彩色多普勒超声与MRI对乳腺癌的联合诊断价值

目的:对比分析彩色多普勒超声与MRI对乳腺癌诊断及联合诊断的价值。方法:回顾性分析我院经病理确诊的115例乳腺癌的高频超声及MRI资料,分析比较2种检查方式及联合应用对乳腺癌的诊断准确率。结果:115例经病理证实非浸润性癌51例,早期浸润性癌34例,浸润性癌30例。非浸润性癌彩色多普勒超声诊断准确率74.5%(38/51),MRI诊断准确率86.3%(44/51),两者联合诊断准确率96.1%(49/51);早期浸润性癌彩色多普勒超声诊断准确率85.3%(29/34),MRI诊断率94.1%(32/34),两者联合诊断准确率97.1%(33/34);浸润性癌彩色多普勒超声诊断准确率96.7%(29/30),MRI诊断准确率96.7%(29/30),两者联合诊断率100.0%(30/30);非浸润性癌及早期浸润性癌彩色多普勒超声诊断率明显低于MRI(均P0.05);非浸润性癌彩色多普勒超声、MRI单独应用诊断准确率均明显低于两者联合应用(均P0.05);早期浸润性癌彩色多普勒超声诊断准确率明显低于两者联合应用(P0.05)。结论:彩色多普勒超声与MRI对乳腺癌诊断均有较高的应用价值,MRI在发现早期乳腺癌及良恶性鉴别诊断中具有更高的诊断敏感性和准确率,但两者联合应用价值更高,尤其是对非浸润性乳腺癌及早期浸润性乳腺癌早期诊断有重要意义。     

多模态磁共振检查在宫颈癌分期诊断中的应用

目的探讨多模态磁共振检查在宫颈癌分期诊断中的应用价值。方法回顾性分析156例经临床证实的宫颈癌患者的术前MRI资料,按照MRI平扫、平扫联合DWI、平扫联合DCE-MRI、多模态组(平扫+DWI+DCE-MRI)进行分组,由两位有经验的放射科医师进行独立阅片并进行影像学诊断及分期,所有分期结果与最终临床分期进行对照。结果平扫准确判断分期112例,错误分期44例,诊断准确率为71.8%;平扫结合DWI准确判断分期135例,错误分期21例,诊断准确率为86.5%;平扫结合DCE-MRI准确判断分期132例,错误分期24例,诊断准确率为84.6%;多模态组准确判断分期149例,错误分期7例,诊断准确率为95.5%。四组之间的诊断准确率不全相等(P0.05);组间比较揭示平扫联合DWI、平扫联合DCE-MRI二者之间在宫颈癌分期诊断准确率上无明显差异(P0.05),二者分期诊断价值高于单一平扫(P0.05)而低于多模态组(P0.05)。结论多模态MRI检查在宫颈癌分期诊断中较单一或者二者联合检查具有更高的诊断价值,可明显提高宫颈癌分期诊断的准确率,可以作为宫颈癌分期诊断的常规有效检查手段。     

经阴道彩色多普勒超声在子宫内膜癌术前筛查中的应用

目的：探讨经阴道彩色多普勒超声（TVCDS）在子宫内膜癌筛查中的应用。方法：应用TVCDS筛查子宫内膜癌高危因素妇女326例,记录子宫内膜形态及病灶的部位、子宫内膜厚度、病灶内血流、阻力指数（RI）等,判断子宫内膜癌及肌层浸润程度等。将TVCDS诊断结果与病理结果对照。结果：326例高危因素妇女中TVCDS诊断子宫内膜癌52例,后经手术病理证实48例,TVCDS诊断子宫内膜癌准确率为92%。结论：TVCDS无创、简便、价廉、易于重复,诊断子宫内膜癌准确率高,在子宫内膜癌术前筛查中具有良好的应用价值。     

CT、MRI在宫颈癌诊断中的应用价值分析

目的 探讨MRI、CT在诊断宫颈癌方面的应用价值。方法 选取在我院就诊的经手术病理确定为宫颈癌的60例患者为观察对象，其中接受MRI检查(行增强扫描)的患者为观察组，接受CT检查(行增强扫描)的患者为对照组。对比两组患者的影像学表现与诊断结果。结果 观察组的MRI诊断准确率为91.66%,明显高于对照组CT检查83.33%的诊断准确率，差异有统计学意义(P<0.05)。结论 利用MRI对宫颈癌患者进行诊断，比CT诊断的影像学表现特征更明显，诊断准确率更高，具有更高的应用价值。     

经阴道彩色多普勒超声诊断宫颈病变的价值

目的:评价经阴道彩色多普勒超声(TVCDS)对宫颈病变的诊断价值。材料和方法:对722例受检者进行经阴道超声(TVS)检查,采用彩色多普勒血流显像(CDFI)检测收缩期血流峰值速度(PSV)及阻力指数(RI),并将187例宫颈病变的宫颈活检或手术病理结果与超声结果进行对照。结果:宫颈囊肿、息肉、肥大、肌瘤的二维声像图特征明显,诊断符合率依次为100%、85.4%、92.1%、100%;宫颈癌的诊断符合率62.5%,并可提示周围的浸润情况;宫颈肌瘤组的PSV和RI值显著低于正常宫颈组,宫颈囊肿组和息肉组的PSV和RI值显著低于正常宫颈组;宫颈癌组的PSV显著高于正常宫颈组,RI值显著低于正常宫颈组。结论:TVCDS是一种诊断宫颈病变的重要影像学方法。     

经腹与经阴道彩色多普勒检查妇产科急腹症临床价值分析

目的探讨经腹与经阴道彩色多普勒超声检查技术在妇产科急腹症临床诊断中的应用价值。方法本研究于2014年1月~2014年12月将在杭钢医院妇产科收治的急腹症患者分别经阴道超声及腹部超声检查,探讨经腹超声与经阴道超声在妇产科急腹症诊断中的应用价值。结果经阴道彩色多普勒超声检查准确率(90.70%)明显高于经腹彩色多普勒超声(75.58%),且差异具有统计学意义。另外,TVS和TAS两种超声检查方法联合使用的诊断准确率达98.84%,明显高于TAS和TVS诊断准确率,且差异具有统计学意义。经腹与经阴道联合超声检查在异位妊娠、黄体破裂、不全流产、子宫穿孔等妇产科急腹症诊断方面的符合率均达到100.00%,其中仅有1例急性盆腔炎患者在进行经腹与经阴道联合超声检查发生误诊。结论经腹与经阴道联合超声检查对妇产科急腹症有重要的诊断价值,明显优于单纯经腹部和经阴道超声,临床早期诊断治疗提供依据。     

经阴道超声在宫颈癌患者中的诊断价值

目的通过观察阴道超声应用于宫颈癌诊断的效果来探讨其临床应用价值。方法回顾性分析我院2010年5月~2015年5月期间160例宫颈癌患者临床影像学资料,患者均分别采用阴道彩色多普勒超声、腹部彩色多普勒超声检查,同时以手术病理结果为金标准,对两者诊断结果准确性进行比较与分析。结果经诊断发现,阴道超声诊断准确率93.8%明显高于腹部超声诊断准确率52.5%,P0.05。结论应用经阴道彩色多普勒超声于宫颈癌诊断中具有较高诊断价值,有利于疾病诊断。     

经阴道超声和 MRI 对剖宫产术后早期子宫瘢痕妊娠的诊断价值比较

目的：探讨经阴道超声和 MRI 在诊断剖宫产术后早期子宫瘢痕妊娠(CSP)中的价值。方法分析28例拟诊为 CSP 患者的经阴道超声和 MRI 资料,以手术和术后病理为金标准,比较两者诊断 CSP 的敏感度、特异度、准确率、显示孕囊及与周围组织关系的差别。结果28例拟诊 CSP 患者经手术和病理证实为 CSP 22例,经阴道超声和 MRI 分别正确诊断20例和19例,两者诊断敏感度、特异度、诊断准确率分别为90.9%,50.0%,82.1%和86.4%,83.3%,85.7%,2种方法诊断准确率无统计学差异(χ2=0.132, P =0.72)。22例 CSP 中病理见孕囊20例,经阴道超声和 MRI 分别证实19例和17例,无统计学差异(χ2=1.11,P =0.29);手术和病理证实卵黄囊14例,胚芽9例,原始心管搏动7例,孕囊局部瘢痕浸润10例,经阴道超声和 MRI 分别诊断12例和2例,8例和2例,5例和0例,3例和9例,均有显著统计学差异(χ2=13.8,P=0.000;χ2=7.7,P =0.006;χ2=7.2,P =0.007;χ2=7.1,P =0.008);手术和病理证实孕囊内出血16例,宫腔积血17例,经阴道超声和 MRI 分别诊断7例和14例,9例和15例,均有统计学差异(χ2=6.6, P =0.01;χ2=5.0,P =0.026)。结论经阴道超声和 MRI 诊断 CSP 的准确率均较高。经阴道超声显示卵黄囊、胚芽和原始心管搏动优于 MRI;MRI 显示妊娠囊内出血、宫腔积血、孕囊与切口及周围组织关系优于经阴道超声,二者联合对诊治 CSP 有重要价值。     

经阴道彩超联合阴道镜诊断早期宫颈癌病变的临床价值分析

目的探讨经阴道彩超联合阴道镜诊断早期宫颈癌病变的效果及其临床价值。方法选取我院收治的95例早期宫颈癌病变患者作为研究对象,均具阴道镜、经阴道彩超、活检资料;以活检结果为金标准,比较阴道镜、经阴道彩超单独及联合诊断效果。结果各检查方法与病理学行一致性比较,阴道镜Kappa值为0. 581,一致性一般;经阴道彩超、联合诊断Kappa值分别为0. 916、0. 979,一致性高。对不同患者阴道彩超的血流参数比较,早期宫颈癌患者PSV显著低于癌前病变患者(t=6. 276,P 0. 05),而RI显著高于癌前病变患者(t=9. 316,P 0. 05)。阴道镜、经阴道彩超联合诊断在早期宫颈癌、癌前病变确诊率上差异显著。结论经阴道彩超联合阴道镜诊断早期宫颈癌病变,可有效区分早期宫颈癌和癌前病变。     

高分辨率MRI联合MSCT及经阴超声检查对宫颈癌患者术前分期的诊断价值

目的探讨高分辨率MRI联合多层螺旋CT(MSCT)及经阴超声(transvaginal ultrasound, TVUS)检查对宫颈癌患者术前分期的诊断价值。方法选取本院收治的宫颈癌患者65例的临床资料,均行高分辨率MRI、MSCT及TVUS检查,比较其对宫颈癌患者术前分期的诊断价值。结果高分辨率MRI联合MSCT检查结果与术后临床分期结果一致性较强。TVUS检查结果与术后临床分期结果一致性较强。高分辨率MRI的符合率为83.08%,MSCT的符合率为81.54%,高分辨率MRI联合MSCT符合率为95.38%,TVUS符合率为84.62%,高分辨率MRI联合MSCT符合率明显高于单纯高分辨率MRI、MSCT、TVUS,比较差异均有统计学意义。结论高分辨率MRI联合MSCT对宫颈癌患者术前分期的诊断价值优于TVUS及单纯高分辨率MRI、MSCT诊断。     

宫颈癌MRI分期与妇科检查分期对比分析

目的 对照妇科检查分期,探讨MRI在宫颈癌尤其是中、晚期宫颈癌分期中的价值。方法 32例具有完整临床及手术病理资料的宫颈癌患者,术前均行MRI检查,将MRI影像分期结果,临床妇科检查分期结果与宫颈癌术后病理分期结果相比较。结果 32例宫颈癌中,MRI分期判断为Iib期以前11例,Iib期（含Iib期）以后21例。与病理结果比较,MRI对二者区分的准确性为93%,对有无宫旁侵犯判断的准确性为94%,敏感性为91%,特异性为94%。妇科检查分期判断为Iib期以前14例,Iib期（含Iib期）以后18例。妇科检查对二者区分的准确性为87%,对有无宫旁侵犯判断的准确性为81%,敏感性为75%,特异性为87%。结论 MRI对早期宫颈癌的诊断及分期尚待改进,但对中晚期宫颈癌及宫颈癌宫旁侵犯,MRI具有重要临床应用价值。     

DWI联合M RI常规序列对早期子宫内膜癌术前评估的价值

目的：探讨DWI联合M RI常规序列对早期子宫内膜癌术前评估的应用价值。方法回顾性分析43例经手术病理证实的I～Ⅱ期子宫内膜癌的M RI资料,观察肿瘤信号、侵及范围,测量肿瘤实质部分的ADC值,并进行肌层浸润深度评估。结果与正常子宫内膜相比,肿瘤T1 WI多呈等信号,T2 WI呈高信号,DWI为明显高信号,ADC值降低。Ia、Ib及II期肿瘤实质部分ADC值比较,差异无统计学意义。M RI常规序列及DWI联合M RI常规序列判断肌层浸润深度的准确率分别为81．4％和86．0％。结论 DWI联合M RI常规序列对早期子宫内膜癌术前判断肌层浸润深度较准确,可作为子宫内膜癌术前评估的重要方法。     

FIGOⅠ Ⅱ期子宫内膜癌MRI征象分析与评价

目的:按照FIGO2009分期标准,分析ⅠⅡ期子宫内膜癌的MRI征象及其病理基础,评价MRI对子宫内膜癌肌层和宫颈侵犯的诊断价值。方法:43例ⅠⅡ期子宫内膜癌患者术前均行MRI检查,采用双盲法,描述肿瘤的MRI表现特征,并将MRI术前分期及判断肌层和宫颈浸润结果,与术后病理结果对照分析。结果:Ⅰa 26例,Ⅰb 8例,Ⅱ期9例。Ⅰ期MRI主要表现为子宫内膜增厚、腔内局限型或弥漫性软组织肿块呈中等强化、T2WI低信号结合带中断及肌层侵犯等,其病理基础为癌细胞呈腺样乳突状结构,突破粘膜层,向肌壁间浸润性生长。Ⅱ期以宫颈内出现与宫体肿瘤相连续的异常信号影及宫颈纤维间质破坏为特征。MRI评价肿瘤浸润肌层深度的诊断准确性为86%,判断宫颈侵犯的敏感性、特异性、准确性分别为78%、91%、88%,与病理结果比较无显著性差异(P0.05)。结论:MRI对Ⅰ、Ⅱ期子宫内膜癌的早期诊断、肌层和宫颈侵犯的判断及术前分期准确性高,具有较高的临床应用价值。     

常规超声联合超声造影成像对宫颈癌诊断及分期初步研究

目的探讨常规超声联合超声造影检查(CEUS)在诊断宫颈癌及分期中的应用价值。方法对36例临床诊断为宫颈癌的患者,在术前进行超声及CEUS根据肿块部位、大小、对周围组织的侵犯情况进行分期,并与手术病理分期对照,分析其诊断宫颈癌分期的准确性。结果常规超声联合CEUS诊断宫颈癌Ⅰb、Ⅱ、Ⅲ、Ⅳ期准确率分别为100.0%(4/4)、75.0%(9/12)、92.9%(13/14)和100.0%(6/6),总准确率达88.9%(32/36),两者检查结果高度一致(Kappa值=0.866)。结论超声联合CEUS诊断宫颈癌分期的准确率较高,可以作为主要影像学检查方法之一。     

磁共振成像检查在宫颈癌的诊断及分期中的应用价值分析

目的探讨磁共振成像检查对宫颈癌患者的诊断及分期价值。方法回顾性分析2016年10月至2018年11月在我院接受治疗的73例疑似宫颈癌患者的临床资料,所有入选者均需接受磁共振成像检查,分析诊断效能以及分期结果。结果以病理组织活检结果作为金标准,磁共振成像对宫颈癌的诊断敏感度为96.6%,特异度为78.6%,准确度为93.2%,阳性预测值为95.0%,阴性预测值为84.6%;磁共振成像对宫颈癌Ⅰa期的诊断符合率为80.0%,Ⅰb期为75.0%,Ⅱa期为75.0%,Ⅱb期为72.7%,Ⅲa期为44.4%,Ⅲb期为50.0%,Ⅳ期为50.0%。结论磁共振成像为临床诊断宫颈癌患者的有效手段,具有良好的诊断效能,且可为临床分期提供有效依据。     

宫颈癌MR分期与临床分期及病理对照研究

目的分析宫颈癌MR影像表现，评价MR在宫颈癌分期中的价值。资料与方法60例均在治疗前行盆腔的轴位SE T1WI，轴位及矢状位快速自旋回波（TSE）T2WI。在MRI上观察肿瘤的位置、大小、信号特征、浸润范围及累及宫旁的情况，并将MR所见进行影像学分期，同时与临床及病理分期进行对比分析。结果MR在判断宫颈癌发生部位的准确性为100％，判断宫旁浸润的准确性为92．31％，判断宫颈癌分期总的准确性为96．67％，对宫旁浸润的特异性和敏感性分别为97．87％和92．31％。结论MR能多方位高分辨率显示宫颈癌病灶的位置、大小及向宫旁浸润的程度，对宫颈癌的分期具有极高的价值。临床检查结合MRI可较为准确地评价宫颈癌的分期，使其更接近于病理分期，从而对宫颈癌的治疗起到指导性的作用。     

3.0TDCE-MRI对宫颈癌的评估价值

目的：探讨3.0T 动态增强磁共振(DCE-MRI)对宫颈癌各组特征的评估价值。方法156例宫颈癌患者在治疗前行常规 MRI 及 DCE-MRI 扫描,在获得病理结果后将宫颈癌患者分成6组(组织学类型,分化程度,FIGO 早晚分期,淋巴结状态,肿瘤直径,年龄段)计算时间-信号强度曲线半定量参数,并利用 SPSS 及 R3.1.1软件进行统计学分析。结果鳞癌注射对比剂后30 s 的强化率(SI30s%)及最大增强斜率(Slope)均高于腺癌,FIGO 早期宫颈癌的达峰时间(TTP)低于 FIGO 晚期宫颈癌,FIGO 早期宫颈癌的 Slope 高于 FIGO 晚期宫颈癌,其余各项分组的各参数之间无明显统计学差异。结论3.0T DCE-MRI 的半定量参数可以有效鉴别宫颈鳞癌与腺癌及 FIGO 早/晚分期宫颈癌,利用 Slope 鉴别宫颈鳞癌与腺癌的价值高于 SI30s%,TTP 与 Slope 鉴别 FIGO早/晚分期宫颈癌的价值相当。     

Role of MRI in detecting involvement of the uterine internal os in uterine cervical cancer: Systematic review of diagnostic test accuracy

Purpose

In patients with uterine cervical cancer, pretreatment recognition of uterine extension is crucial in treatment decision-making for fertility-sparing surgery and for target delineation in radiotherapy. Although MRI is generally considered the most reliable method, its value for detecting involvement of the uterine internal os is unclear.

Methods

Medline, Embase and Cochrane databases were systematically searched (January 1997–December 2012) for MRI studies that measured the accuracy of involvement of the uterine internal os compared to histopathology as reference standard in patients with uterine cervical cancer. Data were assessed using the QUADAS tool. Accuracy concerned either involvement (yes/no) of the uterine internal os, or measuring invasion distance toward the uterine corpus.

Results

Two retrospective and two prospective studies described 366 patients diagnosed with uterine cervical cancer FIGO stage IIB or below, in whom 64 (17%) had uterine internal os involvement. For three studies the summary estimates of specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were 91%, 97%, 99%, 79% and 95%, respectively; one study had an area under the curve (AUC) of 0.8.

Conclusion

MRI has a high level of accuracy; however, data are limited and for validation a large prospective study is needed that compares actual measurements on MRI with histopathological examination.     

Prognostic significance of MRI-detected bladder muscle and/or serosal invasion in patients with cervical cancer treated with radiotherapy

In cervical cancer, the prognostic significance of bladder wall invasion on MRI without pathological evidence of mucosal invasion is not known. From 454 consecutive patients with cervical cancer who were treated with radiation, we reviewed images and analysed the outcome of 92 patients with the Federation of International Gynecology and Obstetrics (FIGO) stage IIIB–IVA. We analysed the patients in three groups, normal, wall (muscle and/or serosal) invasion and mucosal invasion, according to the findings on the MRI. Kaplan–Meier life table analysis and the log-rank test were used to assess the survival rates and differences according to prognostic factors. MRI detected abnormalities in the bladder wall in 42 patients (45.6%): wall invasion in 24 and mucosal invasion in 18. 5 of 18 patients, suspected on MRI to have mucosal invasion, showed no pathological evidence of mucosal invasion. Median follow-up period was 34 months. 3-year cause-specific survival (CSS) in the normal group compared with the wall invasion group was 76.2% vs 71.4% (p = 0.48). 3-year CSS for the wall invasion group compared with the mucosal invasion group was 71.4% vs 54.3% (p = 0.04). Mucosal invasion on MRI (p = 0.03) and concurrent chemoradiotherapy (p = 0.01) was significant for CSS. The prognosis for patients with cervical cancer with evidence of muscle and/or serosal invasion of the bladder on MRI may not differ from that for patients without abnormality on MRI. In patients with the MRI finding of bladder mucosal invasion, further studies should be conducted regarding the role of cystoscopy to determine the need for pathological confirmation.According to the 2006 report by the Federation of International Gynecology and Obstetrics (FIGO) [1], the 5-year survival of patients with stage IVA cervical cancer is about half that of patients with stage IIIB cervical cancer (22.0% vs 41.5%). Reviewing the hazard ratios for patients with stages IIB, IIIB and IVA (2.7, 5.3 and 11.7, respectively), we noted a sharp increase in hazard ratio for stage IVA relative to stage IB. Because as the stage increases, the impact of lymph node involvement or tumour size on survival outcome decreases [1], mucosal involvement of the bladder and/or rectum may potentially have a strong influence on survival.During the past two decades, there have been changing trends not only in the incidence of uterine cervical cancer [2] but also in the process of staging work-up. As MRI has become more applicable in planning the treatment of cervical cancer [3, 4], previously unnoticed invasion of the posterior wall of the urinary bladder without cystoscopic evidence of mucosal invasion appears frequently in advanced disease. However, there have been no published reports regarding the frequency of these findings or the prognosis for these patients with abnormal bladder wall findings on MRI without cystoscopic evidence of mucosal invasion.Evidence suggests that MRI may predict the extent of disease more accurately than clinical staging [5]. With regard to bladder invasion, studies specifically tested the diagnostic accuracy of MRI against cystoscopic examination and/or surgical sampling as reference standards [6–10]. However, non-mucosal invasion cannot be diagnosed with cystoscopy, but can be confirmed only by exploration, which is not usually performed for locally advanced cervical cancer. For this reason, it is difficult to determine the diagnostic accuracy of MRI.Following radiotherapy for advanced-stage tumours, MRI performance can be assessed only with clinical outcome. Few studies have reported on the use of MRI in cervical carcinoma treated with radiotherapy, and most have focused on the relationship between outcome and tumour diameter, tumour volume or lymph node status. We investigated the prognostic significance of abnormal bladder wall findings on MRI, with particular attention to those patients without cystoscopic evidence of mucosal invasion.     

MSCT和MRI对浸润性宫颈癌术前分期的价值对比

目的:对比浸润性宫颈癌在MSCT和MRI上表现差异及术前分期价值。方法:搜集有手术病理结果证实的宫颈癌82例,术前行CT检查74例,行MRI检查63例,以术后病理分期为标准,计算并比较CT、MRI对不同期宫颈癌的诊断符合率;对比分析两组图像上肿瘤大小、阴道或穹窿侵犯、宫体侵犯以及宫旁侵犯,分别计算并比较诊断符合率、敏感度及特异度。结果:对≤ⅠB1期宫颈癌,CT和MRI诊断符合率分别为47.56%、70.73%,ⅠB2～ⅡA期分别为80.49%、87.80%,≥ⅡB期分别为91.46%、82.93%。在显示肿瘤方面,MRI对≤4cm癌肿、阴道或穹窿侵犯方面的显示优于CT;CT对宫体侵犯诊断灵敏度高,对盆腔转移淋巴结的诊断优于MRI。结论:对≤ⅠB1和ⅠB2～ⅡA的早中期浸润性宫颈癌术前行MRI检查更有价值;而对于≥ⅡB的晚期浸润性宫颈癌行MSCT检查则更具有价值。