论著-头颈部
DWI联合高分辨磁共 振T2WI在宫颈癌盆 腔淋巴结转移中的 应用价值
作者:王志涛1 杨耀文2 杨尧华3 黑静雅4 赵建国1 李文玲1 葸燕燕1
所属单位:1.宁夏医科大学总医院放射科 (宁夏 银川 750004) 2.宁夏自治区第五人民医院放射科 (宁夏 石嘴山 753000) 3.宁夏医科大学总医院妇科 (宁夏 银川 750004) 4.宁夏医科大学总医院病理科 (宁夏 银川 750004)
PDF摘要
目的 探讨弥散加权成像联合高 分辨磁共振T2WI在宫颈癌盆腔淋巴结转 移的诊断价值。方法 选取2014年10月至 2016年2月我院收治的35例宫颈癌患者作 为研究对象,所有患者均接经病理检查证 实。其中鳞癌33例,腺鳞癌1例,腺癌1 例,患者术前均接受DWI联合高分辨磁共 振T2WI检查,根据影像结果明确诊断宫颈 癌盆腔淋巴结转移情况,并比较转移淋巴 结与非转移淋巴结平均表观扩散系数值及 最小ADC值是否存在差异。结果 术前磁共 振检查发现短径超过0.8cm盆腔淋巴结95 个,其中明确淋巴结转移108个,与病理 证实结果比较无统计学差异(P>0.05); 转移性淋巴结T2信号强度略高于非转移 性淋巴结,但差异不具有统计学意义 (P>0.05);转移性淋巴结患者平均ADC值 以及最小ADC值均明显低于非转移性淋巴 结,具有统计学差异(P<0.05)。结论 DWI 联合高分辨磁共振T2WI成像能够清晰观察 宫颈癌盆腔淋巴结转移情况,在鉴别转移 淋巴结与非转移淋巴结中准确性较高,同 时可通过对淋巴结ADC值的定量分析预测 宫颈癌是否发生盆腔淋巴结转移,具有临 床应用及推广价值。
Objective To discuss the application value of DWI combined with T2WI of high resolution MRI in pelvic lymph node metastasis of cervical cancer. Methods Thirty-two cases with cervical cancer, which admitted in our hospital from October 2014 to February 2016, were selected as the research object. All patients were confirmed cervical cancer by surgery and pathology. Among these cases, 33 cases were squamous cell carcinomas, 1 case was gland scale cancer, 1 case was adenocarcinoma. All patients were preoperatively examined by DWI combined T2WI of high-resolution MRI. The Pelvic lymph node metastasis of cervical cancer was diagnosed according to the result of image and apparent diffusion coefficient (ADC) value of the lymph nodes. The average ADC value and minimum ADC value of non-metastasis lymph nodes and metastasis lymph node were compared. Results MRI examination preoperatively revealed 95 pelvic lymph nodes with short diameter greater than 0.8 cm and 108 lymph nodes with definite metastases, it was no significant different compared with the pathological results(P>0.05). The T2 signal intensity of metastatic lymph nodes was slightly higher than the nonmetastatic lymph nodes, but it had no significant difference (P>0.05). The average ADC value and the minimum ADC value of metastatic lymph nodes were significantly lower than that of non-metastatic lymph nodes, the difference was statistically different(P<0.05). Conclusion DWI combined with T2WI of high-resolution MRI can clearly show pelvic lymph node metastasis of cervical cancer. Its accuracy in identification with nonmetastasis lymph nodes is higher. At the same time, it can judge whether pelvic lymph node is invaded by cervical cancer with the quantitative analysis of the ADC values. This technique has clinical application value.
【关键词】扩散加权成像;高分辨磁共 振;宫颈癌;盆腔淋巴结转移
【中图分类号】R445.2;R737.33
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2016.08.00720
前言
宫颈癌是女性发病率最高的恶性肿瘤之一,其在女性生殖系统恶 性肿瘤中占据首位。宫颈癌一般恶化程度中等,临床常通过根治性手 术联合辅助放化疗进行治疗,患者1年、5年生存率并不低[1]。而影响 宫颈癌患者临床预后结局的主要因素为盆腔淋巴结是否发生转移,一 旦发生盆腔淋巴结转移,不仅加大了患者的临床治疗难度,同时也导 致患者预后结局较差[2]。磁共振扩散加权成像(DWI)是目前唯一一种能 够观察活体组织内水分子扩散运动情况的无创性影像学检查,能够简 介的反应组织微观结构的细致变化,应用于宫颈癌的诊断中具有较高 的临床价值,但在明确宫颈癌是否发生盆腔淋巴结转移中仍存在诸多 争议[3]。本组研究通过对35例宫颈癌患者术前磁共振检查以及与术后 病理结果进行比对,探讨DWI联合高分辨磁共振T2WI在宫颈癌盆腔淋巴 结转移中的应用价值,现将结果报道如下。
中国CT和MRI杂志
第14卷, 第 8 期
2016年08月
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