、阴性预测值及95%的可信区间分别为98.7(93.2~100.0),96.1(86.5~99.5),97.5(91.4~99.7),98.0(89.4~99.9)。JZmin区分正常与腺肌症的最佳厚度截点为3.4 mm,其敏感度、特异度、阳性预测值、阴性预测值及95%的可信区间分别为73.7(62.7~83.0),76.5(62.5~87.2),83.1(72.3~91.0),65.0(51.6~76.9)。腺肌症组51例患者,50例增厚区可见条或片状T2WI压脂高信号,18例JZ增厚区见小片状T1WI高信号。正常组80例JZ均呈较均匀T2WI压脂低信号,未见明确异常信号。结论 3.0T MRI示子宫腺肌症患者联合带(The Junctional zone,JZ)厚度及信号的变化,并通过ROC曲线分析得到诊断子宫腺肌症的最佳JZ厚度截点,对于临床诊断子宫腺肌症具有较高价值。
Objective To investigate the diagnostic value and ROC curve analysis of 3. 0 T magnetic resonance imaging combined with thickness indexes of junctional zone( JZ) in diagnosis of adenomyosis. Methods The junctional zone thickness and signal characteristics of 3. 0 T MRI in 51 patients with uterine adenomyosis( observation group) and 80 normal controls( control group) were retrospectively analyzed. The maximum value( JZmax) and minimum value( JZmin) of JZ thickness in T2 WI were measured,and the optimal JZ thickness cut-off point of 3. 0 TMRI in diagnosis of uterine adenomyosis was evaluated by means of ROC curve analysis. Results Among the 51 patients with adenomyosis,JZ diffuse or localized thickening were observed,moreover the Jzmax and JZmin in observation group were significantly greater than those in control group( P < 0. 01). The ROC curve analysis showed that JZ thickness measurement of JZmax and JZmin had higher value in diagnosis of uterine adenomyosis,and the area under curve was 0. 997,0. 838,respectively,moreover,the diagnostic value of Jzmax was higher than that of JZmin,there was significant difference between them( P < 0. 01). In addition the optimal JZ thickness cut-off point in diagnosis of uterine adenomyosis was 10. 4 mm,and its sensitivity,specificity,positive predictive value,negative predictive value as well as 95% confidence interval were 98. 7( 93. 2 ~ 100. 0),96. 1( 86. 5 ~ 99. 5),97. 5( 91. 4 ~ 99. 7),98. 0( 89. 4 ~ 99. 9),respectively. Among the 51 patients with adenomyosis,the small schistic T2 WI high signals in thickened area were observed in 50 patients,and small schistic T1 WI high signals in JZ thickened area were observed in 18 patients. However no abnormal signals were found in 80 subjects in control group,with relatively uniform T2 WI low signals. Conclusion The 3. 0 T MRI can show the changes of JZ thickness and signals in patients with uterine adenomyosis,and the optimized cutoff point of JZ thickness in diagnosis of uterine adenomyosis can be obtained through ROC curve analysis.
Objective To investigate the diagnostic value and ROC curve analysis of 3. 0 T magnetic resonance imaging combined with thickness indexes of junctional zone( JZ) in diagnosis of adenomyosis. Methods The junctional zone thickness and signal characteristics of 3. 0 T MRI in 51 patients with uterine adenomyosis( observation group) and 80 normal controls( control group) were retrospectively analyzed. The maximum value( JZmax) and minimum value( JZmin) of JZ thickness in T2 WI were measured,and the optimal JZ thickness cut-off point of 3. 0 TMRI in diagnosis of uterine adenomyosis was evaluated by means of ROC curve analysis. Results Among the 51 patients with adenomyosis,JZ diffuse or localized thickening were observed,moreover the Jzmax and JZmin in observation group were significantly greater than those in control group( P < 0. 01). The ROC curve analysis showed that JZ thickness measurement of JZmax and JZmin had higher value in diagnosis of uterine adenomyosis,and the area under curve was 0. 997,0. 838,respectively,moreover,the diagnostic value of Jzmax was higher than that of JZmin,there was significant difference between them( P < 0. 01). In addition the optimal JZ thickness cut-off point in diagnosis of uterine adenomyosis was 10. 4 mm,and its sensitivity,specificity,positive predictive value,negative predictive value as well as 95% confidence interval were 98. 7( 93. 2 ~ 100. 0),96. 1( 86. 5 ~ 99. 5),97. 5( 91. 4 ~ 99. 7),98. 0( 89. 4 ~ 99. 9),respectively. Among the 51 patients with adenomyosis,the small schistic T2 WI high signals in thickened area were observed in 50 patients,and small schistic T1 WI high signals in JZ thickened area were observed in 18 patients. However no abnormal signals were found in 80 subjects in control group,with relatively uniform T2 WI low signals. Conclusion The 3. 0 T MRI can show the changes of JZ thickness and signals in patients with uterine adenomyosis,and the optimized cutoff point of JZ thickness in diagnosis of uterine adenomyosis can be obtained through ROC curve analysis.
引文
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2 崔杰,许永华,田绍创,等.影响聚焦超声治疗子宫腺肌病消融率的相关因素初步分析.中华临床医师杂志:电子版,2015,9:1846-1850.
3 Levy G,Dehaene A,Laurent N,et al.An update on adenomyosis.Diagn Interv Imaging,2013,94:3-25.
4 曹泽毅主编.中华妇产科学.第3版.北京:人民卫生出版社,2014.1377-1378.
5 Hamimi A.What are the most reliable signs for the radiologic diagnosis of uterine adenomyosis an ultrasound and MRI prospective.Egyp J Radiol Nucl Med,2015,46:1349-1355.
6 Fusi L,Cloke B,Brosens JJ,et al.The uterine junctional zone.Best Pract Res Clin Obstet Gynaecol,2006,20:479-491.
7 Benagiano G,Brosens I,Habiba M.Adenomyosis:a life-cycle approach.Reprod Biomed Online,2015,30:220-232.
8 Aki Kido,Kaori Togashi.Uterine anatomy and function on cine magnetic resonance maging.Reprod Med Biol,2016,15:191-199.
9 He YL,Ding N,Li Y,et al.Cyclic changes of the junctional zone on 3 T MRI images in young and middle-aged females during the menstrual cycle.Clinical Radiology,2016,71:479-481.
10 Sofic A,Azra Husic-Selimovic D,Aladin Carovac M,et al.The significance of MRI evaluation ofthe uterine junctional zone in the early diagnosis of adenomyosis.Original Paper/acta Inform Med,2016,24:103-106.
11 陆海迪,王长梅,强金伟,等.磁共振影像联合带厚度指标与T2WI高信号对子宫腺肌症的诊断价值.中国临床医学,2017,24:37-42.
12 Exacoustos C,Manganaro L,Zupi E.Imaging for the evaluationof endometriosis and adenomyos.Best Pract Res Clin Ob-stet Gynaecol,2014,28:655-681.
2 崔杰,许永华,田绍创,等.影响聚焦超声治疗子宫腺肌病消融率的相关因素初步分析.中华临床医师杂志:电子版,2015,9:1846-1850.
3 Levy G,Dehaene A,Laurent N,et al.An update on adenomyosis.Diagn Interv Imaging,2013,94:3-25.
4 曹泽毅主编.中华妇产科学.第3版.北京:人民卫生出版社,2014.1377-1378.
5 Hamimi A.What are the most reliable signs for the radiologic diagnosis of uterine adenomyosis an ultrasound and MRI prospective.Egyp J Radiol Nucl Med,2015,46:1349-1355.
6 Fusi L,Cloke B,Brosens JJ,et al.The uterine junctional zone.Best Pract Res Clin Obstet Gynaecol,2006,20:479-491.
7 Benagiano G,Brosens I,Habiba M.Adenomyosis:a life-cycle approach.Reprod Biomed Online,2015,30:220-232.
8 Aki Kido,Kaori Togashi.Uterine anatomy and function on cine magnetic resonance maging.Reprod Med Biol,2016,15:191-199.
9 He YL,Ding N,Li Y,et al.Cyclic changes of the junctional zone on 3 T MRI images in young and middle-aged females during the menstrual cycle.Clinical Radiology,2016,71:479-481.
10 Sofic A,Azra Husic-Selimovic D,Aladin Carovac M,et al.The significance of MRI evaluation ofthe uterine junctional zone in the early diagnosis of adenomyosis.Original Paper/acta Inform Med,2016,24:103-106.
11 陆海迪,王长梅,强金伟,等.磁共振影像联合带厚度指标与T2WI高信号对子宫腺肌症的诊断价值.中国临床医学,2017,24:37-42.
12 Exacoustos C,Manganaro L,Zupi E.Imaging for the evaluationof endometriosis and adenomyos.Best Pract Res Clin Ob-stet Gynaecol,2014,28:655-681.