宫颈癌中子刀(^(252)锎)放射治疗前后MRI检查的临床价值

Clinical value in evaluating of cervical cancer to neutron-knife radiation therapy

目的分析宫颈癌中子刀(252锎)放射治疗前后的MRI表现,探讨MRI对宫颈癌中子刀(252锎)放射治疗后的诊断价值。方法对100例经病理证实的宫颈癌患者在中子刀(252锎)放射治疗前及放疗后不同时间段行MRI扫描。每次MRI扫描均用相同的扫描方法。在MRI图像上观察肿瘤中子刀(252锎)放射治疗前后的大小、信号改变及其周围结构的变化,进行对比分析。结果放疗结束时,局部控制率100%;78例肿瘤消失;22例肿瘤明显缩小,缩小率>85%。肿瘤信号改变:放疗结束后,78例肿瘤信号消失,T2WI及STIR无异常信号改变,22例T2WI及STIR见有肿瘤信号;T1WI增强,78例无异常信号改变或轻微强化,22例不均匀强化;放疗后2年内,97例无异常信号改变;T1WI增强成像后,90例无异常信号改变,3例轻微强化。7例T2WI及STIR仍见有不均匀肿瘤信号,但较前期信号明显降低,T1WI增强,肿瘤呈不均匀强化。放疗后盆腔内脏器的表现:并发直肠炎性改变5例,肠壁增厚(6mm～-9.5mm),T1WI呈等信号,T2WI及STIR呈高信号;膀胱炎性改变3例,膀胱壁增厚(6.2mm),T1WI呈等信号,T2WI及STIR呈高信号;子宫颈限局性改变3例,T1WI呈低信号,T2WI及STIR呈高信号。放疗后2年内,上述改变恢复正常或轻微纤维化。结论MRI检查可反映中子刀(252锎)对肿瘤的疗效,是评价宫颈癌中子刀(252锎)放射治疗疗效及预后的最佳检查手段。放疗结束后,肿瘤缩小程度、T2WI上的信号改变及T1WI增强扫描瘤内有无强化区是预测中子刀(252锎)放射治疗效果的重要观测指标。

Objective To analysis the image of MRI and discuss 0the diagnostic value of MRI in evaluating of cervical cancer to neutron-knife radiation therapy. Methods 100cases were checked by MR/before and after radiation therapy that were confirmed by pathology with cervical cancer. Same scan methods were done. We compared and discussed the changing of image in size, signal and surrounding of tumor befor and after neutron-knife radiation therapy. Results At the end of radiation therapy, rate of partial control was 100%. Among them ,tumors was disappear in 78 cases ,tumors got smaller obviously in 22 cases ,small rate was more than 85%. Signal changing of tumors ：At the end of radiation therapy, signal were disappear in 78 cases, no abnormal signal changing were seen at T2WI and STIR. Tumors signal were seen in 22 cases. In T1WI enhancement, no signal changing or slight enhancement were in 78 cases, uneven en- hancement were in 22 cases. In two years after radiation therapy, no abnormal signal changing were in 97 cases. After T1WI enhancement, no abnormal signal changing were in 90 cases, slight enhancement were in 3 cases. Uneven tumors signal were seen in 7 cases at T2WI and STIR. Signals was lower than before. In T1WI enhancement, uneven enhancement were seen in tumors. Pelvis organs image after radiation therapy ： inflammation and thickness of rectal were in 5 cases, T1WI was even signal, T2WI and STIR was high signal ; inflammation and thickness of bladder were 3 cases. T1WI was even signal, T2WI and STIR weres high signal. Changing of cervical were 3 cases, T1WI was low signal, T2WI and STIR were high signal. In 2 years after radiation therapy, the changing was normal or slight fiber. Conclusion Image of MRI can evaluate of cervical cancer of neutron-knife radiation therapy and is good method to do so. After radiation therapy, it is an important evaluating tool in size of tumors, changing of signals and enhancement.