宫颈癌的MRI分期与临床及病理分期研究

Research of MRI staging and clinical and pathological staging of cervical cancer

目的观察比较宫颈癌磁共振成像(MRI)分期、临床及病理分期,分析MRI在宫颈癌术前分期的价值。方法 60例宫颈癌患者,将所有患者进行全面的MRI检查,宫颈癌临床分期采用国际妇产科联盟(FIGO)分期(2009年)的标准进行划分。通过双盲实验在术前划分出宫颈癌的MRI分期,并且将宫颈癌患者MRI、临床及术后病理分期进行对比。结果所有患者中,有4例ⅠA期通过MRI没有检测出,剩余56例患者通过MRI扫描显示出来,由此可知MRI的敏感度为93.3%。所有患者病灶形似椭圆形且边缘不具规则,T2WI显示对应较高信号影,T1WI显示为略低信号。经过MRI扫描的患者有25例病灶增强,所有病灶呈现不同程度不均匀性强化,有12例患者的病灶强化程度同正常子宫相似,有8例患者低于正常子宫,有5例患者略高于正常子宫。宫颈癌分期与手术病理分期比较,其中两者一致的有:ⅠB期15例、ⅡA期16例、ⅡB期5例、ⅢA期1例、ⅢB期1例;由此统计得出临床术前分期的诊断准确率为63.3%(38/60)。将宫颈癌病理分期与MRI分期比较,其中两者一致的有:ⅠB期17例、ⅡA期20例、ⅡB期11例、ⅢA期2例、ⅢB期1例;由此统计得出MRI分期的诊断准确率为85.0%(51/60)。结论 MRI在宫颈癌分期诊断的价值更高,尤其是宫颈癌的术前检测,使得整个检测过程更加安全、可靠、简便、快捷,而且提高了诊断的准确率,值得临床医疗推广应用。

Objective To observe magnetic resonance imaging （MRI） staging, clinical and pathological staging of cervical cancer, and to analyze value by MRI in preoperative staging of cervical cancer. Methods A total of 60 patients with cervical cancer all received comprehensive MRI examination, with International Federation of Gynecology and Obstetrics （FIGO） staging （2009） as clinical staging standard. Preoperative MRI staging of cervical cancer was made by double-blind experiment, and comparison was made on MRI, clinical and postoperative pathological staging in cervical cancer patients. Results There were 4 missed cases by MRI in I A stage, and the other 56 cases were all shown by MRI scanning, along with sensitivity of MRI as 93.3%. All patients had oval lesion with irregular edge, with high signal by T2WI and low signal by T1WI. MRI scanning showed 25 cases with irregular enhanced lesion, including 12 cases with similar enhancement as normal uterus, 8 cases lower than normal uterus and＇5 cases slightly higher than normal uterus. Comparison of cervical cancer staging and surgical pathological staging showed 15 cases in Ⅰ B stage, 16 cases in Ⅱ A stage, 5 cases in ⅡB stage, 1 case in Ⅲ A stage and 1 case in m B stage. Summary showed accuracy of diagnosis in preoperative clinical staging was 63.3% （38/60）. Comparison of cervical cancer staging and MRI staging showed 17 cases in I B stage, 20 cases in Ⅱ A stage, 11 cases in Ⅱ B stage, 2 cases in m A stage and 1 case in m B stage. Summary showed accuracy of diagnosis in MRI staging as 85.0% （51/60）. Conclusion MRI contains high diagnostic value for cervical cancer,especially for preoperative detection of cervical cancer. It provides safety, creditability, convenience and speed for detection process, along with improved accuracy rate of diagnosis. It is worth promoting and applying in clinical treatment.