评价MRI在宫颈癌诊断及分期中的应用价值

The application value of MRI in the assessment of diagnosis and staging of uterine cervical carcinoma

目的：探讨MR成像对宫颈癌诊断及分期的应用价值。方法：128例（手术49例）经病理证实的宫颈癌患者（鳞癌119例，腺癌8例，鳞腺癌1例）行盆腔轴位SE T1WI，轴位、矢状位及冠状位FSE T2WI，轴位、矢状位及冠状位T2WI脂肪抑制（FRFSE），轴位、矢状位及冠状位T1WI脂肪抑制（FSPGR／70）Cd-DTPA增强扫描。分析宫颈癌MRI的表现及侵犯范围，49例MRI术前分期与手术、病理分期对照。结果：宫颈癌的MRI T2WI呈较高信号，T2WI宫颈癌与宫颈基质低信号及宫旁脂肪组织高信号有良好的对比，T1WI呈等或低信号，Gd—DTPA增强后T1WI呈均匀或不均匀强化，MRI对宫旁侵犯判断的准确率为87％，特异性为89％，敏感性为85％，Ⅰ～Ⅱa期宫颈癌MRI分期准确率为92％，对宫颈癌分期总的准确率为86％。结论：MRI能多方位清晰显示宫颈癌瘤灶及其侵犯范围，术前分期优于其它检查方法，理应成为宫颈癌首选的影像检查方法。

Objective： To discuss the value of MR/in the assessment of the value of diagnosis and staging of cervical carcinoma. Methods：Pelvic MRI were performed in 128 patients with cervical carcinoma, including 119 cases of squamous cell cancer, 8 cases of adenocancer and 1 cases squamous-adenocancer. The MRI scanning included axial SE T1WI, axial, sagittal and coronal FSE T2WI, axial, sagittal and coronal FRFSE SE T2WI, and axial, sagittal and coronal enhanced Gd-DTPA FSPGR/70 T1WI. MR images were analyzed for the location and extension of cervical cancer. For 49 of the 128 cases treated by operation, MR staging were compared with surgical-pathologic staging. Results： MR findings of cervical cancer were charactered with a little hyperintense on T2WI, moderate intense or hypointense on T1 WI, and different degree of enhanced by bolus intravenous Gd-DTPA T1WI. There was a significant contrast signal ratioes among the cervical carcinoma, normal cervix, and the parametrial fat tissue. The accuracy, specificity, and sensitivity for parametrial extension were 87%, 89% and 85%, respectively. Tlie accuracy of MR imaging in staging Ⅰ - Ⅱ a and total staging of cervical cancer were 92% and 86%. Conclusion： MR imaging can show the local tumors and extension of the cervical cancer clearly on multiple planes and angles. It is superior to any other methods in the staging of uterine cervical carcinoma , and should be regarded as a preferred method.