扩散加权成像预测宫颈癌新辅助化疗的疗效研究

Application value of diffusion weighted imaging in cervical cancer treated with neoadjuvant chemotherapy

目的 探讨扩散加权成像（DWI）预测宫颈癌的新辅助化疗的疗效及预后.方法 选择海南医学院附属医院2010年6月至2012年6月经病理检查证实的20例宫颈癌患者进行研究,在新辅助化疗前后行常规磁共振成像及DWI检查,对比新辅助化疗前后肿瘤体积、DWI信号及表观扩散系数（ADC）值随时间变化等情况.结果 20例宫颈癌新辅助化疗后肿瘤ADC值较化疗前明显升高[（1.31±0.32） ×10-3 mm2/s比（0.89±0.2 9）×10-3 mm2/s],化疗后肿块平均体积明显小于化疗前肿块平均体积[（92 020±12 994） mm3比（23 584±27 359） mm3],差异均有统计学意义（均P＜0.01）.宫颈癌新辅助化疗前后ADC差值随时间变化趋势显示,化疗后第19天,化疗前后肿块ADC值的平均差值最大,为0.135×10-3mm2/s,早于肿瘤体积变化时间,且ADC值变化率反映预后较体积变化率好.结论 DWI有助于预测宫颈癌化疗前后化疗疗效及预后,优于肿瘤体积变化.

Objective To analyze the value of diffusion weighted imaging （DWI） for neoadjuvant chemotherapy forecasting uterine cervix cancer.Methods Of the 20 patients,the changes of tumor volume,the signal changes of DWI and ADC values,cervical cancer proved by pathology were reviewed with conventional MRI and DWI examination before and after neoadjuvant chemotherapy.Results Of the 20 patients,the ADC values of the solid components of the cancer were significantly increased after chemotherapy [（92 020 ± 12 994）mm3 vs （23 584 ± 27 359） mm3].The tumor volume values after chemotherapy were significantly reduced after chemotherapy [（92 020 ± 12 994） mm3 vs （23 584 ± 27 359） mm3] ; there was a significant difference of tumor volume changes and the ADC value （P 〈 0.01,respectively）.The nineteenth day after the neoadjuvant chemotherapy,the difference between the ADC values of the tumor before and after chemotherapy was maximum.The rate of change of ADC values that predicted the prognosis of cancer chemotherapy was better than that of change of volume.Conclusion DWI can predict chemotherapy response and prognosis after the neoadjuvant chemotherapy of uterine cervix cancer.