3.0T磁共振扩散加权成像在子宫内膜癌诊断中的价值

摘要

目的 探讨3.0T MR扩散加权成像(DWI)在子宫内膜癌诊断中的临床应用价值.方法 对48例子宫内膜癌患者和20例无子宫内膜病变者行盆腔T2WI和DWI,由2名MRI诊断医师采用盲法随机进行MRI阅片后,采用5分制评分,以受试者工作特征曲线(ROC)对比分析单纯T2WI与DWI结合T2WI诊断子宫内膜癌的敏感性和特异性,并对内膜癌和正常内膜的表观扩散系数(ADC)值进行定量分析.结果 2名医师单纯应用T2WI与DWI结合T2WI检出子宫内膜癌的ROC曲线下面积(Az)值分别为0.831与0.944、0.877与0.954,2名医师DWI结合T2WI对内膜癌诊断的准确性均高于单纯应用T2WI(P<0.05).Kappa一致性检验表明2名医师具有良好的一致性(Kappa值分别为0.843和0.898,P<0.01).子宫内膜癌和正常内膜的ADC值分别为(0.954±0.139)×10-3mm2/s、(1.468±0.161)×10-3mm2/s,子宫 内膜癌与正常内膜的ADC值间差异有统计学意义(t=-13.217,P<0.01).结论 3.0T MR-DWI作为常规T2WI的补充检查序列可以明显提高对子宫内膜癌的检出率.%Objective To assess the value of 3. OT MR diffusion-weighted imaging (DWI) in diagnosing endometrial cancer. Methods 48 patients with histologically proven endometrial cancer and 20 patients without endometrial lesions were examined by MR T2 WI and DWI at 3. OT MR unit. Images were independently reviewed by two doctors blindly. The probability of endometrial cancer on T2 WI alone and DWI combined with T2WI were recorded with a five point scale. Differences of corresponding areas under ROC curves(Az) on T2WI and DWI combined with T2WI were compared for each observer. Interobserver agreement was calculated by Kappa statistics. The apparent diffusion coefficient! ADC) value of the tumors and normal endometria were measured. Results The ROC analysis showed that the detectability of endometrial cancer was significantly higher on DWI combined with T2WI than that on T2WI alone. The Az values measured by two doctors on T2WI and DWI combined with T2WI were 0. 831,0. 944 and 0. 877,0. 954 respectively. The values of Kappa were 0. 843 for T2WI and 0. 898 for DWI combined with T2WI. The mean ADC value of endometrial cancer was (0. 954 + 0. 139) X10~3mm2/s, which was significantly lower than of the normal endometrium (1. 468 + 0. 161) X 10~3mm2/s (1= -13. 217,P<0. 01). Conclusion The addition of 3. 0T MR DWI to T2WI can improve the diagnostic performance of MR imaging in endometrial cancer detection.