磁共振扩散加权成像联合增强扫描对早期宫颈癌的诊断价值

The diagnostic value of diffusion-weighted imaging combined with contrast-enhancement in uterus cervical carcinoma

目的探讨MRI增强扫描联合扩散加权成像(diffusion-weighted imaging,DWI)技术对早期宫颈癌分期和诊断的价值,以进一步提高MRI对早期宫颈癌诊断的准确率。方法收集2006年1月-2010年12月在新疆医科大学附属肿瘤医院妇外科经手术确诊的宫颈癌35例,非宫颈癌20例,所有患者术前均行常规MRI平扫、横轴位DWI扫描(b值选取1 000s/mm2)及增强扫描,对宫颈癌患者MRI平扫、MRI平扫结合DWI以及MRI增强扫描联合DWI与手术病理结果符合率进行比较;分析宫颈癌在DWI上的特点及表观弥散系数值(apparent diffu-sion coefficient,ADC)。结果 MRI增强扫描联合DWI未见明确异常信号及占位7例,诊断ⅠA期2例,ⅠB期18例,ⅡA期5例,ⅡB期3例。以手术病理结果为金标准,MRI增强扫描联合DWI对早期宫颈癌的灵敏度为71.4%,特异度为95.0%,阳性预测值为96.1%,阴性预测值为65.5%;非宫颈癌平均ADC值为(1.57±0.13)×10-3 mm2/s,宫颈癌平均ADC值为(0.88±0.15)×10-3 mm2/s,两组ADC值比较差异有统计学意义(t=16.826,P=0.00)。结论 MRI增强扫描联合DWI对早期宫颈癌的分期及诊断明显优于MRI平扫和MRI平扫结合DWI,但对原位癌及ⅠA期宫颈癌的诊断价值有限。

Objective To investigate the values of staging and diagnostic of MRI contrast-enhanced scanning add DWI in early stage cervical cancer,to improve the accuracy of MRI in the early cervical carcinoma.Methods Collected 35 cases with cervical carcinoma and 20 cases with non-cervical carcinoma were confirmed by pathology in our hospital gynecological surgery department from Jan 2006 to Dec 2010.All cases were performed routine MR sequence and axial DWI（b=1 000 s/mm2） and MR contrast-enhanced scanning before operation.Cervical cancer patients plain MRI scan,MRI scan combined DWI and MRI the enhanced scanning United DWI coincidence rate with the surgical and pathological.To analyze the characteristics of cervical cancer on DWI and apparent diffusion coefficient（apparent diffusion coefficient,ADC）.Results To post-surgical pathologic as the gold standard,MR contrast-enhanced scanning combined with DWI technology for the early cervical carcinoma of the sensitivity was 71.4%,specificity was 95.0%,positive predictive value was 96.1%,negative predictive value was 65.5%;the average ADC of non-cervical cancer was（1.57±0.13）×10-3 mm2/s,the average ADC of cervical cancer was（0.88±0.15）×10-3 mm2/s,both ADC value had statistically significant（t=16.826,P=0.00）.Conclusion MR contrast-enhanced scanning add DWI were obviously superior to the routine MR sequences and MR sequence add DWI in staging and in diagnosis for early cervical cancer,but it was limited to study the evaluation of situ carcinoma and ⅠA stage cervical cancer.