磁共振成像在宫颈癌诊断中的应用价值  

Application of Magnetic Resonance Imagingin the Diagnosis of Cervical Cancer

作　　者：杜聚[1] 李仕红 高燕[1] Du Ju;Li Shihong;Gao Yan(Department of Gynecology,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China;Department of Image,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院妇科,上海200040 [2]复旦大学附属华东医院影像科,上海200040

出　　处：《老年医学与保健》2020年第1期84-87,共4页Geriatrics & Health Care

基　　金：上海市卫生计生系统重要薄弱学科建设规划(2015ZB0501)

摘　　要：目的分析宫颈癌的磁共振成像(MRI)表现,探讨MRI在宫颈癌诊断中的应用价值。方法收集复旦大学附属华东医院2016年1月1日—2018年12月31日期间的93例病理证实为宫颈癌的患者,所有患者首次治疗均选择手术治疗,且在首次治疗前均行MRI检查,观察肿瘤的位置、大小、信号特征、宫旁浸润、阴道累及和淋巴结转移等情况,进行影像学分期,并与临床分期、病理分期对比,评价MRI分期的价值。结果93例患者分期分别为ⅠA期12例,ⅠB期63例,ⅡA期17例,ⅡB期1例。以病理诊断为金标准,临床分期总体符合率62.4%(58/93),MRI分期总体符合率75.3%(70/93)。其中12例ⅠA期患者MRI检出率为16.7%(2/12),ⅠB期及以上肿瘤检出率为96.3%(78/81),其中3例未检出病灶者其中2例为锥切术后患者,手术后病理证实锥切时病灶已切除。MRI检查的敏感度为86%(80/93),特异度为75%(60/80),总正确率为64.5%(60/93)。MRI结果误差最大的分期为病理诊断为ⅠB期的患者MRI诊断为ⅡA期,共13例,其中肿瘤直径大于4 cm的9例,绝经后8例。结论MRI对ⅠB期及以上宫颈癌病灶发现率极高,能够较清晰显示阴道受累、宫旁浸润及淋巴结转移的情况,对宫颈癌的诊断及分期的准确率明显高于临床妇科检查,有较高的应用价值。肿瘤大于4 cm及绝经后妇女的宫颈萎缩等变化可能会影响MRI对阴道是否累及的判断,从而影响ⅠB至ⅡA的分期,但对选择治疗方式及预后影响不大。Objective To analyze the magnetic resonance images(MRI)of the cases with cervical cancer so as to explore the diagnostic value.Methods 93 cases with pathologically confirmed cervical cancer during the period from January 1 st,2016 to December 31 st,2018 were enrolled;all the cases were given surgery as the first treatment and MRI was performed to all the cases before surgery;the location and size of the tumor,the signal characteristic,parametrial invasion,vaginal involvement,and lymph node metastasis of cases were observed;staging of cervical cancer based on MRI was performed and comparatively studied with clinical staging and pathological staging.Results The enrolled 93 cases were staged based on pathological diagnosis as the gold standard:ⅠA(12 cases),ⅠB(63 cases),ⅡA(17 cases)andⅡB(1 case);the total coincidence rate of clinical staging was 62.4%(58/93)and the total coincidence rate of MRI staging was 75.3%(70/93);MRI detection rate of IA cervical cancer was 16.7%(2/12)and that of IB and over IB stages was 96.3%(78/81);and out of the 81 cases with IB and over IB stages,3 cases was found with no cervical cancer,2 of the 3 had recieved conization and had the lesions excised before treatment,which was pathologically confirmed after surgery;the sensitivity of MRI was 86%(80/93),specificity was75%(60/80),and the total accuracy was 64.5%(60/93);the maximum error of MRI staging was that 13 cases of IB stage were classified to be IIA stage,and among the 13 cases,9 cases were of tumor diameter greater than 4 cm and 8 cases were postmenopausal.Conclusions MRI has a high detection rate of cervical cancer lesions over stage IB and can clearly show out vaginal involvement,parametrial invasion and lymph node metastasis;MRI diagnosis and staging of cervical cancer is of high clinical value and is much more accurate than clinical gynecological examination;cervical atrophy(mostly in postmenopausal women)and tumor diameter over 4 cm may impair the accuracy of MRI in evaluating vaginal involvement and then lead to certain

关 键 词：宫颈癌 临床分期 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]