DWI评估宫颈癌盆腔淋巴结转移的应用价值  

Evaluation of Metastatic Lymph Nodes in Patients with Uterine Cervical Cancer by DWI

作　　者：刘颖[1] 白人驹[2] 刘海东[3] 王德华[4] 叶兆祥[1] 

机构地区：[1]天津医科大学附属肿瘤医院放射科天津市肿瘤防治重点实验室,300060 [2]天津医科大学总医院放射科,300052 [3]天津市中心妇产科医院放射科,300100 [4]天津医科大学总医院妇科,300052

出　　处：《临床放射学杂志》2011年第6期834-838,共5页Journal of Clinical Radiology

摘　　要：目的探讨扩散加权成像(DWI)对于鉴别宫颈癌转移与非转移淋巴结的诊断价值。资料与方法 36例宫颈癌初诊患者于治疗前行常规MRI及DWI检查,观察并比较宫颈癌转移淋巴结与非转移淋巴结常规MRI及表观扩散系数(ADC)图表现,测量各淋巴结的长径(L)、短径(S)、T2信号强度、平均ADC值和最小ADC值,利用受试者工作特征(ROC)曲线下面积(Az)评价上述各项指标鉴别宫颈癌转移与非转移淋巴结的诊断效能。结果转移淋巴结短径和长径的平均秩次均大于非转移淋巴结,且两者差异具有统计学意义(均为P=0.000),而转移淋巴结与非转移淋巴结的L/S、S/L以及T2信号强度差异均无统计学意义(P=0.261;P=0.157;P=0.166);转移淋巴结的平均ADC值和最小ADC值均低于非转移淋巴结,且差异均具有统计学意义(均为P=0.000);短径、长径、平均ADC值和最小ADC值对鉴别宫颈癌转移与非转移淋巴结均有诊断意义(Az>0.5),其中最小ADC值的诊断效能最高,选取最小ADC阈值为0.983×10-3mm2/s时,其敏感性和特异性分别为94.6%和91.8%。结论 DWI有助于宫颈癌转移和非转移淋巴结的检出,最小ADC值对鉴别宫颈癌转移与非转移淋巴结最敏感,其诊断效能高于平均ADC值和形态学指标。Objective To determine the diagnostic value of diffusion weighted imaging（DWI） in the detection of metastatic lymph nodes in uterine cervical cancer.Materials and Methods Thirty six patients with uterine cervical cancer underwent conventional MRI and DWI examinations before surgery.Size-based criteria（short axis diameter,long axis diameter,L/S ratio and S/L ratio）,the signal intensity on T2WI,mean and minimum ADC values were measured in metastatic lymph nodes and non metastatic lymph nodes.A ROC analysis was used to compare the diagnostic effect of each ADC-based criteria on DWI and each of the conventional size-based criteria on T2WI for the differentiation of metastatic lymph nodes from non metastatic lymph nodes.Results There were significant differences between metastatic and non-metastatic lymph nodes in the short-axis and long-axis diameter（P=0.000,P=0.000）.However,there were no significant differences between metastatic and non-metastatic lymph nodes in the L/S ratio,S/L ratio or the signal intensity on T2WI.The mean ADC and minimum ADC value of metastatic lymph nodes was significantly lower than that of non-metastatic lymph nodes（P=0.000,P=0.000）.The short-axis diameter,long-axis diameter,mean ADC and minimum ADC value were contributory to differentiate metastatic lymph nodes from non-metastatic lymph nodes.The area under the ROC curve was greater for minimum ADC than for other criteria.On the basis of ROC analysis,a lymph node with a minimum ADC equal or less than 0.983×10-3 mm2/s was considered to be a metastatic lymph node.Using the minimum ADC criteria,the sensitivity and specificity for differentiating metastatic from non-metastatic lymph nodes were 94.6% and 91.8%,respectively.Conclusion DWI is useful in detection of metaststic lymph nodes in patients with uterine cervical cancer.The short-axis diameter,long-axis diameter,mean ADC and minimum ADC contribute to the diagnosis of metastatic lymph nodes and the minimum ADC shows superior diagnostic effect.

关 键 词：宫颈癌 扩散加权成像 表观扩散系数值 淋巴结 

分 类 号：R737.33[医药卫生—肿瘤]