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投稿时间：2020-10-26 网络发布日期：2021-06-20
投稿时间：2020-10-26 网络发布日期：2021-06-20
中文摘要: 目的 探讨MRI弥散加权成像(DWI)参数对Ⅰ型和Ⅱ型子宫内膜癌(EC)鉴别诊断的价值。方法 回顾性分析2016年9月至2019年10月南京中医药大学附属医院收治并经手术病理证实的子宫内膜癌86例患者的临床资料。所有患者术前均行MRI-DWI检查并生成表观弥散系数(ADC)图,测量病灶实性部分的ADC最大值(ADCmax)、平均值(ADCmean)及最小值(ADCmin),并统计肿瘤形态、边界、最大径、囊实性成分、出血及患者临床特征如患者年龄、绝经情况等资料,并进行比较。对差异有统计学意义的参数绘制ROC曲线,评估各参数的诊断效能。结果 纳入86例患者中,Ⅰ型52例,Ⅱ型34例。Ⅰ型患者的肿瘤最大径、ADCmean及ADCmin分别为(2.6±1.3)cm、(0.86±0.10)×10-3 mm2/s和(0.74±0.10)×10-3 mm2/s;Ⅱ型患者的肿瘤最大径、ADCmean及ADCmin分别为(3.8±2.1)cm、(0.72±0.10)×10-3 mm2/s和(0.54±0.10)×10-3 mm2/s,Ⅱ型肿瘤最大径大于Ⅰ型,ADCmean及ADCmin低于Ⅰ型,差异有统计学意义(P<0.01)。肿瘤最大径、ADCmean、ADCmin鉴别Ⅰ型和Ⅱ型EC的截断值分别为2.63 cm、0.76×10-3 mm2/s、0.66×10-3 mm2/s,肿瘤最大径、ADCmean、ADCmin及三者联合诊断的ROC曲线下面积分别为0.655、0.835、0.841和0.866,特异性分别为57.7%、64.7%、85.3%和84.6%,敏感性分别为70.6%、90.4%、67.3%和76.5%,准确性分别为62.8%、77.9%、74.4%和81.4%。结论 肿瘤ADCmean、ADCmin值及最大径对Ⅰ型与Ⅱ型EC具有鉴别诊断价值,3个参数的联合模型对Ⅰ型与Ⅱ型EC的鉴别诊断价值最大。
中文关键词: 弥散加权成像；子宫内膜癌 雌激素依赖型 非雌激素依赖型 肿瘤大小 表观弥散系数
Abstract:Objective To investigate the value of diffusion weighted imaging (DWI) parameters in the differential diagnosis of type Ⅰ and type Ⅱ endometrial carcinoma.Methods The clinical data of 86 patients with endometrial cancer confirmed by surgery and pathology in Affiliated Hospital of Nanjing University of Chinese Medicine from September 2016 to October 2019 were retrospectively analyzed.All patients were examined by MRI DWI before operation and generated the ADC chart.The maximum value of ADC (ADCmax),mean value of ADC (ADCmean) and minimum value of ADC(ADCmin) were measured.The tumor morphology,boundary,maximum diameter,cystic and solid components,bleeding and clinical characteristics such as age and menopause were analyzed and compared.ROC curves were drawn for parameters with significant differences.The diagnostic efficiency of each parameter was evaluated.Results There were 52 cases of type Ⅰ and 34 cases of type Ⅱ.The maximum diameter of tumor,ADCmean and ADCmin of type Ⅰ patients were (2.6±1.3) cm,(0.86±0.10)×10-3 mm2/s and (0.74±0.10)×10-3 mm2/s,respectively.The maximum diameter of tumor,ADCmean and ADCmin of type Ⅱ patients were (3.8±2.1)cm,(0.72±0.10)×10-3 mm2/s and (0.54±0.10)×10-3 mm2/s,respectively.Compared with type Ⅰ patients,the maximum diameter of tumor was significantly larger and ADCmean and ADCmin were significantly lower in type Ⅱ patients (P<0.05).The cut-off value of the maximum tumor diameter,ADCmean and ADCmin for differentiating type Ⅰ and type Ⅱ endometrial carcinoma were 2.63 cm,0.76×10-3 mm2/s/s and 0.66×10-3 mm2/s/s,respectively.The area under the ROC curve of the maximum tumor diameter,ADCmean,ADCmin and their combination diagnosis were 0.655,0.835,0.841 and 0.866,respectively.The specificity was 57.7%,64.7%,85.3% and 84.6%,the sensitivity was 70.6%,90.4%,67.3% and 76.5%,and the accuracy was 62.8%,77.9%,74.4% and 81.4%,respectively. Conclusion ADCmean,ADCmin and the maximum diameter of tumor are valuable in the differential diagnosis of type Ⅰ and type Ⅱ endometrial carcinoma.The combined model of three parameters is the most valuable in the differential diagnosis of type Ⅰ and type Ⅱ endometrial carcinoma.
keywords: Diffusion weighted imaging Endometrial carcinoma Estrogen dependent type Estrogen independent type Tumor size Apparent dispersion coefficient
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引用文本：
陈井亚,顾海磊,樊卫民,等.MRI弥散加权成像对Ⅰ型和Ⅱ型子宫内膜癌的鉴别诊断[J].中国临床研究,2021,34(6):746-750.
陈井亚,顾海磊,樊卫民,等.MRI弥散加权成像对Ⅰ型和Ⅱ型子宫内膜癌的鉴别诊断[J].中国临床研究,2021,34(6):746-750.