多b值磁共振扩散加权成像及动态增强扫描在宫颈癌临床分期及疗效评价中的初步研究

Value of Multi-b-Value DWI Imaging Combined with DCE-MRI in Staging and Assessment About Chemo-Radiotherapy of Cervical Cancer

目的通过分析正常宫颈及宫颈癌组织的多b值扩散加权成像(DWI)及动态增强(DCE-MRI)扫描的特点,探讨其对宫颈癌分期及监测宫颈癌放化疗疗效的价值。方法搜集经活检证实的中晚期宫颈癌患者40例(腺癌12例,鳞癌28例),进行常规MRI、多b值DWI和动态增强扫描。使用单因素方差分析法对比宫颈癌放化疗前后的多组不同b值时测得的表观扩散系数(ADC)值;采用卡方检验的Fisher确切概率法对比宫颈癌放化疗前后动态增强时间-信号强度曲线(TIC)类型,并对比宫颈癌与正常宫颈三层结构的TIC类型。结果 12例腺癌和28例鳞癌的多b值平均ADC值差异具有统计学意义(各组P<0.05)。40例宫颈癌患者的TIC分布Ⅰ型2例,Ⅱ型31例,Ⅲ型7例;正常宫颈黏膜Ⅰ型33例,Ⅱ型7例;正常宫颈结合带Ⅰ型31例,Ⅱ型9例,正常宫颈肌层Ⅰ型35例,Ⅱ型5例。宫颈癌与正常宫颈组织的TIC类型分布差异具有统计学意义(χ~2=83.708,P<0.05);常规MRI联合多b值DWI和动态增强扫描对宫颈癌的诊断分期与临床分期的符合率为97.5%;宫颈癌放化疗前后的ADC值差异具有统计学意义(t=30.315,P<0.05);宫颈癌治疗前后的TIC分布差异有统计学意义(χ~2=52.051,P<0.05)。结论多b值DWI联合动态增强检查可以提高宫颈癌的分期准确率,并对监测宫颈癌放化疗疗效有重要价值。

Objective By analyzing the characteristics of multi-b-value DWI imaging of cervical cancer to investigate it＇s value in staging and assessment about chemo-radiotherapy of cervical cancer. Methods 40 patients with pathologically confirmed advanced cervical cancer were included in the study,including 28 squamous cell carcinoma,12 adenomatous carcinoma. All patients underwent conventional MR scan,multi-b-value DWI sequence and DCE-MRI. The ADC value of multi-b-value DWI imaging and TIC types were compared statistically between different pathological types. The main statistical methods including One-Way ANOVA and Chi-square test（ Fisher＇s exact test） were applied. Results The average ADC values of squamous cell carcinoma,adenomatous carcinoma showed statistical difference（ each group P〈0. 05）. In cervical carcinoma group,there was display of type Ⅰ curve（ 2）,typeⅡ curve（ 31） and type Ⅲ curve（ 7）. The cervical endometrial group showed typeⅠcurve（ 33）,typeⅡcurve（ 7） and type Ⅲ curve（ 0）. The junctional zone group showed typeⅠcurve（ 31）,typeⅡcurve（ 9）,type Ⅲ curve（ 0）. The myometrium group showed typeⅠcurve（ 35）,typeⅡ curve（ 5）,typeⅢ curve（ 0）. The difference between curve types was statistically significant.（ χ^2= 83. 708,P〈0. 05）. The coincidence rate between clinic staging and multi-b-value DWI imaging combined with DCE-MRI was 97. 6%. The difference of mean ADC value between pre-chemoradiation and the post-chemoradiation was statistically significant（ t = 30. 315,P〈0. 05）.The TIC types between pre-chemoradiation and post-chemoradiation also changed statistically（ χ-2= 52. 051,P〈0. 05）.Conclusion multi-b-value DWI imaging combined with DCE-MRI can improve the accuracy of the staging in cervical car-cinoma,and has great clinical significance in chemo-radiotherapy assessment of cervical cancer.