DWI在宫颈癌诊断和放疗后疗效评价中的价值  

The value of DWI in diagnosis of cervical cancer and monitoring radiotherapy efficacy

作　　者：王立侠[1] 刘佩芳[2] 叶兆祥[2] 

机构地区：[1]首都医科大学附属北京朝阳医院放射科,北京100020 [2]天津医科大学附属肿瘤医院放射科,天津300060

出　　处：《放射学实践》2014年第2期136-139,共4页Radiologic Practice

基　　金：北京市博士后基金资助(2011ZZ-08)

摘　　要：目的：对宫颈癌组织、正常宫颈、放疗后宫颈癌组织的扩散加权成像（DWI）表现及表观扩散系数（ADC）值进行分析。探讨DWI在宫颈癌诊断以及放疗后疗效监测中的价值。方法：对177例宫颈癌患者、105例正常宫颈对照组和117例放疗后宫颈癌患者进行横断面／矢状面DWI扫描（b取0和500s／ram。），观察正常宫颈、宫颈癌及放疗后宫颈癌的DwI表现，并测量相应的ADC值，比较正常宫颈腺体和纤维间质的ADC值，宫颈癌与正常宫颈的ADC值，宫颈癌放疗后恢复正常或炎症反应、放疗后肿瘤残存分别与初诊宫颈癌及正常宫颈的ADC值，放疗后肿瘤复发与初诊宫颈癌及放疗后恢复正常或炎症反应的ADC值差异。结果：105例正常宫颈于DWI上呈高-低-稍高信号，宫颈腺体和纤维间质的ADC值差异具有统计学意义（P=0．025）。177例宫颈癌于DWI上呈高信号，其ADc值（1．08±0．36）×10-3mm2／s）低于正常宫颈（P=0．001）。b=500s／mm2时，诊断宫颈癌和正常宫颈的ROC曲线下面积（AUC）为0．806，95％可信区间为0．626～0．985。117例放疗后宫颈癌中，54例宫颈恢复正常或呈炎性反应，其ADC值较初诊宫颈癌高（P=0．000），与正常宫颈无明显统计学差异（P=0．056）；46例宫颈癌组织残存，其ADC值与初诊宫颈癌无明显统计学差异（P=0．190），但低于正常宫颈（P=0．000），17例放疗后宫颈癌复发，其ADC值与初诊宫颈癌无明显统计学差异（P=0．060），但与放疗后恢复正常或呈炎性反应患者相比具有统计学差异（P=0．002）。结论：DWI能够区分宫颈癌组织和正常宫颈．可用于宫颈癌诊断及预后监测。Objective： To analyze the diffusion weighted imaging （DWI） features and apparent diffusion coefficient （ADC） values of cervical cancer,post radiotherapy lesion and normal cervix,thereafter to assess the values of DWI in diag- nosis of cervical cancer and monitor of efficacy of radiotherapy. Methods： Axial or sagittal diffusion weighted scan （b-- 500s/mm2） of cervix was performed in 177 patients with cervical cancer, 105 healthy women as control and 117 patients with post-radiotherapy cervical cancer. DWI findings were observed and corresponding ADC value were measured in cervical cancer, post-radiotherapy cervical cancer and normal cervix. The ADC values were recorded and compared through statistical analysis between cervical cancer and control group; between post radiotherapy repair or inflammatory reaction, post-radio- therapy residual or recurrence and untreated lesion and control group respectively. Results：Normal cervix showed hyper-, hypo- and moderate hyper-signal intensity on DWI and the ADC values were significantly different between normal cervical glands and interstitial substance （P=0. 025）. All cervical cancers appeared as high signal-intensity and the ADC value was significantly lower than that of normal cervix （P=0.01）. The area of ROC was 0. 806 and 95% confidence interval was 0. 626-0. 985. The ADC values recovered to normal or presented as inflammatory reaction after radiotherapy in 54 cases, which was significantly higher than that of untreated cervical cancer （P： 0. 000）, and had no significant difference from that of normal cervix （P=0. 056）. The ADC value of post-radiotherapy residual in 46 cases was of no significant difference from that of untreated cancer （P： 0. 190）, but was significantly lower than that of normal cervix （P= 0. 000）. The ADC value of tumor recurrence in 17 cases was significantly different from normal or post-radiotherapy inflammation （P=0. 002）, but no difference was found compared with untreated cancer. Conclusion： DW

关 键 词：宫颈肿瘤 磁共振成像 扩散加权成像 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]