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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (03) : 257 -265. doi: 10.3877/cma.j.issn.1673-5250.2020.03.002

所属专题： 专题评论； 文献；

全民健康助力全面小康

子宫内膜癌的MRI评估
叶芷君1, 宁刚1,†(), 李学胜1, 白万晶1   
  1. 1. 四川大学华西第二医院放射科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
  • 收稿日期:2020-01-30 修回日期:2020-05-09 出版日期:2020-06-01
  • 通信作者: 宁刚

Current research status on evaluation of endometrial carcinoma by MRI

Zhijun Ye1, Gang Ning1,†(), Xuesheng Li1, Wanjing Bai1   

  1. 1. Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-01-30 Revised:2020-05-09 Published:2020-06-01
  • Corresponding author: Gang Ning
  • About author:
    Corresponding author: Ning Gang, Email:
  • Supported by:
    National Key Research & Development Project(2017YFC0109004)
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引用本文：

叶芷君, 宁刚, 李学胜, 白万晶. 子宫内膜癌的MRI评估[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(03): 257-265.

Zhijun Ye, Gang Ning, Xuesheng Li, Wanjing Bai. Current research status on evaluation of endometrial carcinoma by MRI[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(03): 257-265.

子宫内膜癌(EC)是我国妇科常见的3大恶性肿瘤之一。目前，EC发病率呈逐年上升趋势。EC在发病早期是一种相对惰性和可治愈的疾病，而至疾病晚期或复发时，则侵袭性较高。对EC患者准确地进行术前评估，对于制定个体化治疗方案至关重要。MRI作为EC最准确的医学影像学检查方法，可以在术前确定该病患者的国际妇产科联盟(FIGO)临床分期及进行预后评估。目前，除常规MRI检查外，MRI动态增强灌注成像(DCE-MRI)、弥散张量成像(DTI)和体素内不相干运动成像(IVIM)等新技术，在EC患者的术前及预后评估中的应用，已经成为本领域研究热点。笔者拟就EC患者的MRI表现与其FIGO临床分期的关系，EC患者诊治中的MRI新技术，以及MRI对于保留生育功能EC患者的预测价值的研究、应用现状等进行阐述。

关键词: 子宫内膜肿瘤, 子宫肌层, 动态增强MRI, 磁共振成像，弥散, 体素内不相干运动成像, 肿瘤浸润, 生育力, 女(雌)性

Endometrial carcinoma (EC) is one of three most common gynecological malignant tumors in China, and its incidence is with ascending tendency in recent years. EC is a relatively inert and curable disease in early stage, while it is highly aggressive in late stage or recurrence. The accurate preoperative evaluation is an important examination strategy for treatment of EC. MRI as the most accurate imaging examination method for EC can distinguish its clinical stage of International Federation of Gynecology and Obstetrics (FIGO) and evaluate its prognosis. In recent years, except for routine MRI, the application of dynamic contrast enhanced MR imaging (DCE-MRI), diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM) and other new imaging methods in preoperative and prognostic evaluation of EC have become a hotspot in this field. This paper focuses on the latest research status of relationship between MRI findings of patients with EC and its clinical stage of FIGO, new MRI technologies in diagnosis and treatment of EC patients, and predictive values of MRI in EC patients with fertility preservation.

Key words: Endometrial neoplasms, Myometrium, Dynamic contrast enhanced MR imaging, Diffusion magnetic resonance imaging, Intravoxel incoherent motion, Tumor infiltration, Fertility, Female
表1 EC患者的FIGO临床分期与其术前MRI辅助检查结果比较
FIGO临床分期 组织病理学检查结果 术前MRI辅助检查结果
Ⅰ期 肿瘤局限于子宫体
ⅠA期 仅限于子宫内膜或DMI<1/2 肿瘤局限于子宫内膜或侵犯至结合带，DMI<1/2
ⅠB期 DMI≥1/2 DMI≥1/2，而且增强MRI检查时，肿瘤超出结合带外轮廓
Ⅱ期 肿瘤侵犯宫颈间质，但是未超出子宫 宫颈间质环T2低信号破坏，T1增强宫颈间质信号破坏
Ⅲ期 肿瘤局部或区域扩散
ⅢA期 肿瘤侵犯浆膜层和(或)附件 浆膜层连续性破坏，或周围腹膜/附件上出现结节影
ⅢB期 阴道和(或)宫旁受累 肿瘤扩散至阴道上段或宫旁
ⅢC期 盆腔和(或)腹主动脉旁淋巴结转移 盆腔淋巴结或腹主动脉旁淋巴结肿大
ⅢC1期 盆腔淋巴结呈阳性 盆腔淋巴结肿大(短径>8 mm)
ⅢC2期 腹主动脉旁淋巴结呈阳性，伴或不伴盆腔淋巴结呈阳性 腹主动脉旁淋巴结肿大(短径>10 mm)
Ⅳ期 肿瘤侵犯膀胱和(或)直肠，和(或)远处转移
ⅣA期 肿瘤侵犯膀胱和(或)直肠 肿瘤扩散至膀胱/直肠，T2膀胱/直肠壁低信号破坏
ⅣB期 远处转移，包括腹腔转移和(或)腹股沟淋巴结 腹腔内转移，包括腹膜内或腹膜外。远处转移(血行播散)至肺、骨或肝脏，远处淋巴结肿大
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