MRI对早期宫颈癌的诊断和分期价值

Diagnostic Value of MRI in Early Uterus Cervical Cancer

目的：探讨MRI对Ⅰ～Ⅱ期宫颈癌的诊断和分期价值.方法：50例有完整临床及MRI资料的宫颈癌患者,回顾性分析原发肿瘤的大小、位置、信号特点及范围,比较MRI分期、术前临床分期及手术病理分期.所有患者常规行SET1WI和TSE T2WI,快速翻转恢复序列（SPIR）及增强扫描.结果：除2例Ⅰ a期宫颈癌外,MRI显示48例宫颈癌,于T1WI为稍低或等信号,T2WI上为高信号,增强后肿瘤呈轻度均匀或不均匀强化.MRI图像上肿瘤与宫颈基质、子宫内膜及宫旁脂肪有良好的对比,48例宫颈癌MRI定位诊断符合率为96%.以手术后,病理分期为对照,MRI对宫颈癌的分期诊断符合率为78%,术前临床分期诊断符合率为60%,两者比较差异有显著性意义（x2=4.17,P＜0.05）.48例宫颈癌MRI测量的大小为（1.94±1.15）cm,手术病理标本测量结果为（1.94±1.11）cm,两者比较差异无显著性意义（P＜0.05）.结论：MRI能直观、准确显示宫颈癌瘤灶大小及侵犯范围,对于早期宫颈癌（Ⅰ～Ⅱ期）的分期明显优于临床分期,但MRI对Ⅰ a期宫颈癌的诊断价值有限,必须结合临床资料及宫颈刮片检查综合判断.

Objectives：To evaluate the diagnostic value of MRI in stage Ⅰ-Ⅱ uterus cervical cancer and the role of pre-surgery staging. Methods： In 50 patients with surgery and pathology proved uterus cervical carcinoma, their clinical material and MRI findings were retrospectively analyzed. The size,location,signal intensity and extent of tumor were studied. The MR sequences included SE T1WI,TSE T2WI,T2WI-SPIR and contrast enhanced T1WI. Results： Apart from 2 patients with stage Ⅰ a,48 patients having uterus cervical carcinoma were detected by MRI, Showing hypo-intensity and/or iso-intensity on T1WI, heterogeneous and homogeneous hyper-intensity on T2WI, mild homogeneous/heterogeneous enhancement after intravenous bolus administration of Gd-DTPA. The accuracy of MRI in the localization of tumor was 96%. In 40 patients,MRI showed a 62.5% consistency when compared with pathology staging.For the staging of carcinoma of uterine cervix,the accuracy of MRI was 81. 2%, compared with that of physical examination （62. 5 %）, statistically difference existed （χ^ 2= 4.17, P〈0.05）. The tumor size measured by MRI was （ 1.94 ± 1.15） cm, compared with that measured by pathology specimen （1.94±1.11）cm,no （P〉0.05）. Conclusion： The staging/including tumor size and extent assessment of uterus cervical cancer,could be accurately evaluated by MRI,which is superior to that of physical examination before surgery. Yet,the value of MRI is limited in stage Ia carcinoma, study combined with clinical material and cytology findings is mandated.