MRI 在宫颈癌分期及淋巴结转移评估中的价值探讨

摘要： 目的 比较宫颈癌磁共振成像 （MRI） 分期与 2009 版国际妇产科联盟 （FIGO） 分期的准确度并评估 MRI 诊断淋巴结转移的价值。方法 以手术病理为金标准， 比较 86 例宫颈癌病例 （手术病理分期≥Ⅰb 期） MRI 分期与 FIGO 分期的准确度； 取横断面扩散加权成像（DWI） 呈稍高信号， 图像上短径≥1 cm 的淋巴结为转移淋巴结， 分析其特征并评估 MRI 诊断淋巴结转移的准确度、 敏感度、 特异度、 阳性预测值、 阴性预测值及转移基本特征。 结果 FIGO 分期准确度 80.2% （69/86）， MRI 分期准确度 83.7% （72/86）， 差异无统计学意义 （P > 0.05）； MRI 诊断淋巴结转移准确度 94.2% （81/86）、 敏感度 73.3% （11/15）、 特异度 98.6% （70/71）、 阳性预测值 91.7% （11/12） 及阴性预测值 94.6% （70/74）； 11 例真阳性淋巴结转移以左髂内及左髂总淋巴结为主， 平均短、 长直径比 0.76， 包括 3 例类圆形， 3 例边界不规则形， 4 例巨大融合形， 1 例含中心坏死区。1 例假阳性位于右髂内淋巴结， T2WI/TRA 呈巨大融合形， 薄层扫描显示外形较细碎， 而 T2WI/SAG 则呈长条形。结论 MRI 分期与 FIGO 分期准确度均较高， 两者结合有利于提高诊断准确度； MRI 能较准确诊断淋巴结转移。

Evaluation of MRI-staging and assessment of lymphatic metastasis in cervical cancer

Abstract：Objective To contrast the accuracy rate of nuclear magnetic resonance imaging (MRI)-staging and the International Federation of Gynecology and Obstetrics (FIGO, 2009) clinical- staging, and evaluate the value of MRI in diagnosis of lymph node metastasis in cervical cancer. Methods The surgical pathology was used as golden standard, the accuracy rates of MRI- staging and FIGO- staging were compared in 86 patients of cervical cancer (surgical pathological staging ≥Ⅰb). The lymph nodes with slightly hyperintense signal in diffusion-weighted magnetic resonance imaging (DWI) and with minor axis≥1 cm in T2WI-TRA (T2 weighted imaging-transverse section) were considered as metastatic lymph nodes, the characteristics of lymphatic metastasis diagnosed by MRI were analyzed, and the accuracy rate, the sensitivity, the specificity, the positive predictive value and the negative predictive value of MRI were evaluated. Results The accuracy rate of FIGO-staging was 80.2%(69/86), and the accuracy rate of MRI-staging was 83.7%(72/86), there was no significant difference between them (P > 0.05). The accuracy rate of lymphatic metastasis diagnosed by MRI was 94.2%(81/86), the sensitivity was 73.3%(11/15), the specificity was 98.6%(70/71), the positive predictive value was 91.7%(11/12), and the negative predictive value was 94.6%(70/74). The true positive metastatic lymph nodes in 11 cases were located in the external iliac nodes or common iliac lymph nodes, the average short/long diameter was 0.76. The forms of lymph nodes were as follows: quasi-circular (n=3), border irregularity (n=3), huge fusion form (n=4), and 1 with central necrosis area. One case of false positive metastatic lymph node was located in the right external iliac node, with the sharp of huge fusion form in T2WI/TRA, comminution in T2WI-axial thin slices, and long strip in T2WI/SAG. Conclusion The accuracy rates of MRI- staging and FIGO-staging were both higher, which can diagnose lymphatic metastasis relatively accurately when they are combined together.