磁共振灌注成像在宫颈癌诊断及疗效评估价值的初步探讨

Evaluation of MR Perfusion Weighted Imaging in Diagnosis of Uterine Cervix Cancer and Assessment of Therapeutic Effect

目的:探讨PWI对宫颈癌诊断、病理分级、分型及化疗后疗效评估的应用价值。方法:对43例宫颈癌患者及25例正常对照组行盆腔常规磁共振扫描、DWI扫描及灌注成像,获取每个灌注层面感兴趣区的TIC曲线,利用"Basic T1 Perfusion"软件包分析,分别比较宫颈癌与正常宫颈、宫颈鳞癌与腺癌、鳞癌不同病理级别的灌注参数以及9例宫颈癌患者化疗前后的灌注参数。结果:①宫颈癌患者TIC曲以"速升缓降"型为主,正常对照组以"缓慢上升"型为主。②宫颈癌组ME、WIR、WOR较正常宫颈组显著升高(P<0.05),而TTP前组较后组显著减低(P<0.05);宫颈鳞癌与腺癌各参数间无显著差异(P>0.05);宫颈鳞癌高分化组ME、WIR、WOR较低分化组低(P<0.05),而TTP较低分化组高(P<0.05),中分化组WIR较低分化组低(P<0.05),高分化组TTP较中分化组高(P<0.05),余ME、WIR、WOR及TTP组间比较无显著性差异(P>0.05);宫颈癌化疗组:ME、WIR化疗前显著高于化疗后(P<0.05),而TTP化疗后明显较化疗前延迟(P<0.05)。结论:MRI灌注成像可不同程度反映宫颈癌组织的病理学特征,有助于宫颈癌的定性诊断,对宫颈癌的病理分级有一定提示作用,并对监测宫颈癌化疗疗效有重要价值。

Purpose： To explore the application value of perfusion weighted imaging （PWI） in uterine cervix cancer （UCC） including its diagnose, pathological grading, pathological classification and the curative effect assessment after chemotherapy. Methods： Routine magnetic resonance exam, diffusion weighted imaging （DWI） and PWI of pelvic cavity were applied in 43 cases with UCC and 25 cases normal volunteers. The time-intensity curve （TIC） of region of interest was recorded. ＂Basic T1 Perfusion＂ was used to analyze the TIC and the related parameters between UCC patients and the normal controls. The perfusion parameters of UCC and normal cervix, of the squamous carcinoma of the cervix, and of the adenocarcinoma of the uterine cervix, and the perfusion parameters in different pathological levels of cancer, as well as the perfusion parameters of 9 cases of cervical cancer patients before and after the chemotherapy were analyzed respectively. Results： （1） In UCC group, the TIC mainly showed rapid rise with gradual decline, and in the control cases, the TIC mainly showed slow rise type. （2） ME, WIR, WOR of UCC group were higher than the control group, while TTP of UCC group was significantly lower than the control group, and such parameters between cervical squamous cell carcinoma and adenocarcinoma showed no statistical significant differences. Comparison of the perfusion parameters between cervical squamous cell carcinoma of poorly, moderately and well differentiated groups showed： ME, WIR, WOR of well-differentiated group were significantly lower than that of poorly differentiated group, （p 〈0.05）, while TTP of well-differentiated group was significantly higher; WIR of moderately differentiated group was significantly lower than that of poorly differentiated group; TTP of well-differentiated group was significantly higher than that of moderately differentiated group; ME, WIR, WOR and TTP of the rest groups showed no significant differences. In the group with UCC and undergone chemotherapy： ME and WIR were significantly higher before chemotherapy than those after chemotherapy, while TTP delayed significantly after chemotherapy than before that, （P 〈0.05）. Conclusion： PWI can reflect the pathologic features of the UCC, which could help with the etiologic diagnosis of UCC. In addition, PWI is helpful in pathological grading of UCC and plays an important role in the curative effect.