磁共振高分辨T2WI联合弥散加权成像对宫颈癌淋巴结转移的诊断价值

Value of high resolution T2WI combined with diffusionweighted imaging in diagnosis of lymph node metastasis in patients with cervical cancer

目的探讨磁共振高分辨T2WI联合弥散加权成像(DWI)技术对宫颈癌盆腔淋巴结转移的诊断价值。方法回顾性分析74例宫颈癌患者的MR影像及病理资料,18例患者存在淋巴转移,MRI共显示淋巴结264枚,其中转移淋巴结43枚,非转移淋巴结221枚。观察转移淋巴结T2WI信号特点,对比转移与非转移淋巴结的长径(L)、短径(S)、短径/长径(S/L)及表观扩散系数(ADC),并用ROC曲线分析各指标鉴别转移与非转移淋巴结的效能。结果宫颈癌转移淋巴结S、S/L大于非转移淋巴结(P<0.05),ADC小于非转移淋巴结(P<0.05);淋巴结ADC、S、S/L的ROC曲线下面积大于L(P<0.05),ADC、S、S/L的ROC曲线下面积比较无明显统计学差异(P>0.05)。高分辨T2WI显示转移淋巴结中13枚发现中心坏死(30%),非转移淋巴结未发现中心坏死。结论 DWI的ADC、S、S/L对宫颈癌转移与非转移淋巴结具有较高的诊断效能,T2WI所示淋巴结内部坏死有助于鉴别转移与非转移淋巴结。

Objective To investigate the value of high resolution T2WI combined with diffusion-weighted imaging （DWI） in diagnosis of metastasis lymph nodes in patients with cervical cancer. Methods The patho- logical data and imaging findings of 74 patients with cervical cancer were retrospectively analyzed. According to the results, MRI showed 264 lymph nodes in total and histopathology confirmed 43 metastasis lymph nodes in 18 patients. The signal characteristics of metastasis lymph nodes were observed on high resolution T2WI and the length diameter （L）, short diameter （S）, short diameter/length diameter （S/L）, apparent diffusion coeffi- cient （ADC） value of the lymph nodes between metastasis and non metastasis were compared, using receiver operating characteristic （ROC） curve to identify the performance of each indicator in metastasis lymph nodes. Results In patients with cervical cancer, the S, S/L of metastasis lymph nodes were greater than non metastasis and the ADC value of metastasis lymph nodes was lower than non metastasis （P 〈 0.05）. The area under ROCcurve of S, S/L and ADC value were greater than L （P 〈 0.05）, but there were no significant differences between S, S/L andADC value （P 〉 0.05）. Inhomogeneous signal intensity was found in 13 metastasis lymph nodes on high resolution T2WI imaging（30%）. Conclusion The S, S/L and ADC value of lymph nodes had a higher diagnostic efficiency in patients with cervical cancer. Inhomogeneous signal intensity on high resolu- tion T2WI imaging was helpful in differentiating metastasis lymph nodes from non metastasis.