宫颈癌MR扩散加权成像特点研究：ADC值与临床病理特征的关系  

Diffusion Weighted MRI in Cervical Carcinomas:ADC Values and Its Relationship with Clinical and Pathological Features

作　　者：曹崑[1] 张晓鹏[1] 孙应实[1] 唐磊[1] 汪宁[1] 

机构地区：[1]北京大学临床肿瘤学院 北京肿瘤医院暨北京市肿瘤防治研究所医学影像科,100142

出　　处：《临床放射学杂志》2009年第7期957-960,共4页Journal of Clinical Radiology

基　　金：国家重点基础研究发展计划(973)资助项目(项目编号2006CB705706)

摘　　要：目的探讨宫颈癌的扩散成像特征及临床应用价值。通过对表观扩散系数(ADC)值的分析,观察与病灶大小、临床治疗方式及鳞癌病理分化程度等方面的关系。资料与方法搜集本院行盆腔MRI检查并确诊为宫颈癌的连续病例,符合入组条件者共计105例,均于治疗前行扩散成像,b值=1000s/mm2。记录病灶病理类型及分化程度,测量其大小,按临床治疗方式分为手术组和放化疗组。采用后处理工作站的像素分析软件进行ADC值的测量和计算,逐层划定包括全部病灶的感兴趣区(ROI),记录各区段像素的分布情况,计算平均ADC值(ADCav)和中位ADC值(ADCm),以闭孔内肌作为对照部位。统计分析ADC值与病灶大小、分化程度、临床治疗方式的关系。结果ADCav(1.128±0.1468)×10-3mm2/s与ADCm(1.083±0.1591)×10-3mm2/s之间呈强相关性(r=0.990),且前者高于后者,有显著性差异(P<0.001)。两个ADC值与病灶横断面长径(a)、最大面积(S)、体积(V)均具有轻度负相关性(r=-0.265～-0.321,P<0.01)。手术组病灶的a、S、V均小于放(化)疗组(P<0.01),而ADC值均高于放(化)疗组(P<0.05)。不同分化程度鳞癌的病灶大小指标及ADC值均未出现差异。结论宫颈癌扩散加权成像可以提供形态学以外的信息,与病灶临床病理表现有一定关系。病灶内部ADC值为轻微左移的正态分布,病灶越大其ADC值趋向于越低。体积小且ADC值高的病灶在临床上具有相对多的手术机会。Objective To evaluate the role of diffusion weighted imaging（DWI） in uterine cervical carcinoma by exploring the relationship of ADC values with the lesion size, the oncologic therapeutic approach and various pathological grades of squamous cell carcinoma. Materials and Methods Totally 105 consecutive cases with pathologically proved cervical cancers were included in this study. MR examinations, including routine imaging and DWI were performed before therapy on a 1.5T scanner. The size, treatment, and pathological type were recorded. Analysis and measurement of DWI were performed on a post-process workstation with a pixel-analysis-software. Results Mean ADC values（ 1. 128 ＋ 0. 1468×10^-3mm^2/s） were much higher than median ADC values（ 1. 083 ＋0. 1591 ×10^-3mm^2/s） （P 〈0. 001 ） ,and got very strong positive linear correlation （ R = 0. 990）. There was a slightly negative correlation （ R = -0. 265 - - 0.310 ） between ADC values and tumor size. The sizes of lesions in operation group were significantly smaller than that of（chemo-） radiation group （ P 〈 0.01 ） , while the ADC values were higher in operation group（P 〈 0.05 ）. There were no significant differences found in ADC values between different grades of squamous cell carcinomas. Conclusion The ADC value in a whole tumor has normal distribution, with slight shift to left. There is a tendency that the larger the size,the lower the ADC values. Lesions with smaller size and higher ADC values may get more opportunity for operation.

关 键 词：宫颈癌 磁共振成像 扩散加权成像 

分 类 号：R737.33[医药卫生—肿瘤]