多参数磁共振成像在子宫癌肉瘤与低危型子宫内膜癌鉴别诊断中的应用价值
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摘要
目的探讨磁共振成像(magnetic resonance imaging,MRI)定性及定量参数在子宫癌肉瘤(uterine carcinosarcoma,CS)与低危型子宫内膜癌(endometrial carcinoma,EC)鉴别诊断中的应用价值。材料与方法回顾性分析18例CS和30例低危型EC,比较两组肿瘤下列MRI指标:肿瘤形态、肿瘤最大径、内膜厚度与宫腔前后径之比(ET/AP)、结合带情况、出血、囊变/坏死、血管流空影、平均ADC值(mADC)、相对ADC值(rADC)、最大相对强化率(maximum relative enhancement ratio,MRER)和流出率(Washout)。结果 MRI定性指标中,CS常伴出血、囊变/坏死和血管流空影,以上指标与低危型EC的差异均具有统计学意义(P<0.05)。MRI定量指标中,CS与低危型EC的最大径[(58.00±27.42) mm、(28.37±10.03) mm],ET/AP [(0.71±0.21)、(0.35±0.15)],MRER [(2.09±0.68)、(0.56±0.42)]和Washout [(0.04±0.12)、(0.36±0.42)]的差异均具有统计学意义(P<0.05)。根据受试者工作特征(receiver operating characteristic,ROC)曲线,当肿瘤的最大径、ET/AP值、MRER和Washout分别以37.5 mm、0.474、1.299和0.021作为阈值时,诊断CS的敏感度、特异度分别为83.3%、83.3%,88.9%、83.3%,94.4%、96.7%,100.0%、72.2%。结论肿瘤最大径、ET/AP、MRER及washout在CS与低危型EC的鉴别诊断中有较高诊断效能,可作为优化参数帮助临床合理选择治疗方案。
Objective: To explore the applied value of quantitative and qualitative magnetic resonance imaging(MRI) parameters in differentiating uterine carcinosarcoma(CS) from low risk endometrial carcinoma(EC). Materials and Methods: Eighteen CS and 30 low risk EC confirmed by surgery were retrospectively analysed. The following MRI features of the tumors were evaluated: tumor morphology, maximum tumor diameter, ET/AP, the integrity of junction zone, hemorrhagic, necrotic/cystic components, flow voids, mean ADC values(mADC), relative ADC values(rADC), maximum relative enhancement ratio(MRER) and Washout. Results:There were significant differences between CS and EC in the following qualitative parameters:hemorrhagic, necrotic/cystic components and flow voids(P<0.05). For quantitative MRI parameters, maximum dimension, ET/AP, MRER and Washout could significantly distinguish CS from low risk EC(P<0.05). According to the receiver operating characteristic(ROC)curves, when the cut-off values of maximum dimension, ET/AP, MRER and Washout were37.5 mm, 0.474, 1.299 and 0.021, the sensitivity and specificity of the diagnosis were 83.3%,83.3%; 88.9%, 83.3%; 94.4%, 96.7%; 100.0%, 72.2%; respectively. Conclusions: Qualitative and quantitative MRI parameters were of great value in differentiating CS from low risk EC. The maximum diameter, ET/AP, MRER and Washout could be used as optimization parameters to provide imaging information for adequate clinical treatment.
Objective: To explore the applied value of quantitative and qualitative magnetic resonance imaging(MRI) parameters in differentiating uterine carcinosarcoma(CS) from low risk endometrial carcinoma(EC). Materials and Methods: Eighteen CS and 30 low risk EC confirmed by surgery were retrospectively analysed. The following MRI features of the tumors were evaluated: tumor morphology, maximum tumor diameter, ET/AP, the integrity of junction zone, hemorrhagic, necrotic/cystic components, flow voids, mean ADC values(mADC), relative ADC values(rADC), maximum relative enhancement ratio(MRER) and Washout. Results:There were significant differences between CS and EC in the following qualitative parameters:hemorrhagic, necrotic/cystic components and flow voids(P<0.05). For quantitative MRI parameters, maximum dimension, ET/AP, MRER and Washout could significantly distinguish CS from low risk EC(P<0.05). According to the receiver operating characteristic(ROC)curves, when the cut-off values of maximum dimension, ET/AP, MRER and Washout were37.5 mm, 0.474, 1.299 and 0.021, the sensitivity and specificity of the diagnosis were 83.3%,83.3%; 88.9%, 83.3%; 94.4%, 96.7%; 100.0%, 72.2%; respectively. Conclusions: Qualitative and quantitative MRI parameters were of great value in differentiating CS from low risk EC. The maximum diameter, ET/AP, MRER and Washout could be used as optimization parameters to provide imaging information for adequate clinical treatment.
引文
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[14]Genever AV,Abdi S.Can MRI predict the diagnosis of endometrial carcinosarcoma?Clin Radiol,2011,66(7):621-624.
[15]Mainenti PP,Pizzuti LM,Segreto S,et al.Diffusion volume(DV)measurement in endometrial and cervical cancer:a new MRI parameter in the evaluation of the tumor grading and the risk classification.Eur JRadiol,2016,85(1):113-124.
[16]Yan B,Zhao T,Liang X,et al.Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer?Acta Radiol,2018,59(3):1-8.
[17]Zhang GF,Zhang H,Tian XM,et al.Magnetic resonance and diffusionweighted imaging in categorization of uterine sarcomas:correlation with pathological findings.Clin Imaging,2014,38(6):836-834.
[18]Fasmer KE,Bj?rnerud A,Ytre-Hauge,et al.Preoperative quantitative dynamic contrast-enhanced MRI and diffusion-weighted imaging predict aggressive disease in endometrial cance.Acta Radiol,2018,59(8):1010-1017.
[2]Cantrell LA,Blank SV,Duska LR.Uterine carcinosarcoma:a review of the literature.Gynecol Oncol,2015,137(3):581-588.
[3]Colombo N,Creutzberg C,Amant F,et al.ESMOESGO-ESTROconsensus conference on endometrial cancer:diagnosis,treatment and follow-up.Ann Oncol,2016,27(1):16-41.
[4]Berton-Rigaud D,Devouassoux-Shisheboran M,Ledermann JA,et al.Gynecologic cancer intergroup(GCIG)consensus review for uterine and ovarian carcinosarcoma.Int J Gynecol Cancer,2014,24(9 Suppl 3):S55-60.
[5]Bansal N,Herzog TJ,Burke W,et al.The utility of preoperative endometrial sampling for the detection of uterine sarcomas.Gynecol Oncol,2008,110(1):43-48.
[6]Takeuchi M,Matsuzaki K,Harada M.Carcinosarcoma of the uterus:MRI findings including diffusion-weighted imaging and MRspectroscopy.Acta Radiol,2016,57(10):1277-1284.
[7]Barral M,PlacéV,Dautry R,et al.Magnetic resonance imaging features of uterine sarcoma and mimickers.Abdom Radiol,2017,42(6):1762-1772.
[8]Inoue A,Yamaguchi K,Kurata Y,et al.Unenhanced region on magnetic resonance imaging represents tumor progression in uterine carcinosarcoma.J Gynecol Oncol,2017,28(5):e62.
[9]Huang YT,Chang CB,Yeh CJ,et al.Diagnostic accuracy of 3.0t diffusion-weighted MRI for patients with uterine carcinosarcoma:assessment of tumor extent and lymphatic metastasis.J Magn Reson Imaging,2018.[Epub ahead of print]
[10]Felix AS,Stone RA,Bowser R,et al.Comparison of survival outcomes between patients with malignant mixed Mullerian tumors and highgrade endometrioid,clear cell,and papillary serous endometrial cancers.Int J Gynecol Cancer,2011,21(5):877-884.
[11]Vorgias G,Fotiou S.The role of lymphadenectomy in uterine carcinosarcomas(malignant mixed mullerian tumours):a critical literature review.Arch Gynecol Obstet Dec,2010,282(6):659-664.
[12]Major FJ,Blessing JA,Silverberg SG,et al.Prognostic factors in earlystage uterine sarcoma:a gynecologic oncology group study.Cancer,1993,71(4 Suppl):1702-1709.
[13]Ohguri T,Aoki T,Watanabe H,et al.MRI findings including gadoliniumenhanced dynamic studies of malignant,mixed mesodermal tumors of the uterus:differentiation from endometrial carcinomas.Eur Radiol,2002,12(11):2737-2742.
[14]Genever AV,Abdi S.Can MRI predict the diagnosis of endometrial carcinosarcoma?Clin Radiol,2011,66(7):621-624.
[15]Mainenti PP,Pizzuti LM,Segreto S,et al.Diffusion volume(DV)measurement in endometrial and cervical cancer:a new MRI parameter in the evaluation of the tumor grading and the risk classification.Eur JRadiol,2016,85(1):113-124.
[16]Yan B,Zhao T,Liang X,et al.Can the apparent diffusion coefficient differentiate the grade of endometrioid adenocarcinoma and the histological subtype of endometrial cancer?Acta Radiol,2018,59(3):1-8.
[17]Zhang GF,Zhang H,Tian XM,et al.Magnetic resonance and diffusionweighted imaging in categorization of uterine sarcomas:correlation with pathological findings.Clin Imaging,2014,38(6):836-834.
[18]Fasmer KE,Bj?rnerud A,Ytre-Hauge,et al.Preoperative quantitative dynamic contrast-enhanced MRI and diffusion-weighted imaging predict aggressive disease in endometrial cance.Acta Radiol,2018,59(8):1010-1017.