Objective: To evaluate Magnetic Resonance Imaging (MRI) at 3.0T in differential diagnosis of the origin of adenocarcinoma at the junction of the lower uterine segment and endocervix. Methods: 71 patients with adenocarcinoma at the junction of the lower uterine segment and endocervix were retrospectively collected. Pelvic MR examinations, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences, were performed within 2 weeks before surgery. MR images were analyzed and measured by two radiologists, including the location of the tumor center, the enhancement pattern, the anterior and posterior diameters, the left and right diameters, the upper and lower diameters, and the apparent diffusion coefficient (ADC) of the tumor. Immunohistochemical method was used as gold standard in distinguishing cervical adenocarcinoma and uterine adenocarcinoma. Results: The upper and lower diameters of uterine adenocarcinoma were [(5.80±2.31) cm], significantly larger than those of cervical adenocarcinoma [(4.16±2.17) cm, P=0.009]. Using 4.5cm as the best cutoff point value, the sensitivity and specificity in distinguishing uterine adenocarcinoma and cervical adenocarcinoma were 68.4% and 65.4%, respectively. According to the location of tumor center, the sensitivity and specificity were 84.2% and 73.1%, respectively. Using tumor enhancement pattern as the criterion, the sensitivity and specificity of diagnosing uterine adenocarcinoma and cervical adenocarcinoma were 68.4% and 80.8% respectively. Conclusions: MRI has certain clinical value in evaluating the origin of adenocarcinoma at the junction of the lower uterine segment and endocervix. The lesions can be diagnosed according to the main location, the characteristics of dynamic enhancement and the growth pattern of the tumor.
目的： 评估3.0T磁共振成像(MRI)对子宫下段和宫颈交界处腺癌病变来源的鉴别诊断价值。 方法： 回顾性分析71例子宫颈体交界处腺癌患者的资料，术前2周内行盆腔MRI检查，包括扩散加权成像和动态对比增强序列。由2位医师分别对MRI图像进行分析和测量，包括判断肿瘤中心位置，评价肿瘤强化特点，测量肿瘤的前后径、左右径及上下径，测量肿瘤的表观弥散系数(ADC)值。采用免疫组化方法作为区分宫颈腺癌和宫体腺癌的金标准。 结果： 宫颈腺癌19例，宫体腺癌52例。宫体腺癌肿瘤的上下径为[(5.80±2.31)cm]，明显大于宫颈腺癌的上下径[(4.16±2.17)cm，P＝0.009]。以肿瘤上下径≤4.5 cm作为最佳截点值，其诊断宫颈腺癌和宫体腺癌的灵敏度和特异度分别为68.4%和65.4%；以肿瘤中心位置为判断标准，其诊断宫颈腺癌和宫体腺癌的灵敏度和特异度分别为84.2%和73.1%；以肿瘤强化特点为判断标准，其诊断宫颈腺癌和宫体腺癌的灵敏度和特异度分别为68.4%和80.8%。 结论： MRI在评价子宫颈体交界处腺癌的起源方面，具有一定的临床价值。依据MRI图像所示的肿瘤主体位置、动态增强强化特点以及肿瘤生长方式，能够对病变予以诊断。.
Keywords: Adenocarcinoma; Cervical neoplasms; Endometrial neoplasm; Magnetic resonance imaging.