磁共振弥散加权成像在评估子宫颈癌放化疗效果中的应用

Application of diffusion weighted magnetic resonance imaging in assessing the efficacy of chemoradiotherapy for uterine cervical carcinoma

目的 探讨采用磁共振弥散加权成像（DWI）对子宫颈癌放化疗效果进行评价的可行性.方法 收集子宫颈正常志愿者13名,子宫颈癌患者32例,年龄29～72岁,平均45.75岁.32例子宫颈癌患者于放疗前及放化疗后1～3个月内行磁共振成像（MRI）常规扫描和DWI扫描,取b值分别为（0,300）s/mm2及（0,600）s/mm2.在轴位DWI图上分别测量正常子宫颈表面扩散系数（ADC）值及子宫颈癌患者子宫颈肿块ADC值,对放化疗后子宫颈病变区进行ADC值的测量,并进行比较.结果 当b=（0,300）s/mm2时,正常子宫颈ADC值平均为（1.72±0.31）×10^-3 mm2/s,放疗前子宫颈癌为（1.10±0.24）×10^-3 mm2/s,放化疗后的子宫颈病变为（1.61±0.23）×10^-3 mm2/s;当b=（0,600）s/mm2时,正常子宫颈ADC值平均为（1.46±0.25）×10^-3 mm2/s,放疗前子宫颈癌为（0.89±0.21）×10^-3 mm2/s,放化疗后的子宫颈病变为（1.54±0.18）× 10^-3 mm2/s;b=300 s/mm2的ADC值均高于b=600 s/mm2时.子宫颈癌组ADC值低于正常子宫颈组,放化疗后病变子宫颈的ADC值明显高于治疗前,差异均有统计学意义（均P＜0.05）.但同组不同b值的ADC值差异均无统计学意义（均P＞ 0.05）.结论 DWI与ADC值的联合可以更为客观、准确地分析病变,有助于评价放化疗效果.

Objective To explore the feasibility of diffusion-weighted imaging （DWI） in assessing the efficacy of chemoradiotherapy for cervical cancer.Methods Data of magnetic resonance imaging （MRI） and DWI were analyzed in 32 patients with uterine cervical cancer received conventional prior to chemoradiotherapy and after 1 and 3 months of therapy.13 cases of normal controls also had been examed by MRI and DWL DWI with b values of （0,300） s/mm2 and b values of （0,600） s/mm2 were performed in all patients.Pretreatment post-treatmentADC values were compared between the health group and patients group.Results When the b =300 s/mm2,normal cervical average ADC value was （1.72±0.31）×10^-3 mm2/s,cervical cancer was （1.10±0.24）×10^-3 mm2/s before treatment and was （1.61±0.23）×10^-3 mm2/s after treatment.When the b =600 s/mm2,normal cervical average ADC value was （1.46±0.25）×10^-3 mm2/s cervical cancer was （0.89±0.21）×10^-3 mm2/s before treatment and was （1.54±0.18）×10^-3 mm2/s after treatment.When b =300 s/mm2,ADC value was higher than when b =600 s/mm2.ADC values of cervical cancer was significantly lower than that of the normal cervix group,ADC values of cervical lesions after chemoradiotherapy was significantly higher than that before chemoradiotherapy （P 〈 0.05）.In the same group with different b values,ADC value was not significant （P 〉 0.05）.Conclusion Joint observation of DWI and ADC values could be more objective and accurate in the analysis of the disease and would help to evaluate the efficacy of chemoradiotherapy.