动态增强MRI对宫颈癌诊断的临床价值

Diagnosis accuracy,specificity and sensitivity of dynamic enhancement MRI on cervical cancer

目的研究磁共振成像（MRI）动态增强技术对宫颈癌术前分期和诊断的准确度、特异性和灵敏度。方法选取成都医学院第一附属医院2013年8月～2015年12月收治的42例宫颈癌患者作为研究对象，其中18例ⅠB-ⅡA期的患者采用广泛子宫全切术联合盆腔淋巴结清扫术，24例ⅡB期和大于ⅡB期的患者采用开腹关键部位活检术联合盆腔淋巴结活检术，将术后病理学诊断结果确定为对宫颈癌的诊断金标准。所有患者均采用超导MRI仪进行扫描，对盆腔进行常规性MRI平扫序列T1WI、T2WI和DWI，并注射Gd—DTPA进行动态增强扫描。分析患者MRI检查分期、术前临床分期和术后病理学分期MRI资料及阴道受累、深肌层浸润、淋巴结转移和宫旁浸润情况，计算其特异性和灵敏度。结果所有患者的术前临床分期、MRI检查分期与术后病理学分期比较，差异有统计学意义（P〈0．05）；术后病理学分期与MRI检查分期比较，差异无统计学意义（P〉0．05），术前临床分期与MRI检查分期比较，差异有统计学意义（P〈0．05）。将术后病理学分期作为对照，MRI检查分期的准确度为94．5％，而术前临床分期的准确度为75．8％。MRI诊断和术后病理学诊断对深肌层浸润、阴道受累、宫旁浸润和淋巴结转移的灵敏度和特异性均较高，但差异无统计学意义（P〉0．05）。结论动态增强MRI检查对宫颈癌患者术前进行分期，准确度较高，对阴道受累、深肌层浸润、淋巴结转移和宫旁浸润的敏感度和特异性均较高，可将其作为宫颈癌术前分期的首选方法。

Objective To study the diagnostic accuracy, sensitivity and specificity of magnetic resonance imaging （MRI） dynamic contrast enhancement technique for preoperative staging of cervical cancer. Methods 42 cervical cancer patients were select as the research object. 18 cases with I 13 to II a stage were treated with extensive uterine total resection combined with pelvic lymph node dissection. 24 cases with stage II 13 and more severe than stage IIB were treated with open key parts of biopsy combined with pelvic lymph node biopsy and postoperative pathological examination confirmed for the diagnostic gold standard of cervical cancer. All patients used superconducting MRI scanning, pelvic of routine MRI scan sequence TIWI, T2WI and DWI, and injection of GD DTPA dynamic enhancement scanning. And on the cervical cancer patients with vaginal involvement, deep myometrial infiltration, lymph node metastasis and parametrial infiltration were analyzed to calculate the specificity and sensitivity of MRI examination of patients with stage, preoperative clinical staging and postoperative pathological staging MRI data analysis. Results All patients preoperative clinical staging and MRI staging and postoperative pathological staging had significant difference （P〈0. 05）. The postoperative pathological staging and MRI staging did not have significant difference （P〈0.05）. The preoperative clinical and MRI stag-ing had significant difference （P〈0.05）. MRI staging accuracy of postoperative pathological staging and preoperative clinical staging were 94.5%, and the preoperative clinical staging accuracy was and 75.8%. MRI diagnosis and postoperative pathological diagnosis of the depth of myometrial invasion, vaginal invasion, parametrial invasion and lymph node metastasis had higher sensitivity and specificity of four aspects, through the statistical analysis of, have no significant difference （P〉0.05）. Conclusion Dynamic enhancement MRI is accurate for cervical cancer preoperative staging, and issensitive to vaginal involvement, deep myometrial invasion, lymph node metastasis and parametrial infiltration.