MRI扫描技术对宫颈癌精准分期及同步放化疗疗效的预测价值分析

Accurate staging of cervical cancer by MRI scan and its predictive value for curative effect of concurrent chemoradiotherapy

目的探讨并分析磁共振成像(MRI)扫描技术对宫颈癌精准分期及同步放化疗疗效的预测价值。方法选取2019年2月—2021年2月我院收治的经病理证实为宫颈癌且未进行同步放化疗的63例患者作为研究对象,均采用MRI检查,以病理检查为金标准,评估MRI对宫颈癌精准分期的诊断价值。对所有患者实施同步放化疗,于治疗后2个月评估疗效,并对比治疗前后瘤体积、容量转移常数(Ktrans)、回流速率常数(Kep)、容积分数(Ve值)及表观扩散系数(ADC值)的变化情况。根据患者疗效情况分为缓解组(n=45)和无效组(n=18),对比两组治疗前肿瘤体积及定量参数变化水平,采用受试者特征曲线(ROC)曲线评估MRI扫描技术对宫颈癌同步放化疗疗效的预测价值。结果MRI检查与金标准对宫颈癌患者T、N分期的诊断一致性均较高(Kappa=0.799、0.823,P<0.05)。经2个月的同步放化疗后,宫颈癌患者的临床总有效率为71.43%(45/63);治疗后患者的肿瘤体积、Ktrans、Kep、Ve均显著低于治疗前,ADC明显高于治疗前(P<0.05)。治疗前缓解组患者的肿瘤体积、Ktrans、Kep、Ve均显著低于无效组,ADC明显高于无效组(P<0.05);治疗前肿瘤体积、Ktrans、Kep、Ve、ADC及其联合检测在预测宫颈癌患者疗效中的曲线下面积(AUC)分别为0.635、0.696、0.644、0.651、0.742、0.848(P<0.05)。结论MRI扫描技术对宫颈癌患者术前分期有较高的诊断鉴别价值。宫颈癌患者在进行同步放化疗后,可明显缩小肿瘤体积,提高ADC值,临床可通过MRI扫描技术对患者同步放疗疗效进行有效预测。

Objective To explore accurate staging of cervical cancer by magnetic resonance imaging(MRI)scan and its predictive value for curative effect of concurrent chemoradiotherapy.Methods A total of 63 patients who were pathologically confirmed with cervical cancer and admitted to the hospital were enrolled as the research objects from February 2019 to February 2021.All did not undergo concurrent chemoradiotherapy but underwent MRI examination.Taking pathological examination as the golden standard,the diagnostic value of MRI for accurate staging of cervical cancer was evaluated.At 2 months after concurrent chemoradiotherapy,curative effect was evaluated.The changes of tumor volume,volume transfer constant(Ktrans),reflux rate constant(Kep),volume fraction(Ve)and apparent diffusion coefficient(ADC)before and after treatment were compared.According to curative effect,the patients were divided into remission group(n=45)and ineffective group(n=18),and changes of tumor volume and quantitative parameters were compared between the two groups before treatment.The predictive value of MRI scan for curative effect of concurrent chemoradiotherapy was evaluated by receiver operating characteristic(ROC)curves.Results The diagnostic consistency of MRI and the golden standard for T and N staging of cervical cancer was high(Kappa=0.799,0.823,P<0.05).After 2 months of concurrent chemoradiotherapy,total clinical response rate in cervical cancer patients was 71.43%(45/63).After treatment,tumor volume,Ktrans,Kep and Ve were significantly decreased,while ADC was significantly increased(P<0.05).Before treatment,tumor volume,Ktrans,Kep and Ve in remission group were significantly lower than those in ineffective group,while ADC was significantly greater than that in ineffective group(P<0.05).Before treatment,area under the curve(AUC)values of tumor volume,Ktrans,Kep,Ve,ADC and combined detection for predicting curative effect in cervical cancer patients were 0.635,0.696,0.644,0.651,0.742 and 0.848(P<0.05).Conclusion MRI scan has high differential diagnosis value for preoperative staging in patients with cervical cancer.The concurrent chemoradiotherapy can significantly reduce tumor volume and increase ADC.Clinically,MRI scan can effectively predict curative effect of concurrent chemoradiotherapy.