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MRI对宫颈癌子宫动脉化疗栓塞治疗疗效的评价

作者:张 嫣 陈园园 江魁明 王 霞 叶志球 郭庆禄 梅世伟

所属单位:广东省妇幼保健院放射科(广东 广州 511400)

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摘要

目的探讨MRI对子宫动脉化疗栓 塞治疗宫颈癌疗效的评价价值。方法 回 顾性分析经病理证实的44例宫颈癌患者 的临床、MRI资料,所有患者均行子宫动 脉化疗栓塞术治疗且术前、术后均行MR 检查,评估治疗前后MRI影像变化。结果 术前MRI诊断宫颈癌病灶最大径平均值为 (4.7±1.4)cm,术后病灶最大径平均值 为(2.9±1.5)cm,治疗前后病灶最大径差 异有统计学意义,P<0.05;对比治疗前 后宫颈癌病灶的ADC值,治疗前平均值为 (0.904±0.2230)×10-3mm2 /s,治疗后平 均值为(1.041±0.231)×10-3mm2 /s,二者 差异有统计学意义,P<0.05;鳞癌治疗有 效率86.1%,高于其他病理类型总有效率 50.0%,P<0.05;对比鳞状细胞癌治疗前 后ADC值变化,治疗前后两者差异有统计 学意义,P<0.05;对比其他病理类型宫颈 癌治疗前后变化,二者差异无统计学意 义,P>0.05。结论 MRI有助于早期评价子 宫动脉化疗栓塞治疗的疗效;且鳞状细胞 癌对该治疗方案的反应优于其他病理类型 宫颈癌。

Objective To analyze the value of magnetic resonance imaging in assessing the effect of uterine artery chemoembolization of cervical cancer. Methods The retrospective analysis was performed in the clinical, MRI and pathological information of 44 cervical cancer patients. All the patients accepted the Uterine artery chemoembolization and the MRI examination was performed before and after the treatment. The variation of MRI images was evaluated before and after the treatment. Results The MRI diagnosis before the operation shows the average value of the maximum diameter of the focus was (4.7±1.4) cm, after the operation the average value of the maximum diameter of the focus was (2.9±1.5) cm. The change had the statistical significance, P<0.05, to compared the ADC value of the cervical cancer lesions before and after the treatment, the average value before the treatment was (0.904±0.2230)×10-3mm2 /s, the average value after the treatment was (1.041±0.231)×10-3mm2 /s and the difference between them had the statistics significance, P<0.05, patients with squamous cell carcinoma showed a better response rather than patients with other pathological types(86.1% vs. 50.0%) , P<0.05. To compared the variation of ADC value of squamous-cell carcinoma before and after the treatment, the difference between them had the statistics significance, P<0.05; to compared the variation of other pathological types of cervical cancer before and after the treatment, the change has no statistics significance, P>0.05. Conclusion MRI may be useful for early evaluation the treatment effect of Uterine artery chemoembolization in cervical cancer and the response of this treatment plan of the squamous cell cancer was better than that of the cervical cancer of other pathological types.

【关键词】宫颈癌;磁共振成像;弥散加权成像;新辅助化疗;子宫动脉化疗栓塞

【中图分类号】R445.2

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.07.035

前言

宫颈癌是严重威胁女性健康的最常见的恶性肿瘤之一,其恶性程 度高,预后差。近年来其治疗模式在发生不断的变化,术前新辅助化 疗应用越来越广泛,已成为缩小局部晚期宫颈癌病灶或盆腔局限性晚 期宫颈癌术前降期的一种有效方法。子宫动脉栓塞化疗是一种疗效快 且副作用少的化疗方式,近年已成熟应用于宫颈癌新辅助化疗。MRI是 诊断宫颈癌最优的影像检查手段,能提供准确的分期信息[1],且结合 弥散加权成像能早期无创性评价新辅助化疗后病灶的变化[2]。本研究 中,笔者通过分析宫颈癌患者子宫动脉化疗栓塞治疗前后的MRI影像资 料,探讨MRI对动脉化疗栓塞术疗效的评估价值。