The Value Of Multimodal MRI In The Preoperative Staging And Grading Of Endometrial Carcinoma

Purpose: The multimodal MRI examination in patients with suspected endometrial cancer was diagnosed,and the corresponding multimodal MRI image were compared with the postoperative pathological analysis,explore the mode of MRI for the assessment of endometrial cancer preoperative staging value,including the MRI plain scan,DCE-MRI combined with the function of MRI diffusion weighted imaging(DWI)weighted;Correlation between different pathological grading and assessment of tumor tissue DWI and quantitative index ADC value;the control signal curve characteristic analysis of endometrial carcinoma and normal myometrium,to explore its mechanism of endometrial carcinoma under multimode MRI imaging.Procedures: A review of 45 patients with endometrial cancer confirmed by pathology in our hospital from January 2013-October 2016,aged 49-79 years,with an average age of 60.1 years,including 34 menopausal women,who mainly had irregular vaginal bleeding for weeks or months.MRI scan and post-processing analysis were performed in 45 cases of endometrial cancer diagnosed by pathological biopsy,including MRI plain scan,magnetic resonance dynamic enhancement(DCE-MRI),diffusion weighted(DWI)and time signal curv e(TIC).About 2 weeks after MRI examination,surgical resection and pathology were perfo rmed.The double blind method was used to compare the imaging findings with pathologic a findings,and to explore the role of multimodal MRI in preoperative staging and grading of endometrial carcinoma.All cases were excluded from contraindication before routine MRI examination.No endocrine or radiochemotherapy was performed.IV had lost operation chance,so it was not included in this study.Results:1?40 cases were adenocarcinoma,3 adenosine squamous cell carcinoma and 2 serous papillary carcinoma.Among them,26 cases were highly differentiated,10 cases were moderately differentiated,4 cases were poorly differentiated,2 cases were highly differentiated in adenosine squamous cell carcinoma,and 1 were moderately differentiated.2?The postoperative pathological staging as the gold standard,of which 24 cases of Ia(53.3%),10 cases of stage Ib(22.2%),II 5 cases(11.1%),IIIa 4 cases(8.9%),IIIb 2 cases(4.5%);MRI plain scan diagnosis rate was 80.0%,of which 19 cases of Ia Ib(79.2%),7 cases(70%),II 5 cases(100%),IIIa 3 cases(75%),IIIb 2 cases(100%),2 cases in stage I underestimated(4.4%),7 cases(15.6%)were overvalued.The diagnostic rate of DCE-MRI combined with DWI was 93.3%,of which Ia stage was 22 cases(91.7%),Ib stage was 9 cases(90%),II stage 5 cases(100%),IIIa stage 4 cases(100%),IIIb stage 2 cases(100%),I case underestimated,and two cases overestimated.3?In 28 cases,moderately differentiated 11 cases,poorly differentiated 4 cases of well differentiated endometrial carcinoma,the corresponding ADC value(10-3mm2/s)and different r ADC values,respectively: high differentiation(0.956 ± 0.010;0.854 ± 0.009),middle differentiation(0.917±0.077;0.818±0.069)and low differentiation(0.733±0.109;0.654±0.097).There was a positive correlation between the degree of tumor differentiation and the value of ADC.There was significant difference between the middle,low,high and low differentiation groups(P<0.05),but there was no significant difference between the high and middle differentiation groups.4?45 cases of endometrial carcinoma TIC curve in 31 cases,type I 12 cases,III type 2 cases,no IV type;normal myometrium TIC curve in III type 40,II type 4 cases,I type 1 cases,II.Of all 43 cases,the D values of each phase in the curve were all lower than those in the normal myometrium.Among them,there was a statistically significant difference between the D value of the five stage except for 30 s and the ER value(P<0.05),but the D value and ER difference between 30 s were not statistically significant(P>0.05).In 43 cases of endometrial carcinoma,TTP was(50 + 10)s.2 cases of endometrial carcinoma showed III curve,and there was no significant difference in the corresponding D value,ER and TTP with the normal myometrium(P>0.05).Conclusion:1.DCE-MRI combined with DWI can accurately show the depth of myometrial invasion in endometrial cancer compared with MRI plain scan,so the accuracy of preoperative staging is significantly improved,especially for identifying Ia and Ib stage.2.There was a positive correlation between the degree of tumor differentiation and the value of ADC.There was significant difference between the middle and low,high and low differentiation groups(P<0.05),but there was no significant difference between the high and middle differentiation groups.but there are still small amount of overlap,therefore has great value in differentiating different pathological grades.3.TIC curve can directly show the contrast between the endometrial cancer and normal muscle layer,which can preliminarily reflect its' hemodynamic characteristics.