LAVA增强技术对判断宫颈癌淋巴结转移的临床价值

The Application Values of LAVA Enhanced MRI in Diagnosis of Cervical Cancer Lymph Node Metastasis

目的探讨MRI使用腹部容积快速三维成像(LAVA)序列增强扫描对判断宫颈癌淋巴结转移的临床价值。方法经病理活检证实的36例宫颈癌患者,手术前行盆腔MRI平扫和LAVA序列增强扫描,与术后病理结果进行对比分析。结果 36例患者288组淋巴结中清扫出759枚淋巴结,21组淋巴结中33枚(4.3%)淋巴结病理检查阳性。LAVA序列增强扫描显示出42枚淋巴结,其中28枚呈不均匀强化,2枚呈中心液化坏死。以LAVA序列上淋巴结横断面短径≥10 mm为淋巴结阳性的诊断标准,MRI判断淋巴结转移的敏感性和准确性均较高,分别为52.4%、93.8%。LA-VA序列增强扫描的不均匀强化对淋巴结转移的诊断敏感性、准确性分别为87.5%、61.9%,中心液化坏死对淋巴结转移的诊断敏感性、准确性分别为12.5%、66.7%。结论 MRI采用LAVA扫描技术进行增强扫描时,LAVA序列上淋巴结横断面短径≥10 mm为淋巴结转移的最佳诊断标准。

Objective To assess the value of LAVA technique in diagnosis of lymph node involvement in cervical cancer.Methods We retrospectively recruited 36 patients with biopsy-confirmed cervical cancer in our hospital and evaluated the diagnostic performance of Gd-DTPA LAVA dynamic contrast enhanced MRI for pelvic lymph node involvement using surgicopathological findings as the reference standard.Results Seven hundred and fifty-nine lymph nodes were harvested from 288 lymph node regions;of these,33 lymph nodes from 21 lymph node regions were metastatic.MRI showed 42 lymph nodes in total,of which 28 lymph nodes showed heterogeneous enhancement patterns,and 2 showed central necrosis.When a short-axis diameter of more than 10 mm was applied as the criterion for the diagnosis of metastasis,the sensitivity and accuracy of MRI imaging in the diagnosis of lymph node metastasis on a region to region basis were 52.4% and 93.8%,respectively.The sensitivity and accuracy rates of heterogeneous enhancement patterns for detecting metastatic lymph nodes were 87.5%,61.9% respectively;for central necrosis,those rates were 12.5%,66.7%,respectively.Conclusion MRI enhanced imaging with LAVA scanned technique has a good predictive value in the diagnosis of lymph node metastasis in patients with cervical cancer.The short-axis diameter of more than 10 mm are useful in the evaluation of pelvic lymph node metastasis.