术前半定量DCE-MRI对子宫内膜癌诊断及肿瘤浸润的评估价值

Value of preoperative semi-quantitative DCE-MRI in the diagnosis of endometrial cancer and the assessment of tumor invasion

摘要:

目的 分析术前半定量动态增强磁共振成像（DCE-MRI）在子宫内膜癌（EC）诊断及肿瘤浸润的评估价值。方法 选取2020年1月—2024年12月常州市妇幼保健院收治的79例疑似EC患者，对患者采取半定量DCE-MRI检查，以手术病理检查为金标准，分析EC诊断结果和EC肌层浸润结果，以及半定量DCE-MRI检查EC和EC肌层浸润的诊断价值，比较EC肌层浸润程度患者半定量DCE-MRI参数。结果 79例患者中病理确诊EC有62例（78.48%）。DCE-MRI诊断EC的敏感性为85.48%（95% CI：0.740，0.922）、特异性为76.47%（95% CI：0.527，0.905）、准确率为83.54%（95% CI：0.739，0.901）、阳性预测值为92.98%（95% CI：0.833，0.972）、阴性预测值为59.09%（95% CI：0.387，0.768）。在62例EC患者中，DCE-MRI评估肌层浸润的敏感性为85.42%（95% CI：0.728，0.928）、特异性为71.43%（95% CI：0.454，0.883）、准确率为82.26%（95% CI：0.710，0.898）、阳性预测值为91.11%（95% CI：0.793，0.965）、阴性预测值为58.82%（95% CI：0.360，0.784）一致性亦较好（Kappa=0.762）。深肌层浸润组的达峰时间长于浅肌层浸润组，而最大对比剂浓度、浓度-时间曲线下面积及最大斜率均低于浅肌层浸润组（P 0.05）。结论 半定量DCE-MRI检查诊断EC和评估EC肌层浸润程度的效能较高，可为临床制订个体化治疗方案提供影像学依据。

Abstract:

Objective To assess the value of preoperative semi-quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in diagnosing endometrial cancer (EC) and assessing tumor invasion.Methods A total of 79 patients with suspected EC who were admitted to Changzhou Maternal and Child Health Hospital from January 2020 to December 2024 were selected. Semi-quantitative DCE-MRI examination was performed on the patients. Using surgical histopathology as the gold standard, the diagnostic results for EC and myometrial invasion, as well as the diagnostic value of semi-quantitative DCE-MRI for EC and its myometrial invasion, were analyzed. Semi-quantitative DCE-MRI parameters were compared among patients with different degrees of myometrial invasion.Results Among the 79 patients, 62 (78.48%) were pathologically confirmed to have EC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of DCE-MRI for diagnosing EC were 85.48% (95% CI: 0.74, 0.922), 76.47% (95% CI: 0.527, 0.905), 83.54% (95% CI: 0.739, 0.901), 92.98% (95% CI: 0.833, 0.972), and 59.09% (95% CI: 0.387, 0.768), respectively. Among the 62 patients with EC, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of DCE-MRI for assessing myometrial invasion were 85.42% (95% CI: 0.728, 0.928), 71.43% (95% CI: 0.454, 0.883), 82.26% (95% CI: 0.710, 0.898), 91.11% (95% CI: 0.793, 0.965), and 58.82% (95% CI: 0.360, 0.784), respectively, with good agreement (Kappa = 0.762). The time to peak was longer in the deep myometrial invasion group than in the superficial invasion group, whereas the maximum contrast concentration, area under the concentration-time curve, and maximum slope were all lower in the deep invasion group (P 0.05).Conclusions Semi-quantitative DCE-MRI has relatively high efficacy in diagnosing EC and assessing the degree of myometrial invasion of EC, and can provide imaging evidence for formulating personalized treatment plans in clinical practice.