基于MR-DWI的宫颈癌新辅助化疗及其病理反应性的对照研究

A COMPARATIVE STUDY IN CERVICAL CANCER BETWEEN DIFFUSION WEIGHTED MR IMAGING AND HISTOPATHOLOGIC RESPONSE WITH PREOPERATIVE CHEMOTHERAPY

目的探讨MR-DWI在宫颈癌新辅助化疗的反应性及其相关组织病理学变化的关系。方法 22例符合手术指征宫颈癌患者分别于新辅助化疗前1d、化疗中2周(第十四天)和4周(第二十八天,术前)行MR-DWI扫描。分别测量记录肿瘤的最大径和多点平均ADC值,比较治疗前后的变化,及其组织病理学变化的相关性并行统计学评价分析。结果肿瘤最大径治疗后2周对比治疗前,无明显变化的22例;治疗后4周对比治疗前,有所缩小的12例,无明显变化的10例(P<0.05);平均ADC值治疗后2周对比治疗前,明显增大的4例,相对增大的12例,变化不大的6例;治疗后四周对比治疗前,明显增大的12例,相对增大的9例,变化不大的1例(P<0.01);术后相关组织病理显示ADC值明显上升的病例镜下组织炎性反应、细胞核异型性、肿瘤细胞死亡程度均显著增大,ADC值相对增大的次之。结论传统手段检测肿瘤最大径治疗后2或4周变化不明显。对照相关组织病理学变化,DWI能更早地监测到肿瘤治疗的反应性。DWI可作为肿瘤治疗的早期检测指标,并可预测治疗效果。

Objective To investigate the diffusion weighted magnetic resonance imaging （DWI）in the re-sponse to preoperative cervical cancer induced by chemotherapy,and explore the correlation between DWI response and histopathologic changes.Methods Twenty-two cervical cancer patients,who had the surgi-cal indications,patients underwent conventional MRI and DWI examinations at 1 day before induced by chemotherapy,two weeks （14 days）and four weeks （28 days,preoperative）induced by chemotherapy . The maximum diameter of the tumor volume and mean value of ADC were measured before and after thera-py,the correlation between DWI response and histopathologic changes were performed with statistical anal-ysis software.Results Two weeks after treatment,the maximum diameter of the tumor volume were un-changed from all of the 22 patients compared with un-therapy patients.Four weeks after treatment,the maximum diameter of the tumor volume was decreased in 12 patients （P 〈0.05）.two weeks after treat-ment,the mean ADC value of the tumor was increased significantly in 4 patients,was relative increased in 12 patients,was little changed in 6 patients compared with the un- therapy patients;Four weeks after treatment,the mean ADC value of the tumor was significantly increased,was relative increased in 9 pa-tients,was little changed in 1 patient（P 〈0.01）compared with the un-therapy patients.According to the histopathological analysis,patient after surgery showed that tissue inflammation,nuclear atypia,and de-gree of tumor cell death were significantly increased with the rise of ADC value,and the ADC values in-crease relatively inferior to ADC values increase significantly.Conclusions Traditional methods detecting tumor volume biggest diameter presented were no significant changes after two or four weeks treatment. Based on the changes of histopathology,we find that the diffusion weighted magnetic resonance imaging can detect the curative effect for tumor earlier treatment.The diffusion weighted magnetic resonance imaging can be used as the early detection of cancer therapy and the curative effect may be predicted according to the in-crease of ADC value.