MRI检查诊断宫颈癌术前分期及盆腔淋巴结转移的临床价值

Clinical value of MRI examination in the diagnosis of preoperative staging and pelvic lymph node metastasis of cervical cancer

目的分析MRI检查诊断宫颈癌术前分期及盆腔淋巴结转移中的临床价值。方法回顾性分析2019年11月至2021年11月曲靖市第一人民医院收治的130例宫颈癌患者的临床资料,所有患者均于术前行MRI检查,并以术后病理检查结果为金标准,比较患者术前临床分期、术前MRI分期、术后病理分期,分析术前MRI对宫颈癌的诊断效能及典型宫颈癌患者术前MRI影像学特征。结果130例宫颈癌患者术前临床分期、术前MRI分期、术后病理分期比较差异均无统计学意义。4种宫颈癌病变类型灵敏度比较差异无统计学意义;4种宫颈癌病变类型特异度、阳性预测值、阴性预测值、诊断符合率比较差异有统计学意义(P<0.05)。深肌层浸润特异度、诊断符合率均高于宫旁浸润、阴道受累、盆腔淋巴结转移,盆腔淋巴结转移阳性预测值低于宫旁浸润、深肌层浸润,深肌层浸润、盆腔淋巴结转移阴性预测值均高于宫旁浸润,阴道受累阴性预测值低于深肌层浸润,差异有统计学意义(P<0.05);其他两两比较差异无统计学意义。典型病例MRI图像显示,随着临床分期的增加,患者肿瘤边缘组间变毛糙,宫颈处团块状变长,DWI成像病灶弥散受限呈信号变强。结论术前MRI检查及术前临床分期诊断宫颈癌分期与术后病理相近,且术前MRI检查诊断宫颈癌宫旁浸润、深肌层浸润、阴道受累、盆腔淋巴结转移均具有较高的诊断效能,临床可据术前MRI检查结果对宫颈癌患者进行诊疗。

Objective To analyze the clinical value of MRI examination in the diagnosis of preoperative staging and pelvic lymph node metastasis of cervical cancer.Methods Clinical data of 130 patients with cervical cancer admitted to the First People's Hospital of Qujing City from November 2019 to November 2021 were retrospectively collected,all patients underwent preoperative MRI examination,and the postoperative pathological examination results were used as the gold standard,the preoperative clinical stage,preoperative MRI stage,and postoperative pathological stage of patients were compared,and the diagnostic efficacy of preoperative MRI for cervical cancer and preoperative MRI imaging features of typical cervical cancer patients were analyzed.Results There was no statistically significant difference in preoperative clinical staging,preoperative MRI staging,and postoperative pathological staging among 130 cervical cancer patients.There was no significant difference in sensitivity among the four types of cervical cancer.There were significant differences in the specificity,positive predictive value,negative predictive value and diagnostic coincidence rate among the four types of cervical cancer lesions(P<0.05).The specificity and diagnostic coincidence rate of deep muscle invasion were higher than those of paruterine invasion,vaginal involvement and pelvic lymph node metastasis,the positive predictive value of pelvic lymph node metastasis was lower than that of paruterine invasion and deep muscle invasion,the negative predictive value of deep muscle invasion and pelvic lymph node metastasis was higher than that of paruterine invasion,and the negative predictive value of vaginal involvement was lower than that of deep muscle invasion,with statistical significance(P<0.05).Other pairwise comparisons were not statistically significant.The preoperative MRI images features of typical cases showed that as clinical staging increases,the tumor margins of the patient become rougher between groups,and the cervical area becomes longer in clusters.DWI imaging also shows limited diffusion of lesions and increased signal intensity.Conclusion Preoperative MRI examination and clinical staging in the diagnosis of cervical cancer are similar to postoperative pathology,and preoperative MRI examination have high diagnostic efficacy in the diagnosis of cervical cancer with parametrial infiltration,deep muscle layer infiltration,vaginal involvement,and pelvic lymph node metastasis,clinical diagnosis and treatment of cervical cancer patients can be based on the results of preoperative MRI examination.