扩散加权成像在宫颈癌诊断及盆腔淋巴结转移中的应用

Diffusion-weighted imaging in the diagnosis of cervical cancer and pelvic lymph node metastasis in the application

目的探讨扩散加权成像(DWI)和表观扩散系数(ADC)在诊断宫颈癌和盆腔淋巴结转移中的应用价值。方法对49例行盆腔淋巴结清扫术的宫颈癌患者进行磁共振成像检查,DWI使用单次平面回波技术,身体相控阵线圈,b=0、400、800 s/mm2。20例非子宫疾病者行盆腔磁共振检查。对宫颈癌和正常宫颈组织DWI的ADC值分别进行了测量和比较。采用诊断试验方法,以敏感度、特异度、准确性3项指标判断盆腔淋巴结转移。组织病理结果作为参考标准。结果宫颈癌在DWI表现为弥漫高信号,其ADC值为(0.89±0.07)×10-3mm2/s,明显低于正常宫颈组织的平均ADC值。子宫颈癌最易受累淋巴结为闭孔淋巴结,DWI对盆腔淋巴结转移判断的敏感度为86.7%,特异度为94.1%,准确性为91.8%。结论宫颈癌和盆腔淋巴结转移DWI和ADC显示更为突出,DWI区分正常宫颈和宫颈癌具有重要的价值,有助于准确的诊断。

Objective To evaluate the value of diffusion-weighted imaging （DWI） and apparent diffusion coefficient （ADC） in diagnosis of cervical cancer and the pelvic lymph node metastasis. Methods Forty-nine patients scheduled for pelvic lymph node dissection were enrolled for magnetic resonance imaging （MRI） using a single-shot echo-planar DWI technique, body-phased array coil, b= 0, 400, 800 s/mm2. Twenty patients without cervical disease were enrolled for MRI. Cervical cancer and normal cervical tissue ADC values of DWI were measured and compared, respectively. The use of diagnostic tests, sensitivity, specificity, accuracy, three indicators to determine the pelvic lymph node metastasis. Histopathologie results served as the reference standard. Results Cervical cancer in DWI showed diffuse high signal, the ADC value （0.89±0.07）×10^-3 mm2/s, significantly lower than the mean ADC value of cervical tissue. The cervical carcinoma showed higher rate of obturator node involvement. The sensitivity, specificity and accuracy of DWI in detecting the pelvic lymph node metastasis were 86.7%, 94.1% and 91.8% respectively. Conclusion Cervical cancer and pelvic lymph node metastasis in DWI and ADC shows more prominent, for distinguishing normal cervix and cervical cancer has important value to help accurate diagnosis.