MRI平扫及DWI在宫颈癌术前分期评估中的应用研究

Application of MRI plain scan and diffusion weighted imaging in preoperative staging evaluation of cervical cancer

目的探讨磁共振成像(MRI)平扫及磁共振弥散加权成像(DWI)在宫颈癌术前分期评估中的显像特点及应用价值。方法选取2017年1月至2018年5月在温州市中心医院接收检查治疗的400例宫颈癌患者为研究对象。所有患者均接受临床分期评估、MRI平扫及DWI检查。将手术病理分期结果作为金标准,分析临床分期、MRI及MRI+DWI对宫颈癌分期诊断的准确性及符合率,并比较MRI不同分期的宫颈癌组织弥散加权成像的表观弥散系数(ADC)和指数化表观弥散系数(eADC)变化。结果宫颈癌患者MRI显像特点为宫颈形态主要呈类圆形、不规则形状,TIWI主要为等信号或低信号,T2WI呈稍高信号。临床分期、MRI平扫、MRI+DWI分期诊断的总体准确性分别为78.00%、88.75%、94.50%。以病理分期为金标准,常规MRI分期诊断的总体一致率明显高于临床分期(96.25%vs.92.67%,χ~2=29.44,P<0.01),两者符合率的差异在ⅡA期、ⅡB期和ⅢA期的诊断中较为显著(χ~2值分别为6.61、15.63、6.02,均P<0.05)。而DWI+MRI分期诊断的总体一致率明显高于常规MRI(98.17%vs.96.25%,χ~2=16.25,P<0.01),两者符合率的差异在ⅢA期的诊断中较为明显(χ~2=6.48,P=0.01)。此外,不同MRI分期的宫颈癌组织弥散加权成像的ADC值之间的差异具有统计学意义(F=2.59,P<0.05)。结论 MRI平扫及MRI联合DWI在宫颈癌分期诊断中有较高的准确性,尤其是对中晚期宫颈癌有较高的诊断能力,可作为宫颈癌常规检查方法推广应用于临床。

Objective To explore the imaging characteristics and application value of conventional magnetic resonance imaging(MRI)plain scan and magnetic resonance diffusion weighted imaging(DWI)in preoperative staging evaluation of cervical cancer.Methods Four hundred patients with cervical cancer who were examined and treated in Wenzhou Central Hospital from January 2017 to May 2018 were enrolled.All patients had received clinical staging assessment,MRI plain scan and DWI examination.Taking results of surgical and pathological staging as gold standard,clinical staging,accuracy and coincidence rate of MRI and MRI combining DWI in cervical cancer staging were analyzed,and apparent diffusion coefficient(ADC)and exponential apparent diffusion coefficient(eADC)in diffusion-weighted MRI of cervical cancer tissues with different stages were also compared.Results MRI imaging of cervical cancer patients was characterized by a round,irregular shape of cervix,TIWI was mainly equal or low signal and T2 WI was slightly higher signal.Overall accuracy of clinical staging,MRI plain scan and MRI combining DWI was 78.00%,88.75%and 94.50%,respectively.With pathological staging as gold standard,overall consistency rate of conventional MRI staging diagnosis was obviously higher than that of clinical analysis(96.25%vs 92.67%,χ~2=29.44,P<0.01),and difference was especially significant inⅡA,ⅡB andⅢA period(χ~2 value was 6.61,15.63 and 6.02,respectively,all P<0.05).And overall consistency rate of DWI combining MRI in staging diagnosis was obviously higher than that of MRI(98.17%vs 96.25%,χ~2=16.25,P<0.01),and difference was especially significant in consistency rate inⅢA period(χ~2=6.48,P=0.01).In addition,difference in ADC value of DWI of cervical cancer tissues at different MRI stages was statistically significant(F=2.59,P<0.05).Conclusion MRI plain scan and MRI combined with DWI have higher accuracy in staging diagnosis of cervical cancer,especially in diagnosis of middle and advanced cervical cancer,which could be promoted and applied in clinical practice as routine cervical cancer examination method.