多模态MRI评价ⅠB1-ⅡA2期宫颈癌宫旁浸润的应用研究

Application of multimodal MRI in predicting parauterine invasion of stage IB1–IIA2 cervical cancer

目的探讨多模态MRI检查评价ⅠB1-ⅡA2期宫颈癌宫旁浸润的应用价值。方法收集2015年8月—2021年4月在陕西省人民医院行根治性子宫切除术的106例宫颈癌患者的多模态MRI检查及术后病理资料,依据检查序列将其分为平扫MRI组及多模态MRI组,分别由两位有经验的医师对影像资料进行宫旁浸润评价。结果106例患者中有28例存在宫旁浸润(26.4%)。平扫MRI组中医师1诊断宫旁浸润的敏感性、特异性、阳性预测值、阴性预测值、诊断准确率分别为71.4%、84.6%、62.5%、89.2%及81.1%,医师2的相应结果分别为67.9%、79.5%、54.3%、87.3%及76.4%;多模态MRI组医师1诊断宫旁浸润的敏感性、特异性、阳性预测值、阴性预测值、诊断准确率分别为85.7%、98.7%、96.0%、95.1%及95.3%,医师2的相应结果分别为89.3%、97.4%、92.6%、96.2%及95.3%。两名医师利用多模态检查对宫旁浸润的判定均优于单一平扫,其中特异性、阳性预测值及诊断准确率具有统计学差异(P<0.05);同时两名医师在多模态检查评估宫旁浸润的一致性方面表现为高度的一致性(κ=0.790),优于平扫的中度的一致性(κ=0.410)。结论多模态MRI检查较常规平扫MRI能显著提高ⅠB1-ⅡA2期宫颈癌宫旁浸润的诊断准确率,可以作为判断宫颈癌宫旁浸润的常规有效手段。

Objective The objective of this study was to investigate the application value of multimodal MRI in evaluating parauterine invasion of stage IB1-IIA2 cervical cancer.Methods The multimodal MRI examination and postoperative pathological data of 106 patients with cervical cancer who underwent radical hysterectomy in Shaanxi Provincial People′s hospital from August 2015 and April 2021 were collected.Two groups of MRI status were performed by two experienced physicians to evaluate the parauterine infiltration of the imaging data.Results Parauterine invasion was found in 28 of 106 patients(26.4%).In the plain MRI group,the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of physician 1 in diagnosing parauterine invasion were 71.4%,84.6%,62.5%,89.2%and 81.1%,respectively.The corresponding rates of physician 2 were 67.9%,79.5%,54.3%,87.3%and 76.4%,respectively;the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy of physician 1 in the diagnosis of parauterine invasion in the multimodal MRI group were 85.7%,98.7%,96.0%,95.1%and 95.3%,and the corresponding results for physician 2 were 89.3%,97.4%,92.6%,96.2%and 95.3%,respectively.The judgment of parauterine invasion by two physicians using multimodal MRI was better than that of single plain scan,and the specificity,positive predictive value and diagnostic accuracy were statistically different(P<0.05).There was a high degree of agreement(κ=0.790)in the examination to assess the consistency of parauterine invasion,which was better than moderate agreement(κ=0.410)for plain scans.Conclusion Compared with conventional plain MRI,multimodal MRI can significantly improve the diagnostic accuracy of parauterine invasion in stage IB1-IIA2 cervical cancer,and can be used as a routine and effective method for judging parauterine invasion of cervical cancer.