不同表观扩散系数评估子宫内膜癌盆腔淋巴结转移的应用价值
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摘要
目的探讨扩散加权成像(diffusion weighted imaging, DWI)对子宫内膜癌盆腔转移性与非转移性淋巴结的鉴别诊断价值。方法对我院27例子宫内膜癌患者的常规MR及DWI图像进行分析,自动生成表观扩散系数(diffusion weighted imaging, ADC);依据病理结果,分别比较转移性淋巴结与非转移性淋巴结之间ADCmax值、ADCmean值以及ADCmin值的差异,以ROC曲线比较各ADC值诊断效能。结果共计检出转移性淋巴结28例、非转移性淋巴结68例;两者ADCmax值、ADCmean值以及ADCmin值的两两比较均有统计学差异(均P<0.05);ADCmax值、ADCmean值以及ADCmin值诊断转移性淋巴结对应的ROC比较(AUC分别为0.832、0.908、0.966),差异亦均具有统计学意义(均P<0.05)。结论不同ADC值对子宫内膜癌盆腔转移性淋巴结的定性诊断具有较高的价值,其中ADCmin值的诊断效能最佳。
Objective To explore the diagnostic value of Diffusion weighted imaging(DWI) for pelvic metastasis and non-metastatic lymph nodes in endometrial carcinoma. Methods The routine MR and DWI images of patients with endometrial carcinoma in our hospital were analyzed, and the Diffusion coefficient imaging(ADC) was automatically generated. According to the pathological results, the ADCmax value, ADCmean value and ADCmin value of the metastatic lymph nodes were compared with that of the non-metastatic lymph nodes, and the ADC values was compared with the ROC curve. Results 28 cases of metastatic lymph node and 68 non-metastatic lymph nodes were detected. Both ADCmax values, ADCmean values and ADCmin values were statistically different(P < 0.05). The value of ADCmax, ADCmean value and ADCmin were compared with the ROC comparison of metastatic lymph nodes(AUC was 0.832, 0.908 and 0.966 respectively), and the differences were statistically significant(P<0.05). Conclusion The different ADC values are of high value in the qualitative diagnosis of pelvic metastatic lymph nodes in endometrial carcinoma, and the diagnostic value of ADCmin is the best.
Objective To explore the diagnostic value of Diffusion weighted imaging(DWI) for pelvic metastasis and non-metastatic lymph nodes in endometrial carcinoma. Methods The routine MR and DWI images of patients with endometrial carcinoma in our hospital were analyzed, and the Diffusion coefficient imaging(ADC) was automatically generated. According to the pathological results, the ADCmax value, ADCmean value and ADCmin value of the metastatic lymph nodes were compared with that of the non-metastatic lymph nodes, and the ADC values was compared with the ROC curve. Results 28 cases of metastatic lymph node and 68 non-metastatic lymph nodes were detected. Both ADCmax values, ADCmean values and ADCmin values were statistically different(P < 0.05). The value of ADCmax, ADCmean value and ADCmin were compared with the ROC comparison of metastatic lymph nodes(AUC was 0.832, 0.908 and 0.966 respectively), and the differences were statistically significant(P<0.05). Conclusion The different ADC values are of high value in the qualitative diagnosis of pelvic metastatic lymph nodes in endometrial carcinoma, and the diagnostic value of ADCmin is the best.
引文
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[12] 左志超,张卫,邓文娟,等.MRI表观扩散系数值与相对表观扩散系数值对宫颈癌患者盆腔转移性淋巴结的诊断价值[J].广西医学,2017,39(5):606-609.
[13] Lambregts DMJ,Beets GL,Monique M,et al.Tumour ADC measurements in rectal cancer:effect of ROI methods on ADC values and interobserver variability [J].Eur Radiol,2012,21(12):2567-2574.
[14] Hirano M,Satake H,Ishigaki S,et al.Diffusion-weighted imaging of breast masses:comparison of diagnostic performance using various apparent diffusion coefficient parameters [J].AJR,2012,198(3):717-722.
[15] Woodhams R,Kakita S,Hata H,et al.Diffusion-weighted imaging of mucinous carcinoma of the breast:evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings [J].AJR,2009,193(1):260-266.
[2] Mitamura T,Watari H,Todo Y,et al.Lymphadenectomy can be omitted for low-risk endometrial cancer based on preoperative assessments [J].J Gynecol Oncol,2014,25(4):301-305.
[3] 吴婉莉,万小云,谢幸.Ⅰ期子宫内膜癌盆腔淋巴清扫术的意义[J].现代妇产科进展,2006,15(10):746-749.
[4] Seo JM,Kim CK,Choi D,et al.Endometrial cancer:utility of diffusion-weighted magnetic resonance imaging with background body signal suppression at 3T [J].J Magn Reson Imaging,2013,37(5):1151-1159.
[5] An Q,Ynag J,Zhu Y.Diffusion weighted imaging and contrast-enhanced magnetic resonance imaging in the evaluation of early stage endometrial cancer [J].Zhongguo Yi Xue Ke Xue Yuan Xue Bao,2012,34(5):486-491.
[6] 孙晓伟,朱颖,王霄英,等.子宫内膜癌盆腔淋巴结转移的不同MR序列诊断研究[J].中国医学影像学杂志,2011,19(5):394-398.
[7] 郭靖,汪俊萍,李威.扩散加权成像在鉴别诊断子宫内膜癌盆腔淋巴结性质中的应用[J].中国医学影像学杂志,2013,(3):227-230.
[8] Baiocchi G,Mantoan H,Kumagai L Y,et al.The impact of sentinel node-mapping in staging high-risk endometrial cancer [J].Ann Surg Oncol,2017,24(13):3981-3987.
[9] 温宏武,张丽敦.盆腔淋巴清扫术对子宫内膜癌预后的影响[J].中华妇产科杂志,2004,39(3):152-155.
[10] Zhu M,Jia N,Huang F,et al.Whether intermediate-risk stage 1A,grade 1/2,endometrioid endometrial cancer patients with lesions larger than 2 cm warrant lymph node dissection?[J].Bmc Cancer,2017,17(1):696.
[11] 邢庆娜,张小安,赵鑫,等.子宫内膜癌MRI征象与血管内皮生长因子、Ki-67表达的相关性研究[J].中国医学影像学杂志,2011,19(9):688-692.
[12] 左志超,张卫,邓文娟,等.MRI表观扩散系数值与相对表观扩散系数值对宫颈癌患者盆腔转移性淋巴结的诊断价值[J].广西医学,2017,39(5):606-609.
[13] Lambregts DMJ,Beets GL,Monique M,et al.Tumour ADC measurements in rectal cancer:effect of ROI methods on ADC values and interobserver variability [J].Eur Radiol,2012,21(12):2567-2574.
[14] Hirano M,Satake H,Ishigaki S,et al.Diffusion-weighted imaging of breast masses:comparison of diagnostic performance using various apparent diffusion coefficient parameters [J].AJR,2012,198(3):717-722.
[15] Woodhams R,Kakita S,Hata H,et al.Diffusion-weighted imaging of mucinous carcinoma of the breast:evaluation of apparent diffusion coefficient and signal intensity in correlation with histologic findings [J].AJR,2009,193(1):260-266.