The Differential Diagnostic Value Of Multimodal MRI In Cervical Cancer And Endometrial Cancer Involving Both The Uterine Body And Cervix Simultaneously

Objective:To explore the value of multimodal MRI in the differential diagnosis of cervical carcinoma（CC）and endometrial carcinoma（EC）with uterine body and cervix simultaneously involved.First,observe and describe the morphological characteristics of the lesions at the macro level,measure the diameters of the two tumors,and then use Dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）to conduct a semi-quantitative analysis of the blood perfusion characteristics of the two cancer lesions,finally,based on the apparent diffusion coefficient（ADC）map in diffusion-weighted magnetic resonance imaging（DW-MRI）,the microscopic structure of two malignant tumors was quantitatively analyzed.Evaluate whether there are statistical differences between the indicators of the two diseases.Methods:Retrospective collection of cervical cancer patients（48cases）and endometrial cancer patients（34 cases）confirmed by biopsy or postoperative pathology from May 2016 to October 2022 in our hospital.All subjects underwent routine MRI imaging,3.0T DCE-MRI and DWI before surgery.First,we analyzed the age distribution characteristics of the two diseases、tumor diameter[(sagittal upper and lower diameter（SI）/vertical diameter corresponding to the maximum diameter in the transverse axis（VL）,the maximum diameter in the transverse axis（ML）/sagittal upper and lower diameter（SI）];and described the relevant MRI morphological characteristics:early enhancement mode of tumor（high enhancement,low enhancement）,cervical interstitial integrity and endometrial secretion retention;then obtain the time-intensity curve（TIC）of the region of interest（ROI）,summarize and compare the curve type composition ratio of the two groups of tumors for diagnostic significance,and calculate the time to peak（TTP）、maximum slope of increase（MSI）、signal enhancement ratio（SER）and clearance ratio（WR）.Draw box chart and receiver operating characteristic curve（ROC）for valuable indicators,compare the diagnostic efficacy of each indicator,and calculate the diagnostic threshold,sensitivity and specificity to distinguish the two diseases;finally,draw the ROI on the ADC map of the two cancers,calculate and compare whether the average ADC values of the two cancers are statistically different,and if there are differences,calculate the diagnostic threshold,sensitivity and specificity to identify the two cancers.Results:（1）The age of patients with cervical cancer ranged from 37to 86 years old,with an average age of（56±11）years;the age of endometrial cancer patients ranged from 29 to 76 years old,with an average age of（57±9）years.There was no statistical difference between the two groups（P>0.05）.The SI/VL[1.28（1.06～1.54）]cm of cervical cancer and the SI/VL[1.92（1.60～2.35）]cm of endometrial cancer were significantly different（P<0.05）.The AUC was 0.835,the diagnostic threshold was 1.59,the sensitivity was 81.3%,and the specificity was79.4%;there was a significant difference between the ML/SI[0.92（0.81～1.10）]cm of cervical cancer and the ML/SI[0.78（0.56～0.94）]cm of endometrial cancer（P<0.05）.The AUC was 0.704,the diagnostic threshold was 0.73,the sensitivity was 89.6%,and the specificity was47.1%.（2）Morphological features of MRI:the number of high enhancement in cervical cancer was significantly higher than that in endometrial cancer,and there was a significant difference between them（P<0.001）,AUC was 0.762,sensitivity was 72.9%,specificity was 79.4%.Cervical cancer and cervical fibrous matrix are more susceptible to involvement,and there is a significant difference between the two（P<0.001）,the AUC is 0.754,the sensitivity is 97.9%,the specificity is52.9%;the retention of endometrial secretion in the differentiation of the two was not statistically significant（P>0.05）.（3）DCE-MRI TIC type and semi-quantitative analysis:among 48cases of cervical cancer,1 case of TIC showed type I,13 cases of TIC showed type II,and 34 cases of type III;Among 34 cases of endometrial carcinoma,2 cases of TIC showed type I,10 cases showed type II,and 22cases showed type III.There was no statistical difference between the two curve types（P>0.05）.There was no significant difference between the peak time of cervical cancer[46.7（35.99～67.78）]s and that of endometrial cancer[43.26（35.99～75.82）]s（P>0.05）;The slope value of cervical cancer[0.03（0.02～0.04）]is higher than that of endometrial cancer[0.02（0.01～0.03）]（P<0.05）,AUC is 0.703,diagnostic threshold is 0.02,sensitivity is 72.9%,specificity is 67.6%;the enhancement rate of cervical cancer[145（114～176）%]was higher than that of endometrial cancer[103（86～116）%]（P<0.001）,the AUC was 0.83,the diagnostic threshold was 120%,the sensitivity was 72.9%,and the specificity was85.3%;the clearance rate of cervical cancer[9（7～15）%]was lower than that of endometrial cancer[16（9～25）%]（P<0.05）,the AUC was 0.676,the diagnostic threshold was 11%,the sensitivity was 58.3%,and the specificity was 73.5%.（4）DWI quantitative analysis:there was a significant difference between the ADC of 34 cases of endometrial cancer[77（66～86）x10^–5mm²/s]and 48 cases of cervical cancer[85（78～92）x10^–5mm²/s]（P<0.05）,the AUC was 0.683,the diagnostic threshold was74.6×10^-5mm²/s,the sensitivity was 85.4%,and the specificity 44.1%.Conclusion:Morphological features of MRI are of great help to differentiate them.The semi-quantitative parameters of DCE-MRI can directly compare the internal blood perfusion information of the two cancer foci,that is,the enhancement characteristics,and have high diagnostic efficiency.The average ADC value has certain reference significance for the differentiation of endometrial cancer and cervical cancer.