摘要
目的 探讨超声与MRI在宫颈癌分 期中应用价值。方法 回顾性分析医院61 例经手术病理确诊为宫颈癌患者的术前阴 道超声和MRI影像学资料,分析影像学表 现,对比两种影像学诊断方式诊断宫颈癌 及术前分期的准确性。结果 61例宫颈癌 均经临床病理检查确诊,术前超声诊断宫 颈癌及临床分期的准确率分别为60.66%、 50.82%明显低于MRI的93.44%、85.25%(P <0.05)。37例超声表现异常,宫体不规 则增大,子宫颈形态异常,回声不均匀改 变;肿块呈实质性低回声,血流信号较正 常组织丰富,宫颈黏膜线弯曲、中断或消 失。9例淋巴结肿大,11例侵犯阴道,7例 侵犯宫体,1例侵犯膀胱。57例MRI图像异 常,T1WI等信号或低信号,T2WI以高信号 为主,STIR序列上T2WI高信号,且高于平 扫T2WI,增强扫描后有不同程度的强化。 14例淋巴结肿大,15例侵犯阴道,10例侵 犯宫体,2例侵犯膀胱,1例侵犯直肠。结 论 MRI诊断宫颈癌及其分期的准确率高于 超声,可为临床确定治疗方案提供客观资 料。
Objective To explore the application value of ultrasound and MRI in staging of cervical cancer. Methods The preoperative transvaginal ultrasound and MRI data of 61 patients with cervical cancer confirmed by surgery and pathology were analyzed retrospectively. The imaging findings were analyzed, and the accuracy rates in the diagnosis of cervical cancer and preoperative staging were compared between the two imaging diagnostic methods. Results 61 cases of cervical cancer were diagnosed by clinical and pathological examination. The accuracy rates of preoperative ultrasound in the diagnosis of cervical cancer and clinical stage (60.66%, 50.82%) were significantly lower than those of MRI (93.44%, 85.25%) (P<0.05). Ultrasound of 37 cases showed abnormalities, irregular enlargement of uterine body, abnormal shape of uterine neck and inhomogeneous changes of echo. The tumors presented substantial low echo, and blood flow signals were richer than those in normal tissues. The cervical mucosa line was bent and interrupt or disappeared. There were 9 cases of lymph node enlargement, 11 cases of invasion of the vagina, 7 cases of invasion of the uterine and 1 cases of invasion of the bladder. MRI images of 57 cases were abnormal, showing equal signal or low signal on T1WI and high signal on T2WI, T2WI high signal on STIR sequence, higher than that of plain scan T2WI. After enhanced scan, there were different degrees of enhancement. There were 14 cases with lymph node enlargement, 15 cases with invasion of the vagina, 10 cases with invasion of the uterine, 2 cases with invasion of the bladder and 1 case with invasion of the rectum. Conclusion The accuracy of MRI in the diagnosis of cervical cancer and its staging is higher than that of ultrasound, which can provide objective information for clinical diagnosis and treatment.
【关键词】宫颈癌;MRI;经阴道超声; 术前分期;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- 5131.2016.09.033
前言
宫颈癌是临床常见的恶性肿瘤,发病率位居女性恶性肿瘤的第二 位,近年来发病趋于年轻化[1]。目前,宫颈癌分期标准参照国际妇产 科联盟(FIGO)[2],分期不同临床治疗方案也存在明显差异,直接影响 着疾病预后。因此,术前明确肿瘤分期,了解宫旁浸润程度,对临床 选取合适方式治疗有积极意义。超声是临床诊断宫颈癌的常用方式, 虽然能提高宫颈癌的检出率,但诊断术前分期、宫旁浸润程度的准确 率仍相对较低。MRI具有无创、软组织分辨率高、多方位成像的特点, 可临床治疗提供丰富资料。对此,本文分析了51例宫颈癌患者术前超 声及MRI的影响学资料,并与手术病理对比,现报道如下。
中国CT和MRI杂志
第14卷, 第 9 期
2016年09月
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