The Application Of MRI In Preoperative Staging Of Endometrial Carcinoma And The Diagnostic Value Of ADC

Part ?:The Application of MRI in Preoperative Staging of Endometrial carcinomaObjective:To investigate the application value of MRI in preoperative staging of endometrial cancer compared with postoperative pathology.Materials and methods: To collect 76 patients from Bengbu Medical College First Affiliated Hospital from October,2017 to October,2018,during which they were diagnosed with endometrial carcinoma after surgery by pathology.Their ages are from 31 to 76 and the average ages are 54.11±7.82.Among them 73 are with endometrial adenocarcinoma,2 with serous gonadal carcinoma and 1 with transparent cell carcinoma.Routine MRI scans and diffusion weighted imaging scanning are performed in all of the 76 patients before surgery.The sensitivity,specificity,positive predictive value,negative predictive value and the accuracy of MRI before operation are calculated according to the preoperative staging of the patients by MRI images and the postoperative pathological staging as the gold standard.The kappa value of the method and the postoperative pathological staging are detected.Results:The sensitivity,specificity,positive predictors and negative predicted values of endometrial carcinoma ?a,?b,? and ? in the preoperative period diagnosed by MRI are respectively 90.6%,95.7%,98% and 81.5%.87.5%,94.1%,63.6%,98.5%;88.9%,95.5%,72.7,98.5%;83.3%,100%,100%,92.1%;the accuracy is 89.5%(68/76),and the kappa value is 0.795.Conclusion: The pathological accuracy and consistency of MRI in preoperative staging of endometrial carcinoma is higher than that after operation.MRI can be used to guide the clinical staging of patients with endometrial carcinoma,and to bring better help to clinical treatment.Part ?:Correlation analysis of the prognostic factors of MR Apparent diffusion coefficient(ADC) in endometrial carcinomaObjective:To investigate the relationship between the ADC value of MR and different pathological classification of endometrial carcinoma,and to explore the correlation between the ADC value of MR and staging,thus to determine the prognosis of endometrial cancer more accurately.Materials and Methods:To choose 73 cases of female patients with endometrial adenocarcinoma confirmed by pathology in the first part,and excluding 2 cases of serous adenocarcinoma and 1 case of transparent cell carcinoma.The above patients are measured multiple times at the Philips Achieva 3.0 T MR post-processing workstation to obtain the average ADC value.The difference of ADC value between pathological grading is compared by single factor variance analysis.The correlation between the two is then analyzed by Spearman level correlation analysis.Then the patients with middle differentiation endometrial carcinoma are selected from the above objects.Cases with fewer high differentiation and low differentiation are excluded.The correlation between ADC value and staging is analyzed by Spearman correlation analysis.The correlation between ADC value and age is analyzed by pearson correlation analysis.Results: In this study,the average ADC values of 73 cases of endometrial adenocarcinoma with high(level ?),Medium(level ?)and Low(level ?)differentiation are respectively(0.917±0.077)x10-3mm2/s,(0.769±0.081)x10-3mm2/s,(0.709±0.092)X10-3MM2/S.There is a statistically significant difference between any two ones of them(P=0.000) and also between pathological classification groups by single factor Variance analysis(f=30.09,p<0.01).Further comparison of any two ones in the group of pathological classification is done by using LSD multiple comparison.There are significant differences in the average ADC values between level ? and level ?,Level ? and level ?,level ? and level ?(p<0.05) in the pathological classification of endometrial adenocarcinoma.The ADC value of high differentiation endometrial carcinoma is divided into a group,and the cases of middle and low differentiation are divided into one group.The area under the curve,after the analysis of the two groups by ROC curves,is 0.929.When the ADC value takes 0.795,the sensitivity is 94% and the specificity is 22%.The Spearman grade correlation analysis shows that the ADC value is negatively correlated with the pathological classification of endometrial adenocarcinoma(r=-0.651,p<0.05)and that there is no significant correlation between ADC value and middle differentiation endometrial adenocarcinoma staging(r=-0.116,p=0.483>0.05).there is no significant correlation between ADC value and middle differentiation endometrial adenocarcinoma age(r=-0.217,p=0.185>0.05).Conclusion: 1.There is a statistically significant difference between the ADC value and the different pathological grades of endometrial adenocarcinoma,and the correlation between them is negative;ADC can predict the differentiation degree of endometrial carcinoma and has a reference value for the determination of pathological classification of endometrial carcinoma,so as to better evaluate the prognosis of endometrial carcinoma patients.2.There is no significant correlation between ADC value and middle differentiation endometrial adenocarcinoma staging.3.There is no significant correlation between ADC value and middle differentiation endometrial adenocarcinoma age.