多模态MRI检查对宫颈癌诊断与放疗疗效评价临床应用价值  

Application of multimodal MRI in the diagnosis and evaluation of radiotherapy for cervical cancer

作　　者：武霞 朱振凤 王维青 刘学键 王彩霞[2] WU Xia1 , ZHU Zhen-feng1 , WANG Wei-qing1 , LIU Xue-jian1 , WANG Cai xia2(1. Department of Oncology , Third People＇s Hospital of Linyi , Linyi 276023, P. R. China 2. Department of Chemotherapy,Provincial Hospital of Shandong Province. Jinan 250021, P. R. Chin)

机构地区：[1]临沂市第三人民医院肿瘤科,山东临沂276023 [2]山东省立医院化疗科,山东济南250021

出　　处：《中华肿瘤防治杂志》2018年第3期201-206,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：国家自然科学基金重点项目(30930038);国家自然科学基金(81302292)

摘　　要：目的宫颈癌居于妇科恶性肿瘤的首位,严重威胁着女性健康,放射治疗是宫颈癌主要治疗方法之一。宫颈癌准确的诊断、分期及治疗方案的制订、治疗效果取决于临床检查方法。本研究探讨多模态磁共振(magnetic resonance imaging,MRI)检查在宫颈癌患者的诊断分期及评价放疗疗效的应用价值。方法选取2015-01-01-2016-12-30临沂市第三人民医院肿瘤中心经宫颈活检确诊的宫颈癌患者78例为宫颈癌组,其中经MRI检查分期Ⅱ期以上68例(10例为Ⅰ期患者选择手术)为放疗组;选择同期经妇科常规检查、超声和CT等排除宫颈病变者20例为正常对照组。所有入组者均行常规MRI、DWI及早期增强率(DCE)增强检查,分析其动态曲线、DCE、TIC,观察其平均表观扩散系数值(ADC)及最小ADC值,比较宫颈癌患者的FIGO分期与MRI分期。结果宫颈癌组平均ADC值为(1.036 1±0.019 4)×10^(-3) mm^2/s,与正常组的(1.873±0.027 4)×10^(-3) mm^2/s比较,差异有统计学意义,t=10.411,P=0.009 2;宫颈癌组最小ADC值为(0.910±0.018 3)×10^(-3) mm^2/s,与正常组的(1.760±0.024 3)×10^(-3) mm^2/s比较,差异有统计学意义,t=11.795,P=0.008 1;放疗前后平均ADC值的比较差异有统计学意义,t=9.896,P=0.018 7;放疗前后最小ADC值的比较差异有统计学意义,t=10.124,P=0.009 3。宫颈癌放疗前后DCE比较差异有统计学意义,χ~2=13.722,P=0.017 8;放疗前后TIC比较差异有统计学意义,χ~2=14.183,P=0.016 4。68例宫颈癌放疗前60例为平台型,放疗后8例为平台型(放疗后残瘤存在),χ~2=14.526,P=0.009 66;放疗前64例呈单相型,放疗后8例为单相型,差异有统计学意义,χ~2=15.986,P=0.008 04。MRI显示病灶分期与FIGO分期基本一致。结论多模态下MRI检查能清晰显示宫颈癌肿瘤大小及侵犯范围,为宫颈癌诊断、分期及放疗疗效评估方面提供有力的依据,可作为宫颈癌分期及评价放疗疗效的常规检查。OBJECTIVE Cervical cancer is the first in gynecological malignant tumor, which seriously threatens women＇s health. Radiotherapy is one of the main treatment methods for cervical cancer. The accurate diagnosis, staging and treatment of cervical cancer are determined by the clinical examination method. This study investigated the application value of multimodality magnetic resonance imaging （MMR） in the diagnosis of cervical cancer patients and the evaluation of radiotherapy. METHODS From January 1,2015 to December 30,2016,78 cases pathologically conformed cervical canc- er patients in Tumor Center of Third People＇s Hospital of Linyi were selected as the observation group,including MRI grade 11 or above 68 cases as the radiation group, 20 cases gynaecologic patients as normal group. All the patients were given routine MRI and DWI and DCE examination and the dynamic curve, early enhancement rate （DCE）, TIC, the average apparent diffusion coefficient （ADC） value and the minimum ADC values were observed. FIGO staging with MRI staging of cervical cancer patients were compared. RESULTS The average ADC value of cervical cancer group was compared with normal group （t=10. 411,P=0. 009 2）. The minimum ADC value of cervical cancer group was compared with the normal group （t= 11. 795, P = 0. 008 1）. Before and after radiotherapy, the average ADC value was compared （t= 9. 896, P = 0.018 7）. The minimum ADC value before and after radiotherapy was compared （t = 10. 124, P = 0. 009 3）. There was significant difference between the two groups（P〈0.05）. The early enhancement rate （DCE） of cervical cancer radiothera- py was compared （X^2 = 13. 722, P = 0. 017 8）. Before and after radiotherapy, TIC was compared （X2 = 14. 183, P = 0. 016 4）. There was significant difference between the two groups （P〈0.05）. 68 cases of cervical cancer radiotherapy were platform-type, and 8 of them were platform-type after radiotherapy Totally （X^2 = 14. 526, P = 0. 009 66）. The first 64 cases of

关 键 词：宫颈癌 磁共振成像 弥散加权成像 表观扩散系数 放射治疗 

分 类 号：R737.9[医药卫生—肿瘤]