Purpose

To evaluate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging for differentiation of endometrial adenocarcinoma and uterine benign lesions.

Procedures

This prospective study enrolled 22 normal volunteers and 113 patients with suspicious uterine lesions, including endometrial adenocarcinoma, leiomyoma, and adenomyosis. Pelvic APTw MRI was performed on a 3-T MRI scanner with default APTw parameters. Two radiologists blindly evaluated uterine lesion APTw image quality by a 3-point Likert scale and independently measured APTw values on images with excellent to good image quality. Inter-reader agreement was evaluated. The Mann-Whitney U test with Bonferroni correction was used to compare the differences among different types of uterine lesions. A receiver operating characteristic analysis was performed.

Results

A total of 111 lesions (33 endometrial adenocarcinoma, 26 leiomyoma, and 52 adenomyosis lesions) from 99 patients revealing a majority of good quality with excellent inter-reader agreement were included for the image quality evaluation. APTw values of endometrial adenocarcinoma were 2.9 ± 0.1 %, significantly higher than those of leiomyoma (1.9 ± 0.1 %), adenomyosis (2.2 ± 0.1 %), and normal uterine myometrium (1.9 ± 0.1 %) (all p < 0.0001). The area under the receiver operating characteristic curve for differentiating endometrial adenocarcinoma from leiomyoma, adenomyosis, and myometrium was 0.87, 0.85, and 0.91, respectively. Feasible threshold APTw values of each group were determined as 2.4 %, 2.7 %, and 2.4 % with a sensitivity of 83.3 %, 76.7 %, and 83.3 % and a specificity of 83.3 %, 81.6 %, and 86.4 %, respectively.

Conclusions

Malignant endometrial adenocarcinoma had significantly higher APTw values than leiomyoma, adenomyosis, and normal uterine myometrium. Our study adds to the growing body of validation on 3D APTw imaging and uterine lesions.

中文翻译：

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利用酰胺质子转移加权 MRI 无创鉴别子宫内膜腺癌与子宫良性病变

目的

评估三维 (3D) 酰胺质子转移加权 (APTw) 成像在区分子宫内膜腺癌和子宫良性病变中的效用。

程序

这项前瞻性研究招募了 22 名正常志愿者和 113 名可疑子宫病变患者，包括子宫内膜腺癌、平滑肌瘤和子宫腺肌病。骨盆 APTw MRI 在具有默认 APTw 参数的 3-T MRI 扫描仪上进行。两名放射科医师通过李克特 3 点量表盲目评估子宫病变 APTw 图像质量，并独立测量图像质量优至优的 APTw 值。评估了读者之间的一致性。采用带有 Bonferroni 校正的 Mann-Whitney U检验比较不同类型子宫病变之间的差异。进行了接收器操作特性分析。

结果

图像质量评估包括来自 99 名患者的 111 个病灶（33 个子宫内膜腺癌、26 个平滑肌瘤和 52 个子宫腺肌病病灶），这些病灶显示大部分质量良好，具有良好的读者间一致性。子宫内膜腺癌的 APTw 值为 2.9 ± 0.1 %，显着高于平滑肌瘤 (1.9 ± 0.1 %)、子宫腺肌病 (2.2 ± 0.1 %) 和正常子宫肌层 (1.9 ± 0.1 %) (所有p< 0.0001)。区分子宫内膜腺癌与平滑肌瘤、子宫腺肌病和子宫肌层的受试者工作特征曲线下面积分别为0.87、0.85和0.91。每组的可行阈值 APTw 值分别确定为 2.4%、2.7% 和 2.4%，灵敏度分别为 83.3%、76.7% 和 83.3%，特异性分别为 83.3%、81.6% 和 86.4%。

结论

恶性子宫内膜腺癌的 APTw 值显着高于平滑肌瘤、子宫腺肌病和正常子宫肌层。我们的研究增加了对 3D APTw 成像和子宫病变的验证。