3D VIBE动态增强和DWI评估子宫内膜癌病理分期的价值研究

doi:10.11904/j.issn.1002-3070.2025.04.010

摘要/Abstract

摘要： 目的探讨三维容积内插体部检查(three-dimensional volume interpolated body examination,3D VIBE)动态增强和扩散加权成像(diffusion weighted imaging,DWI)评估子宫内膜癌病理分期的应用价值。方法选取2021年1月—2024年1月南通市海门区人民医院收治的224例子宫内膜癌患者,均进行3D VIBE动态增强扫描和DWI扫描,分析3D VIBE动态增强扫描结果与病理分期的一致性,比较不同病理分期患者表观扩散系数(apparent diffusion coefficient,ADC)和相对表现扩散系数(relative apparent diffusion coefficient,rADC)值差异,分析ADC、rADC对子宫内膜癌病理分期的评估价值。结果 224例子宫内膜癌患者中,ⅠA期122例(54.46%),ⅠB期39例(17.41%),Ⅱ期27例(12.05%),ⅢA期25例(11.16%),ⅢB期11例(4.91%);3D VIBE动态增强评估ⅠA、ⅠB、Ⅱ、ⅢA、ⅢB期的灵敏度分别为92.62%、87.18%、85.19%、80.00%和81.82%,特异度分别为96.08%、93.51%、97.96%、98.49%和99.06%,准确率分别为94.20%、92.41%、96.42%、96.42%和98.21%,3D VIBE动态增强对子宫内膜癌分期的评估结果与病理分期结果具有较高一致性(Kappa=0.829,P＜0.05);不同病理分期子宫内膜癌患者ADC、rADC差异有统计学意义(P＜0.05),ⅠB、Ⅱ、ⅢA、ⅢB期患者ADC、rADC均低于ⅠA期(P＜0.05),Ⅱ、ⅢA、ⅢB期患者ADC、rADC均低于ⅠB期,ⅢB期患者ADC、rADC均低于Ⅱ期(P＜0.05);ROC曲线分析结果显示,ADC、rADC诊断子宫内膜癌不同病理分期(ⅠA vs. ⅠB~ⅢB、ⅠA~ⅠB vs. Ⅱ-ⅢB、ⅠA~Ⅱ vs. ⅢA~ⅢB、ⅠA~ⅢA vs. ⅢB)的AUC分别为0.878、0.935、0.942、0.974和0.935、0.962、0.954、0.955(P＜0.001)。结论 3D VIBE动态增强和DWI在评估子宫内膜癌病理分期方面均具有较好的临床应用价值,可为子宫内膜癌诊疗方案的制定提供参考。

关键词: 子宫内膜癌, 病理分期, 三维容积内插体部检查动态增强, 扩散加权成像

Abstract: Objective The aim of this study was to explore the evaluation values of dynamic contrast-enhanced and diffusion-weighted imaging(DWI)of three-dimensional volume interpolated body examination(3D VIBE)for pathological stages of endometrial carcinoma(EC). Methods A total of 224 patients with EC admitted to Haimen District People′s Hospital in Nantong city from January 2021 to January 2024 were selected for 3D VIBE dynamic enhanced scanning and DWI scanning.The consistency between the results of 3D VIBE dynamic enhanced scanning and pathological staging was analyzed,and the differences in the apparent diffusion coefficient(ADC)and relative apparent diffusion coefficient(rADC)value among EC patients with different pathological stages were compared.The evaluation values of ADC and rADC for the pathological stages of EC were analyzed. Results Among 224 patients with EC,122(54.46%)were in the stage ⅠA,39(17.41%)were in the stage ⅠB,27(12.05%)were in the stage Ⅱ,25(11.16%)were in the stage ⅢA,and 11(4.91%)were in the stage ⅢB.The sensitivity,specificity,and accuracy of 3D VIBE dynamic enhanced evaluation for stages ⅠA,ⅠB,Ⅱ,ⅢA and ⅢB were 92.62%,87.18%,85.19%,80.00%,and 81.82%,respectively,for the sensitivities,96.08%,93.51%,97.96%,98.49%,and 99.06%,respectively,for specificities,94.20%,92.41%,96.42%,96.42%,and 98.21%,respectively,for accuracies.The 3D VIBE dynamic enhancement demonstranted substantial agreement with the pathological staging of endometrial cancer(Kappa=0.829,P＜0.05).There was a statistical difference in ADC and rADC among patients with different pathological stages of EC(P＜0.05).ADC and rADC in EC patients with stages IB,Ⅱ,ⅢA and ⅢB were lower than those in EC patients with stage ⅠA(P＜0.05).ADC and rADC were lower in the stage Ⅱ,ⅢA,and ⅢB EC patients than those in the stage ⅠB,and ADC and rADC were lower in the stage ⅢB EC patients than those in the stage Ⅱ(P＜0.05).The ROC curve analysis results revealed that the AUCs of ADC and rADC in the diagnosing pathological stages(ⅠA vs. ⅠB-ⅢB、ⅠA-ⅠB vs. Ⅱ-ⅢB、ⅠA-Ⅱ vs. ⅢA-ⅢB、ⅠA-ⅢA vs. ⅢB) of EC were 0.878,0.935,0.942,0.974 and 0.935,0.962,0.954,0.955,respectively(P＜0.05). Conclusion Both 3D VIBE dynamic enhancement and DWI have good clinical application value in evaluating the pathological stages of EC,and can provide a reference for the development of diagnosis and treatment plans for EC.

Key words: Endometrial carcinoma, Pathological staging, Dynamic enhancement of three-dimensional volume interpolated body examination, Diffusion weighted imaging

中图分类号:

俞晓玲, 黄红娟. 3D VIBE动态增强和DWI评估子宫内膜癌病理分期的价值研究[J]. 实用肿瘤学杂志, 2025, 39(4): 324-329.

YU Xiaoling, HUANG Hongjuan. The values of 3D VIBE dynamic enhancement and DWI in evaluating the pathological staging of endometrial carcinoma[J]. Journal of Practical Oncology, 2025, 39(4): 324-329.

参考文献

1 王榆平,思美丽,孙小霞,等.HPIP在子宫内膜癌中高表达及其在生存预后分析中的意义[J].实用肿瘤学杂志,2022,36(1):44-48.
2 赵湘铃,徐杰茹,段朝晖,等.1990-2019年中国子宫内膜癌发病趋势及其年龄-时期-队列分析[J].中华肿瘤防治杂志,2022,29(20):1446-1451.
3 Kido A,Himoto Y,Kurata Y,et al.Preoperative imaging evaluation of endometrial cancer in FIGO 2023[J].J Magn Reson Imaging,2023,60:1225-1242.
4 Liu T,Wang Y,Xu Z,et al.Application study of 3D LAVA-Flex on lumbar intervertebral disc degeneration[J].Eur J Med Res,2021,26(1):43.
5 Ota T,Tsuboyama T,Onishi H,et al.Diagnostic accuracy of MRI for evaluating myometrial invasion in endometrial cancer:a comparison of MUSE-DWI,rFOV-DWI,and DCE-MRI[J].Radiol Med,2023,128(6):629-643.
6 王鹏飞,赵丹,杨莹,等.DWI、DCE-MRI参数值对Ⅰ型与Ⅱ型子宫内膜癌的鉴别诊断及与Ki-67、p53的关系[J].中国CT和MRI杂志,2023,21(4):137-139.
7 国家卫生健康委办公厅.子宫内膜癌诊疗规范(2018年版)[EB/OL].(2018-12-13)[2024-04-10].http://www.nhc.gov.cn/yzygj/s7659/201812/b21802b199814ab7b1219b87de0cae51.shtml.
8 邵建中,李青松,张兴芳,等.ADC与rADC对子宫内膜癌诊断及病理分级的诊断价值[J].安徽医学,2021,42(5):539-543.
9 Berek JS,Matias-Guiu X,Creutzberg C,et al.FIGO staging of endometrial cancer:2023[J].Int J Gynaecol Obstet,2023,162(2):383-394.
10 Maheshwari E,Nougaret S,Stein EB,et al.Update on MRI in Evaluation and Treatment of Endometrial Cancer[J].Radiographics,2022,42(7):2112-2130.
11 涂永波,陈凤喜,李康,等.3D肝脏容积加速采集动态增强联合DWI评估子宫内膜癌病理分期的价值[J].中国医学物理学杂志,2020,37(11):1398-1402.
12 Deng H,Dong X,Zhang Y,et al.Preliminary study on the feasibility of united compressed sensing with radial acquisition as a routine method for liver dynamic contrast-enhanced examination in elderly patients with malignancy[J].Insights Imaging,2025,16(1):65.
13 Rafiee F,Mehan WA,Rincon S,et al.Diagnostic Utility of 3D gradient-echo MR imaging sequences through the filum compared with spin-echo T1 in children with concern for tethered cord[J].AJNR Am J Neuroradiol,2023,44(3):323-327.
14 Petrila O,Nistor I,Romedea NS,et al.Can the ADC value be used as an imaging "Biopsy" in endometrial cancer?[J].Diagnostics(Basel),2024,14(3):325.
15 Feng A,Yuan P,Huang T,et al.Distinguishing tumor recurrence from radiation necrosis in treated glioblastoma using multiparametric MRI[J].Acad Radiol,2022,29(9):1320-1331.
16 卢晓娟,林锦仕,王晓野,等.多模态磁共振成像诊断子宫内膜癌及其与病理诊断对照研究[J].中国医学装备,2023,20(2):58-62.
17 Kakkar C,Gupta K,Jain K,et al.Diagnostic accuracy of calculated tumor volumes and apparent diffusion coefficient values in predicting endometrial cancer grade[J].Int J Appl Basic Med Res,2022,12(1):37-42.
18 林培培,周晓冬,宋伟.子宫内膜癌肿瘤体积与子宫体积比值联合肿瘤ADC值对病理分级的预测价值[J].实用医学杂志,2023,39(23):3071-3075.

[1]	庄忆君, 孙禹琪, 杨微. β-榄香烯调控PI3K/Akt/mTOR信号通路对子宫内膜癌Ishikawa细胞增殖、迁移、侵袭及凋亡的影响[J]. 实用肿瘤学杂志, 2023, 37(5): 395-402.
[2]	夏建洪, 周立庆, 严研, 马婷婷, 苏欣宇. lncRNA DUXAP8在子宫内膜癌细胞中的作用机制研究[J]. 实用肿瘤学杂志, 2023, 37(2): 137-143.
[3]	王榆平, 思美丽, 孙小霞, 郭玉琳. HPIP在子宫内膜癌中高表达及其在生存预后分析中的意义[J]. 实用肿瘤学杂志, 2022, 36(1): 44-48.
[4]	牟冠男, 马强. NK细胞极化在子宫内膜癌中的作用[J]. 实用肿瘤学杂志, 2021, 35(6): 534-537.
[5]	夏天一, 张博淼, 姚克非, 崔滨滨. PTPN9表达水平与结直肠癌的临床关系研究[J]. 实用肿瘤学杂志, 2019, 33(5): 415-419.
[6]	李美艳, 陈永学, 侯俊德. Leptin、VEGF及不同麻醉方式对子宫内膜癌患者预后生存的影响[J]. 实用肿瘤学杂志, 2018, 32(5): 426-431.
[7]	毕琦玲, 周立红, 韩毅敏. HOX基因与妇科肿瘤的研究进展[J]. 实用肿瘤学杂志, 2018, 32(2): 140-143.
[8]	龚伟, Md Tofiz Uddin, 陆佩欧, 于丽娟. PET/CT诊断子宫内膜癌的优势及展望[J]. 实用肿瘤学杂志, 2018, 32(2): 144-148.
[9]	吴杰，刘翠兰，综述，敬宗林，审校. 扩散成像技术在乳腺癌诊断中的研究进展[J]. 实用肿瘤学杂志, 2016, 30(6): 563-567.
[10]	王明霞, 白治英, 耿俐. 高分化子宫内膜癌或非典型子宫内膜增生患者保守治疗后妊娠结局影响因素分析[J]. 实用肿瘤学杂志, 2016, 30(5): 409-413.
[11]	崔满华,许天敏. 子宫内膜癌治疗新进展[J]. 实用肿瘤学杂志, 2013, 27(3): 202-205.
[12]	刘运铎,孟凡玲,徐冶,杨萌. AEG-1、DLL4在子宫内膜癌中的表达及临床病理相关性的研究[J]. 实用肿瘤学杂志, 2013, 27(3): 223-228.
[13]	孙先虹, 杨枫, 毕春丽, 戚基萍. 雌激素对机体的影响及其导致子宫内膜癌的分子机制[J]. 实用肿瘤学杂志, 2011, 25(4): 389-392.
[14]	穆彦如, 谢凯. VEGF的研究进展及其在妇科肿瘤中的应用[J]. 实用肿瘤学杂志, 2010, 24(1): 90-92.
[15]	刘建琴, 包申华, 陈淼. ER、PR与子宫内膜癌预后因素关系分析[J]. 实用肿瘤学杂志, 2009, 23(2): 160-162.