磁共振成像 2024年第10卷第7期 Chin J Magn Reson Imaging, 2024, Vol 10, No 7临床研究 | Clinical Articles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
沈逸青，吕发金*，刘晓曦，熊域霖
作者单位：[摘要]?目的?探讨磁共振成像(magnetic resonance imaging，MRI)定性及定量参数在重庆医科大学附属第一医院放射科，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，比重庆 400016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通信作者：值(rADC)、最大相对强化率(maximum relative enhancement ratio，MRER)和流出率吕发金，E-mail：fajinlv@163.com(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的收稿日期：2024-01-21最大径[(58.00±27.42) mm、(28.37±10.03) mm]，ET/AP [(0.71±0.21)、(0.35±0.15)]，接受日期：2024-05-21MRER [(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)曲中图分类号：R445.2；R737.33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文献标识码：A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%、DOI: 10.12015/issn.1674-8034.2024.07.01196.7%，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。Cite this article as: Shen YQ, Lü FJ, [关键词] 子宫肿瘤；癌肉瘤；子宫内膜肿瘤；磁共振成像；诊断，鉴别Liu XX, et, al. The applied value of multiparametric MRI in differentiating uterine carcinosarcoma from low risk The applied value of multiparametric MRI in differentiating endometrial carcinoma. Chin J Magn uterine carcinosarcoma from low risk endometrial carcinomaReson Imaging, 2024, 10(7): 535-539.本文引用格式：沈逸青, 吕发金, 刘晓SHEN Yiqing, Lü Fajin*, LIU Xiaoxi, XIONG Yulin 曦, 等. 多参数磁共振成像在子宫癌肉Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China瘤与低危型子宫内膜癌鉴别诊断中*的应用价值. 磁共振成像, 2024, 10(7): Correspondence to: Lü FJ, E-mail: fajinlv@163.comReceived 21 Jan 2024, Accepted 21 May 2024535-539.Abstract 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 were 37.5 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.Key words uterine neoplasms; carcinosarcoma; endometrial neoplasms; magnetic resonance imaging; diagnosis, differential子宫癌肉瘤(uterine carcinosarcoma，CS)是由上皮细胞和间质成分组成的去分化型子宫内膜癌[1]。因复发率高，生存率低[2]，ESMO-ESGO-ESTRO共识会议将CS列为高危型子宫内膜癌(endometrial carcinoma，
http://www.cjmri.cnEC)，并主张行淋巴结清扫术(lymphadenectomy，LD)以全面分期[3]。低危型EC预后良好，淋巴结转移风险低，目前学术界认为可以不行LD[3]。临床上，CS与低危型EC症状相似[4]，但二者的治疗方式及预后差别较
·535·
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 - 论文
