MRI动态增强扫描对宫颈癌的诊断价值

Dynamic contrast-enhanced MRI in the diagnosis of uterine cervical cancer

目的探讨宫颈癌MRI动态增强的特征，评价其定量数据及曲线类型的诊断价值。方法回顾性分析经宫颈刮片证实为宫颈癌的40例患者的MRI动态增强表现，选取ROI绘制宫颈癌病灶及邻近正常组织的动态增强时间-信号曲线。测量ROI16、32、48、64和300s的动态早期相对信号增强率（ARSI％）和最大相对信号增强率（MRSI％）并对曲线分型。对不同征象分组间的ARSI％和MRSI％差异行独立样本t检验。结果宫颈癌在动态增强早期明显强化，与周围正常组织对比明显。16S宫颈癌与邻近正常组织ARSI％分别为（1．97±0．55）％及（1．22±0．56）％，差异有统计学意义（t=151．000，P〈0．01）。病灶直径〉3cm组ARSI％为（1．70±0．25）％，MRSI％为（2．26±0．18）％；直径≤3cm组ARSI％和MRSI％分别为（0．57±0．16）％及（0．73±0．04）％，两者差异均有统计学意义（t值分别为5．396及11．595，P〈0．05）。伴有宫旁浸润组ARSI％为（1．69±0．21）％，MRSI％为（2．26±0．11）％，不伴有宫旁浸润组的相应值分别为（0．63±0．23）％及（0．83±0．03）％，差异均有统计学意义（t值分别为4．886及18．358，P〈0．05）。39例宫颈癌表现为Ⅰ型（25例）或Ⅱ型（14例）；而邻近正常组织多表现为Ⅲ型（26例）及Ⅱ型（11例），仅2例为Ⅰ型曲线。结论MR动态增强扫描能定量分析宫颈癌在各阶段的强化特点，反映肿瘤的血供状态。动态增强的早期及延迟期可以提高小病灶的检出率，其定量数据ARSI％及MRSI％可以进一步判断预后、指导分期。

Objective To investigate the imaging characteristics of dynamic contrast-enhanced MR imaging （DCE-MRI） in uterine cervical cancer（UCC）, and to evaluate the efficacy of DCE-MRI in the diagnosis of UCC. Methods A total of 39 cases of scratch-pathologically confirmed UCC patients with MRI data were analyzed （one ease of carcinoma in situ being negative on MRI was excluded in this study）. Time- intensity curves of ROI in pathological regions and adjacent normal regions were obtained and the enhanced rates at different times （16,32,48,64 and 300 s） were calculated. The ARSI% and MRSI% of various groups were compared with t test. Results All the 39 lesions enhanced at 16 s in DCE, and there was maximum signal contrast between lesions and the surrounding normal tissue in the early arterial phase. ARSI% of tumor （1.97 ±0. 55 ）% was higher than normal tissue （1.22±0. 56 ）%, and there was statistically significant difference between them （t = 151. 000,P 〈 0. 01 ）. ARSI% and MRSI% of diameter 〉 3 cm group [ （ 1.70 ± 0. 25 ） % and （2. 26 ± 0. 18 ） % ] were higher than ≤ 3cm group [ （0. 57± 0. 16） % and （0. 73 ±0. 04 ）% ]. ARSI% and MRSI% were higher in the peri-uterine tissue infiltration group [（1.69±0.21）% and （2.26±0. 11）%1 than that of confined group[（0.63±0.23）% and （0.83 ±0.03 ） % ] with statistically significant difference （P 〈 0. 05 ）. The TIC of the 39 cases with UCC included type Ⅰ in 25 cases （25/39）, type Ⅱ in 14 cases （ 14/39）, and there was no type Ⅲ cases. The TICs of the surrounding normal tissue were of type Ⅲ （26/39） and type Ⅱ （11/39）, and only 2 cases type Ⅰ. Conclusions The DCE-MRI can reflect the blood supply of the UCCs quantitatively. The early arterial phase in DCE-MRI can improve the detection rate of small lesions. The ARSI% and MRSI% may be helpful in some degree in prognostic assessment and staging of the uterine cervical cancer.