目的 比较不同病理类型子宫内膜恶性肿瘤(腺癌、鳞癌及间质肉瘤)的表观扩散系数(apparent diffusion coefficient ,ADC)值是否有区别,探讨磁共振扩散加权成像对子宫恶性肿瘤的临床应用价值。方法 收集手术后经病理证实为子宫恶性肿瘤患者102例(子宫内膜腺癌36例,宫颈腺癌4例、宫颈鳞癌47例、子宫内膜间质肉瘤15例),以及怀疑有其他盆腔病变的女性患者47例(26例卵巢囊肿、21例子宫肌瘤),所有患者术前均行盆腔磁共振扫描(包括常规序列及DWI,DWI选择b值为700 s/mm²),分析不同病理类型子宫恶性肿瘤与正常子宫内膜ADC值之间以及不同病理类型子宫恶性肿瘤ADC值之间的差异。结果 子宫内膜腺癌、鳞癌、内膜间质肉瘤及正常子宫内膜的ADC值分别为:(1.032±0.14) s/mm²、(1.063±0.21) s/mm²、(0.89±0.26)s/mm²、(1.55±0.13) s/mm²。统计分析结果显示:子宫内膜腺癌、鳞癌及肉瘤与正常子宫内膜的ADC值之间的差异有统计学意义(均P<0.05),腺癌与鳞癌的ADC值之间的差异无统计学意义(P>0.05),腺癌与肉瘤、鳞癌与内膜间质肉瘤的ADC值之间的差异有统计学意义(均P<0.05)。子宫内膜恶性肿瘤的ADC值明显低于正常子宫内膜,起源不同的子宫恶性肿瘤的ADC值之间有差异。子宫内膜间质肉瘤的ADC值明显低于腺癌与鳞癌。结论 ADC值有助于子宫内膜恶性肿瘤的量化,对内膜间质肉瘤与腺癌和鳞癌有鉴别诊断价值。

Objective To compare the apparent diffusion coefficient (ADC) value of different pathological types of uterine malignancies (adenocarcinoma, squamous cell carcinoma and sarcoma), and investigate the clinical value of diffusion-weighted MR imaging of malignant tumors of the uterus.Methods A total of 102 patients pathologically confirmed as uterine malignancies (36 cases of endometrial adenocarcinoma, 4 cases of cervical adenocarcinoma, 47 cases of cervical squamous cell carcinoma, and 15 cases of uterine sarcoma) and 47 female patients suspected of other pelvic lesions were selected. The difference between different pathological types of uterine malignancies and normal endometrial ADC values was analyzed,so was the difference between the ADC values of different pathological types of uterine malignancies.Results ADC values of uterine adenocarcinoma, squamous cell carcinoma, sarcoma and normal endometrium were(1.032±0.14) s/mm²,(1.063±0.21) s/mm²,(0.89±0.26)s/mm² and(1.55±0.13) s/mm² respectively. Statistical analysis of the results showed that there was significant difference between the ADC values of uterine adenocarcinoma, squamous cell carcinoma, and endometrial sarcoma and normal ones(P<0.05). The difference of the ADC value between adenocarcinoma and squamous cell carcinoma was not statistically significant (P>0.05),but there was significant difference between the ADC values of adenocarcinoma and sarcoma and between those of squamous cell carcinoma and sarcoma (P<0.05). The ADC value of uterine malignancies was significantly lower than that in normal endometrial. There was difference between the ADC values of uterine malignancies of different origins. The ADC value of uterine sarcoma was significantly lower than that of adenocarcinoma or squamous cell carcinoma.Conclusions The ADC value can facilitate the quantification of endometrial malignant tumors, and is of differential diagnostic value for endometrial stromal sarcoma and adenocarcinoma and squamous cell carcinoma.