MRI与CT灌注成像在宫颈癌宫旁浸润和淋巴结转移诊断中的应用

Significance of MRI and CT perfusion imaging in the diagnosis of parametrial invasion and lymph node metastasis of cervical cancer

目的 :探讨MRI与CT灌注成像在Ib^IIa期宫颈癌宫旁浸润和淋巴结转移诊断中的应用。方法 :选择2011年7月-2015年1月在我院行宫颈癌手术治疗患者107例,术前均进行MRI和CT灌注成像检查,比较术前MRI和CT灌注成像检查宫颈癌癌旁浸润和淋巴结转移结果与术后病理结果的一致性。结果 :术前MRI检查诊断宫颈癌宫旁浸润的敏感性100.00%,特异性96.94%,准确性97.20%,诊断一致率K值为0.801 0,P<0.05;诊断淋巴结转移的敏感性68.75%,特异性96.70%,准确性92.52%,诊断一致率K值为0.689 9,P=0.023。术前CT灌注成像诊断宫颈癌宫旁浸润的敏感性88.89%,特异性94.90%,准确性94.39%,诊断一致率K值0.697 1,P=0.017;诊断淋巴结转移的敏感性81.25%,特异性95.60%,准确性93.46%,诊断一致率K值为0.749 3,P=0.001。术前MRI联合CT灌注成像诊断宫颈癌宫旁浸润的敏感性100.00%,特异性95.92%,准确性96.26%,诊断一致率K值为0.798 1,P<0.05;诊断淋巴结转移的敏感性87.50%,特异性96.70%,准确性95.33%,诊断一致率K值为0.752 0,P=0.001。术前MRI、CT灌注成像及MRI联合CT灌注成像诊断宫颈癌宫旁浸润曲线下面积分别为(0.95±0.08)、(0.87±0.05)和(0.96±0.05),三者比较差异具有统计学意义(P<0.05);MRI、CT灌注成像及MRI联合CT灌注成像诊断淋巴结转移曲线下面积分别为(0.91±0.08)、(0.94±0.04)和(0.95±0.06),三者比较差异具有统计学意义(P<0.05)。结论 :术前MRI与CT灌注成像检查判断宫颈癌宫旁浸润和淋巴结转移与术后病理诊断结果相比较具有良好一致性,但MRI检查诊断宫颈癌宫旁浸润方面优于CT,CT检查诊断淋巴结转移优于MRI,结合两者优势可提高诊断宫颈癌宫旁浸润和淋巴结转移的效能。

Objective： To discuss the significance of MRI and CT perfusion imaging in the diagnosis of parametrial invasion and lymph node metastasis of cervical cancer. Methods： One hundred and seven cases of patients with cervical cancer, who were operated in our hospital from July, 2011 to January, 2015 and had MRI and CT perfusion imaging examination before operation, were retrospectively analyzed and their results were compared with postoperative pathologic ones. Results： The sensitivity, specificity, accuracy and Kappa value for the diagnosis of parametrial invasion were 100.00%, 96.94%, 97.20% and 0.801 0 by MRI （P〈0.05）, 88.89%, 94.90%, 94.39% and 0.6971 by CT perfusion imaging （P=0.017）, and 95.92%, 95.92%, 96.26% and 0.798 1, by combination of MRI with CT perfusion imaging （P〈0.05）, respectively. The sensitivity, specificity, accuracy and Kappa value for the diagnosis of lymph node metastasis were 68.75%, 96.70 %, 92.52% and 0.689 9 by MRI （P=0.023）, 81.25%, 95.60%, 93.46% and 0.749 3 by CT perfusion imaging （P=0.001）, and 87.50%, 96.70 %, 95.33% and 0.752 0 by combination of MRI with CT perfusion imaging （P=0.001）, respectively. The area under the curve of MRI, CT and MRI combined with CT perfusion imaging were 0.95 ± 0.08, 0.87 ± 0.05, 0.96 ± 0.05 for the diagnosis of parametrial invasion （P〈0.05） and 0.91 ± 0.08, 0.94 ± 0.04, 0.95± 0.06 for the diagnosis of lymph node metastasis （P〈0.05）, respectively. Conclusion：Preoperative MRI and CT perfusion imaging in the diagnosis of parametrial invasion and lymph node metastasis show good consistency compared with pathologic diagnosis, however, the performance of MRI in the diagnosis of parametrial invasion is better than CT and vice versa in the diagnosis of lymph node metastasis, and combination of the advantages of both imaging can improve the diagnosis of parametrial invasion and lymph node metastasis of cervical cancer.