ADC值在常见病理组织学类型宫颈癌中的应用价值

The Role of ADC Value Applications in the Common Histopathologic Type of Cervical Cancer

目的探讨磁共振弥散加权成像(diffusion weighted imaging,DWI)测得的表观扩散系数(apparent diffusion coefficient,ADC)值与宫颈癌常见的病理组织学类型间的关系,为宫颈癌治疗方案的选择及预后评估提供理论依据。材料和方法收集中晚期宫颈癌患者42例(其中A组为腺癌、12例,B组为鳞癌、30例,均经病理组织学确诊),行常规盆腔MRI及DWI扫描(取b值分别为0,400s/mm2;0,1000s/mm2);于矢状位及横断位ADC图划取ROI,测量宫颈癌病灶平均ADC值(ADC mean)。结果取b值0,400s/mm2时测得宫颈癌病灶ADC mean值较取b值0,1000s/mm2测得的明显要高,差异有统计学意义(t=5.809,p<0.001),且后者产生的ADC图对盆腔解剖及病灶的显示较前者清晰;取b值0,1000s/mm2时,宫颈腺癌(A组)平均ADC值较宫颈鳞癌(B组)高,差异有统计学意义(t'=5.785,P=0.008)。结论高b值(0,1000s/mm2)ADC图测定的ADC值能更精确地反映宫颈癌肿瘤内部水分子扩散受抑制的状况;ADC值对宫颈癌腺癌、鳞癌的病理组织学分类有一定的指导意义。

Objective To explore the relationship of apparent diffusion coefficient（ADC） value with the histopathologic type of cervical cancer and provide a theoretical basis for therapeutic schedule and prognosis in treating cervical cancer. Methods 42 locally advanced cervical cancer patients were grouped into adenocarcinoma group（named as group A, n=12） and squamous-celled carcinoma（named as group B, n=30） according to the histopathologic diagnosis. All of them received conventional magnetic resonance imaging（MRI） and DWI examination. DWI was performed with b values of 0,400s/mm^2 and 0,1000s/mm^2. The region of interest（ROI）was selected, according to the axial and sagittal ADC map, and used to measure the mean value of ADC in cervical cancer lesions. Results At b values of 0,400s/mm^2, the cervical cancer mean value of ADC was determined to be higher than that determined at b values of 0,1000s/mm^2（t=5.809, p0.001）. Moreover, the ADC map performed at b value of 0,1000s/mm^2 was imaged more clearly for the anatomic structure of cavitas pelvis, as well as for the cervical cancer lesion, when compared with that at b value of 0,1000s/mm^2. At the b values of 0,1000s/mm^2, adenocarcinoma group（group A） had higher mean value of ADC（t＇=5.785,P=0.008）, when compared with that in squamous-celled carcinoma group（group B）. Conclusion Conclusion At high b-value（0,1000s/mm^2）, the result from ADC map could reflect more accurate diffusing phenomenon of water molecules in cervical cancer. The value of ADC provide us a meaningful direction in classifying histopathologic type for cervical adenocarcinoma and squamous cell carcinoma.