Diagnostic performance of preoperative MR imaging findings for differentiation of uterine leiomyoma with intraligamentous growth from subserosal leiomyoma
Diagnostic performance of preoperative MR imaging findings for differentiation of uterine leiomyoma with intraligamentous growth from subserosal leiomyoma
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DOI：
10.1007/s00261-021-03042-7
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发表时间：
2021-04-02
影响因子：
2.4
通讯作者：
Nakamoto, Yuji
中科院分区：
文献类型：
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作者：
Yajima, Ryo;Kido, Aki;Nakamoto, Yuji
目的评价MRI对韧带内生长的子宫肌瘤或阔韧带肌瘤与浆膜下平滑肌瘤的鉴别诊断价值。方法37例经手术证实的子宫平滑肌肿瘤（36例平滑肌瘤和1例恶性潜能不明的平滑肌瘤）均为韧带内生长（IL），37例为大小匹配的浆膜下平滑肌瘤（SS）。两名放射科医生独立评估了八项术前MRI检查结果：肿瘤形状、变性、与子宫附着、卵巢抬高、输尿管移位、膀胱变形、直肠移位以及圆韧带（RL）和子宫动脉（UA）分离。这些结果的诊断价值和观察者之间的一致性进行了评估。对诊断IL的阳性MRI结果的数量进行受试者工作特征（ROC）分析。比较两组患者的手术方法、手术时间、术中出血量、围手术期并发症、术后住院时间等临床结局。结果IL与SS在肿瘤形态、与子宫的附着、卵巢抬高、输尿管移位、RL与UA分离等方面存在显著差异。其中4项结果（不包括输尿管移位）显示了中度至实质性的观察者间一致性。当这四个结果中的两个或更多个为阳性时，读片者1的灵敏度、特异性和ROC曲线下面积分别为91%、77%、0.90，读片者2的灵敏度、特异性和ROC曲线下面积分别为82%、89%、0.91。IL的手术时间明显长于SS。结论肿瘤形态、附着于子宫、卵巢抬高、RL与UA分离是鉴别韧带内平滑肌瘤与浆膜下平滑肌瘤的重要MRI表现。
Purpose To evaluate the diagnostic performance of MRI findings for differentiating uterine leiomyoma with intraligamentous growth, or broad ligament fibroid, from subserosal leiomyoma. Methods This study included 37 patients with surgically confirmed uterine smooth muscle tumors (36 leiomyomas and one smooth muscle tumor of uncertain malignant potential) with intraligamentous growth (IL) and size-matched control of 37 patients with subserosal leiomyoma (SS). Two radiologists independently evaluated eight preoperative MRI findings: tumor shape, degeneration, attachment to uterus, ovary elevation, ureter displacement, bladder deformation, rectal displacement, and separation of round ligament (RL) and uterine artery (UA). The diagnostic values of these findings and interobserver agreement were assessed. Receiver-operating characteristic (ROC) analysis of the number of positive MRI findings for diagnosing IL was performed. Clinical outcomes including surgical method, operation time, intraoperative blood loss, perioperative complications, and postoperative hospital stay of the two groups were compared. Results Significant differences in tumor shape, attachment to uterus, ovary elevation, ureter displacement, and separation of RL and UA were found between IL and SS. Four of these findings, excluding ureter displacement, showed moderate to substantial interobserver agreement. When two or more of these four findings were positive, sensitivity, specificity, and area under the ROC curve were 91%, 77%, 0.90 in reader 1 and 82%, 89%, 0.91 in reader 2. The operation time was significantly longer for IL than for SS. Conclusion Tumor shape, attachment to uterus, ovary elevation, and separation of RL and UA are useful MRI findings for differentiating intraligamentous leiomyoma from subserosal leiomyoma.