摘要
目的探讨3.0TMR 3D肝脏容积超快速采集（liver acquisition with volume acceleration,LAVA）动态增强扫描结合多平面重组（multiplanar reconstruction,MPR）技术在判断子宫内膜癌肌层浸润深度的应用价值。资料与方法对55例经手术病理证实为2009国际妇产科联盟会（FIGO）Ⅰ期的子宫内膜癌患者行常规扫描和高分辨3DLAVA动态增强扫描,后者采用高压注射器经肘前静脉以2.5~3.0 ml/s的流率注入Gd-DTPA 0.2 mmol/kg体重,分别于注药后15 s、45 s、90 s、120 s、150 s及180 s 6个时相屏气扫描,分析肿瘤与正常外肌层在各个时相的强化趋势,分别计算每个增强时相肿瘤与正常外肌层的对比噪声比（CNR）。选取CNR最大时相的增强图像,采用MPR技术判断肿瘤肌层浸润深度,并与手术病理对照。根据2009年FIGO子宫内膜癌新分期的标准,即ⅠA期（局限于内膜＋浸润浅肌层）、ⅠB期（浸润深肌层）,计算LAVA结合MPR技术对肿瘤浸润肌层深度的敏感性、特异性、阳性预测值、阴性预测值和准确性。结果在动态增强图像上,所有内膜癌病灶均呈轻度渐进性强化,信号强度始终低于明显强化的外肌层,肿瘤与正常外肌层的CNR在延迟180 s扫描时达到最大。采用3D LAVA增强扫描结合MPR技术,对内膜癌判断的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为90%、83%、87%、87%和88%。结论采用高分辨率3D LAVA动态增强扫描并结合MPR技术,能较准确地判断肿瘤侵犯子宫肌层的深度,为临床制定不同的手术方式提供帮助。
Objective To assess the diagnostic accuracy of 3D LAVA dynamic contrast enhanced MR combined with MPR technique for evaluating endometrial cancer myometrial invasion.Materials and Methods Fifty five patients with pathologically proved as stageⅠ endometrial cancer were prospectively enrolled for preoperative evaluation.All the patients performed both conventional MR series and high resolution 3D LAVA dynamic contrast enhanced scanning using 3.0-T magnetic resonance（MR） scanner.The dynamic post contrast sequences were obtained at 15 s,45 s,90 s,120 s,150 s and 180 s respectively after Gd DTPA bolus injection.Quantitative analysis included tumor and myometrium contrast-to-noise ratios（CNR） during different dynamic phases.At the phase with the optimal CNR,the depth of myometrial invasion was evaluated on multiplanar reconstruction（MPR）images.MPR findings were compared with surgicopathologic findings.According to the 2009 revised FIGO staging of endometrium carcinoma,stageⅠA means no or less than half myometrial invasion,stageⅠB means invasion equal to or more than half of the myometrium.The sensitivity,specificity,diagnostic accuracy,and positive and negative predictive values of MR imagings in depicting myometrial infiltration were calculated.Resu-lts The CNR of the tumor and myometrium progressively improved from the precontrast phase to the delayed phase.The optimal CNR was achieved at the 180 s delayed phase.The sensitivity,specificity,diagnostic accuracy,and positive and negative predictive values in assessing myometrial infiltration were 90%,83%,88%,87%,and 87% in the delayed phase combined with MPR technique.There was significantly accordant between MR imaging and surgicopathologic findings in assessment of myometrial invasion.Conclusion High-resolution 3D LAVA contrast material-enhanced dynamic MR imaging combined with MPR technique is highly accurate in predicting myometrial invasion.
出处
《临床放射学杂志》
CSCD
北大核心
2011年第6期830-833,共4页
Journal of Clinical Radiology
关键词
磁共振成像
多平面重组
子宫
内膜
新生物
肌层浸润
Magnetic resonance imaging Multiplanar reconstruction Uterus Endometrium Neoplasms Myometrial invasion
