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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 investigate the value of 3.0TMR 3D LAVA dynamic contrast-enhanced scanning combined with multiplanar reconstruction (MPR) in determining the depth of myometrial invasion in endometrial cancer. Materials and Methods 55 cases of endometrial carcinoma patients with FIGO Stage Ⅰ confirmed by operation and pathology were routinely screened and high-resolution 3DLAVA dynamic contrast-enhanced scanning. The latter was treated with high-pressure syringe through the antecubital vein The Gd-DTPA 0.2 mmol / kg body weight was infused at a flow rate of 2.5-3.0 ml / s, and the tumor was analyzed at six time points after 15, 45, 90, 120, 150 and 180 s Compared with normal muscularis at each phase, the contrast-to-noise ratio (CNR) of each augmented phase versus normal muscularis was calculated. Select the CNR maximum phase enhanced images, the use of MPR technology to determine the depth of tumor myometrial invasion, and surgical pathology control. According to 2009 new stage of FIGO endometrial cancer staging criteria, that Ⅰ A (limited to the intima + superficial myometrial invasion), Ⅰ B stage (infiltration of deep myometrial), LAVA combined with MPR technology to calculate the depth of tumor-infiltrating myometrial sensitivity Sex, specificity, positive predictive value, negative predictive value, and accuracy. Results In the dynamic enhancement images, all of the endometrial carcinomas showed mild progressive enhancement with the signal intensity always lower than that of the obviously enhanced outer muscular layer. The CNR of the tumor and the normal outer muscular layer reached the maximum after a delay of 180 s. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 3D LAVA combined with MPR were 90%, 83%, 87%, 87% and 88%, respectively. Conclusions High-resolution 3D LAVA dynamic contrast-enhanced scan combined with MPR technique can accurately determine the depth of tumor invasion of the myometrium, which can be helpful for the clinical development of different surgical approaches.