论著-头颈部
3.0T MRI功能成像 对宫颈癌术前分期 的临床价值*
作者:向 旭1 殷 洁1 尤国庆2 吕国义1 李建灵1
所属单位:1.河南省南阳市中心医院核磁共振 室 (河南 南阳 473009) 2.河南省南阳市中心医院核磁CT室 (河南 南阳 473009)
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目的 探讨3.0T MRI功能成像对 宫颈癌术前分期的临床诊断价值。方法 选取2012年9月至2017年5月期间郑州大学 附属医院/南阳市中心医院收治的108例 宫颈癌患者为研究对象,均使用GE 3.0T 磁共振扫描仪以快速自旋回波(FSE)序列 行横轴位、矢状位扫描,以横轴位平面回 波成像(ERPI)序列行弥散加权成像(DWI) 扫描。根据影像学特点确定宫颈癌分期、 分化程度,并与术后病理诊断结果对比。 结果 术前MRI分期和术后病理分期比较差 异无统计学意义(χ2 =2.77,P>0.05), MRI对宫颈癌临床分期Ⅰb期、Ⅱa期、 Ⅱb期、Ⅲa期、Ⅲb期、Ⅳa期及Ⅳb期鉴 别诊断准确性依次为84.62%、87.50%、 75.00%、80.00%、77.78%、86.67%、 90.91%,敏感性依次为78.57%、82.35%、 83.33%、75.00%、82.35%、81.25%、 100.00%。术前MRI分化程度和术后病理 分化程度诊断结果比较差异无统计学意 义(χ2 =0.09,P>0.05),MRI对宫颈癌中 低分化、高分化鉴别诊断准确性分别为 90.67%、80.00%,敏感性分别为93.15%、 80.00%。结论 3.0T MRI功能成像对于宫 颈癌术前精确分期有较高的准确性及特异 性,并可用于评价其分化程度,临床应用 价值高。
Objective To evaluate the clinical value of 3.0T MRI functional imaging in preoperative staging of cervical cancer. Methods 108 patients with cervical cancer treated in the Affiliated Hospital of Zhengzhou University/Nanyang Central Hospital from September 2012 to May 2017were selected as the subjects. All patients underwent transverse axial and sagittal scanning performed with GE 3.0T magnetic resonance scanners by the fast spin echo (FSE) sequence. The transverse axial echo planar imaging (EPI) sequence was used for diffusion weighted imaging (DWI) scanning.The stage and differentiation degree of cervical cancer were determined according to the imaging findings, and the results were compared with the results of pathological diagnosis after operation. Results There was no significant difference in preoperative MRI staging and postoperative pathological staging (χ2 =2.77, P>0.05). The accuracies of MRI in the diagnosis of clinical stage I b, stage II a, stage II b, stage III a, stage III b, stage IV a and stage IV bof cervical cancer were 84.62% 87.50%, 75.00%, 80.00%, 77.78%, 86.67% and 90.91%, respectively while the sensitivities were 78.57%, 82.35%, 83.33%, 75.00%, 82.35%, 81.25% and 100.00%.There was no statistically significant difference in differentiation degree diagnosed by preoperative MRI and postoperative pathology (χ2 =0.09, P>0.05). The accuracies of MRI in the diagnosis of low to moderate differentiation and high differentiation of cervical cancer were 90.67% and 80.00%, respectively, and the sensitivities were 93.15% and 80.00%, respectively.Conclusion 3.0T MRI functional imaging is of high accuracy and specificity for accurate staging of cervical cancer, and it can be used to evaluate thedifferentiation degree.
【关键词】MRI;功能成像;宫颈癌;分期
【中图分类号】R711.74
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2018.01.035
前言
近年来,随着广大女性生活方式、习惯的改变及工作生活压力增 大,宫颈癌筛查技术得到普及,性传播疾病增加,宫颈癌的诊断率不 断增加,且呈年轻化趋势。目前宫颈癌治疗以手术治疗为主,其对 切除淋巴结、控制肿瘤转移和复发、改善预后有明显的效果,但肿 瘤大小、浸润深度和范围、淋巴结转移情况等均可影响肿瘤治疗方 案的选择及预后判断[1]。因此,对宫颈癌进行准确诊断及术前分期十 分重要。目前虽然临床可通过活检、血清肿瘤标志物等获得宫颈癌 病理信息,但由于活检不可重复操作或取样数量有限、肿瘤存在异 质性,诊断与术后病理结果可能存在偏差;而宫颈癌血清肿瘤标志 物缺乏特异性,敏感性仍有待提高[2]。随着我国软硬件技术的发展, MRI在盆腔疾病中的应用日益广泛,尤其是弥散加权成像(Diffusion weighted imaging,DWI)作为一种功能成像,可通过测量表观扩散系 数(Apparent Diffusion Coefficient,ADC)值定量区分良、恶性病 变[3]。目前,临床关于3.0T MRI功能成像DWI用于宫颈癌术前分期及分 化程度鉴别诊断的报道较为少见。为此,本研究重点探讨3.0T MRI扫 描及DWI对宫颈癌术前分期及分化程度的评估价值。
中国CT和MRI杂志
第16卷, 第 1 期
2018年01月
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