磁共振T2WI联合DWI对宫颈癌宫旁浸润的诊断价值

Diagnostic value of magnetic resonance imaging T2WI combined with diffusion weighted imaging in parametrial invasion of cervical cancer

目的探讨磁共振T2WI联合DWI成像对宫颈癌宫旁浸润的诊断价值。方法收集2013年1月至2017年12月在陕西省人民医院收治行根治性子宫切除的87例宫颈癌患者的术前磁共振影像及术后病理资料,根据检查序列将术前的MRI检查图像依次分为MRI常规扫描、T2WI联合DWI成像及MRI常规联合增强扫描组,由2名高年资主治医师在影像PACS工作站共同对图像分析判断。结果 87例宫颈癌中有24例存在宫旁浸润。肿瘤直径(<4cm及≥4cm)、FIGO分期(ⅠB1、ⅠB2及ⅡA)及病理分级(低分化、中分化及高分化)在宫旁浸润阴性与阳性组之间的分布差异有统计学意义(χ2值分别为6.800、7.227、7.498,均P<0.05)。MRI常规序列扫描诊断宫旁浸润的敏感性、特异性、阳性预测值、阴性预测值、准确率及ROC曲线下面积分别为73.91%、81.25%、58.62%、89.65%、79.31%、0.795,T2WI联合DWI成像诊断宫旁浸润的敏感性、特异性、阳性预测值、阴性预测值、准确率及ROC曲线下面积分别为84.00%、95.16%、87.50%、93.65%、91.95%、0.942,MRI常规序列联合增强扫描诊断宫旁浸润的敏感性、特异性、阳性预测值、阴性预测值、准确率及ROC曲线下面积分别为83.33%、92.06%、86.96%、90.63%、89.66%、0.898。宫旁浸润阴性与阳性组肿瘤平均ADC值差异比较有统计学意义(t=-3.066,P<0.01),宫旁浸润阳性组肿瘤平均ADC值低于阴性组。结论 T2WI联合DWI成像诊断宫颈癌宫旁浸润的能力优于其他两种序列组合,具有重要的临床应用价值。

Objective To investigate the value of magnetic resonance imaging（MRI）T2WI combined with diffusion weighted imaging（DWI）in the diagnosis of parametrial invasion of cervical cancer.Methods Preoperative MRI images and postoperative pathological data of 87 patients with cervical cancer who underwent radical hysterectomy in Shaanxi Provincial People＇s Hospital during the period of January 2013 to December 2017 were collected.According to the examination sequence,the MRI images were divided into MRI routine scan group,T2WI combined with DWI imaging group,and MRI routine sequence combined with enhancement scan group.The images were analyzed and judged by two senior radiologists at the PACS workstation.Results Among 87 cases,24 had parametrial invasion.The difference in distribution of tumor diameter（4 cm and≥4 cm）,FIGO staging（IB1,IB2 and IIA）and pathological grading（low differentiation,moderate differentiation and high differentiation）was statistically significant between parametrial invasion negative group and parametrial invasion positive group（χ~2 value was 6.800,7.227 and 7.498,respectively,all P〈0.05）.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and the area under the ROC curve of MRI routine scan were 73.91%,81.25%,58.62%,89.65%,79.31% and 0.795,respectively.Those of T2WI combined with DWI imaging were 84.00%,95.16%,87.50%,93.65%,91.95% and 0.942,respectively.And those of MRI routine sequence combined with enhancement scan were 83.33%,92.06%,86.96%,90.63%,89.66% and 0.898,respectively.The difference in average ADC value of tumor between parametrial invasion negative group and positive group was statistically significant（t=-3.066,P〈0.01）,and the average value in parametrial invasion positive group was lower than in negative group.Conclusion T2WI combined with DWI imaging is superior to the other two methods in the diagnosis of parametrial invasion,which has important value for clinical use.