MRI评估宫颈癌病变范围的临床分析

目的评价磁共振成像对宫颈癌分期的价值。方法对33例宫颈癌患者在手术前进行磁共振成像(MRI)检查,依临床分期制定治疗计划。以术后病理诊断为金标准,将临床、磁共振成像分期结果中癌浸润的部位和范围、淋巴结转移,尤其对宫旁浸润采用患者自身对照法与手术病理所见进行对比,评价宫颈癌分期。结果MRI对宫旁浸润判断的准确度为94%,特异度为96%,敏感度为90%。MRI对宫颈癌总的分期预测的准确性为75.7%。在局限性和宫旁浸润的区分中MRI有着94%的准确性。结论MRI在宫颈癌中对区分局限性和浸润性病灶有着较高的准确性。引入MRI技术于临床,有利于治疗计划的制定,应成为宫颈癌术前常规的影像检查方法。     

Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer

ObjectiveTo investigate diffusion-weighted magnetic resonance imaging (DWI) as an early and reproducible response indicator in women receiving concurrent radiotherapy and chemotherapy (chemoradiation) for advanced cervical cancer.MethodsTwenty women with advanced cervical cancer were included in a prospective cohort study. DWI was carried out prior to chemoradiation, repeated after 2 weeks of therapy and at the conclusion of therapy using a 1.5 T MRI scanner. The apparent diffusion coefficient (ADC) was calculated from the diffusion data at each assessment. This was correlated with final tumour response as determined by change in tumour size using MRI and conventional clinical response. Twelve women also underwent 2 separate pre-treatment DWI examinations to test for reproducibility of the ADC measurements.ResultsADC values after 2 weeks of therapy showed a significant correlation with eventual MR response (p = 0.048, ρ = 0.448, Spearman's correlation) and clinical response (p = 0.009, ρ = 0.568) as did the change in ADC after 2 weeks of therapy (p = 0.01, ρ = 0.56 for MR response, p = 0.03, ρ = 0.48 for clinical response). Reproducibility of ADC measurements was confirmed with a mean difference in ADC of ? 0.003 between consecutive pre-therapy MRI assessments and 95% confidence intervals of ? 0.12 and 0.11.ConclusionDWI has potential to provide a surrogate biomarker of treatment response in advanced cervical cancers. The use of ADC offers an early and reproducible indication of tumour response which may ultimately allow the development of individualised regimens.     

Thinning of preserved stromal cervical ring at magnetic resonance imaging in patients with early cervical cancer: a possible predictor of extracervical invasion

The sensitivity of magnetic resonance (MR) imaging in predicting extracervical tumor invasion on the basis of the detection of a thinning of the uninvolved cervical stromal ring (3 mm or less) was compared to the sensitivity achieved by visualization of a complete stromal interruption. Fifty-seven consecutive patients with squamous carcinoma of the uterine cervix (FIGO stage IB-IIA), scheduled for radical surgery, were examined with axial and sagittal weighted MR sequences. The sensitivity in predicting extracervical involvement on the basis of the MR imaging visualization of a thinned stroma was 87.5%, whereas the sensitivity obtained by detection of a complete stromal interruption was 70%. Among women with a spared cervical stroma of more than 3 mm at MR imaging, only two had microscopic extracervical involvement at pathologic examination, accounting for a negative predictive value of 92.8%. The results of our study show a high concordance between MR imaging and pathologic findings, and indicate that the detection of an intact cervical stromal ring exceeding 3 mm at MR imaging is related to a very low risk of extracervical seeding of tumor. On the other hand, the detection of a thinned stromal ring is related to a high incidence of microscopic parametrial invasion. The information obtained by this imaging technique may therefore be extremely useful in accurate treatment planning for these patients.     

Combined ultrasound and magnetic resonance imaging findings on cervical verrucous carcinoma with endometrial invasion: a case report

BACKGROUND: Cervical verrucous carcinoma is a rare form of cervical cancer. Very few reports present the correlation between diagnostic images and clinicopathologic findings. CASE: A 50-year-old woman was treated with laser ablation for cervical condyloma 6 years prior to her presentation with progressive vaginal bleeding and a foul-smelling discharge at our clinics in August 2004. Biopsy of the cervical mass was compatible with pathologic features of condyloma acuminata. Ultrasonography with color Doppler revealed a 5.9x4.1-cm, hyperechogenic mass with a honeycomb appearance in the lower uterine corpus and hypervascularization of the tumor with resistance indexes ranging from 0.41 to 0.47. Magnetic resonance imaging (MRI) showed that the tumor had a homogeneous intensity on T1-weighted images and heterogeneous intensity on T2-weighted images. After administration of contrast medium, the tumor exhibited a lower signal intensity than did the surrounding cervical stroma. A human papillomavirus test was positive for types 11 and 53. Combined with the clinicopathologic findings, verrucous carcinoma of the cervix, stage Ib2, was suspected and the patient underwent radical hysterectomy and bilateral pelvic lymph node dissection. The final pathology report proved the impression of malignancy. The patient had an uneventful postoperative course, and no disease recurred during 1 year of follow-up. CONCLUSION: The diagnosis of cervical verrucous carcinoma requires a good clinical and pathologic correlation. Nevertheless, detailed imaging studies, such as ultrasound and MRI, as in our case, may provide valuable presurgical information for treatment.     

Magnetic resonance imaging appearances of recurrent cervical carcinoma

Our aim was to describe the patterns of disease recurrence and residual disease in patients treated for cervical carcinoma and to evaluate imaging features, which can help to differentiate recurrence and/or residual disease from posttreatment change. In a retrospective observational study, magnetic resonance imaging (MRI) scans of 48 patients with recurrent or residual cervical carcinoma were reviewed by two radiologists. Sixteen patients had undergone primary surgical treatment and 32 were treated by chemoradiotherapy. Recurrence was confirmed by histology (28), clinical and radiologic progression (6), and by patient death (14) due to progressive disease. Magnetic resonance images were analyzed for the site of recurrent/residual disease, signal characteristics, and invasion of adjacent structures. There were 29 recurrences, while 19 patients had residual disease. Most of the recurrences (70.4%) occurred within the first year of the start of treatment. Recurrent disease was confined to the central axis of the cervix in six patients following chemoradiotherapy and to the vaginal cuff in three of these patients following surgery. The recurrent tumor was isointense to the adjacent muscles on T1-weighted sequence in 95.3% and hyperintense on T2-weighted in 88.9%. The cervix was involved in every case of residual disease and in 10 of 29 (34.5%) patients with recurrent disease. Recurrent disease was present in the vaginal cuff in 14 of 16 (87.5%) postsurgical patients. Parametrial invasion was present in 13 (81.3%) patients treated surgically and in 22 (68.8%) of those receiving chemoradiotherapy. Involvement of the uterosacral ligaments was seen in 8 (57.1%) surgical patients and 14 (43.8%) nonsurgical ones. Bladder invasion was seen in four (25.0%) patients treated surgically and three (9.4%) of those treated with chemoradiotherapy. Radiotherapy change within the marrow was seen in 13 (27.0%) patients in total, whereas bone metastases were present in 4 (8.3%) patients. Recurrent cervical carcinoma can present with varied imaging features. Knowledge of the patterns of recurrence can aid early detection and may determine further therapeutic options.     

应用MRI评价宫颈癌分期的临床研究

目的探讨应用磁共振成像(MRI)指导宫颈癌分期的价值。方法对64例宫颈癌患者在手术前行MRI,均依临床分期结果制定治疗计划。以术后病理诊断为金标准,采用病例自身对照法将临床、MRI分期中癌浸润的部位和范围、淋巴结转移,尤其是宫旁浸润情况与手术病理所见对比,评价宫颈癌分期。结果MRI对浸润性宫颈癌判断的准确率为93.7%,特异性为95.7%,敏感性为88.9%。MRI预测宫颈癌总的分期的准确率为75.1%。在区分局限性和宫旁浸润中MRI的准确率为93.7%。MRI对宫颈癌侵犯部位和范围判断的准确率达88.5%。MRI对淋巴结转移预测的准确性为90.6%。结论MRI可多方位成像清楚显示宫颈肿瘤病变范围,MRI对区分局限性和浸润性病灶、淋巴结转移有着较高的准确性。临床引入MRI技术,有利于合理制定治疗计划,应成为宫颈癌术前常规的影像检查方法。     

Assessment of cervical cancer radioresponse by serum squamous cell carcinoma antigen and magnetic resonance imaging

OBJECTIVE: To investigate the possibility of objective clinical assessment of the radioresponse of cervical cancer via determination of serum squamous cell carcinoma antigen levels and magnetic resonance imaging (MRI)-based estimation of tumor shrinkage. METHODS:The cases of 60 patients undergoing definitive radiotherapy for cervical squamous cell carcinoma (stage I-II: n = 20; stage III-IV: n = 40) were reviewed. Measurements of serum squamous cell carcinoma antigen levels (n = 60), estimated tumor volume on preradiotherapy MRIs (n = 60), and evaluated tumor shrinkage on postradiotherapy MRIs available (n = 30) were taken. The relation between postradiotherapy squamous cell carcinoma antigen level 2 months after the start of radiotherapy and disease recurrence was investigated. Regression analysis of tumor volume measured on MRIs was used to estimate the extent of tumor shrinkage 2 months after the start of radiotherapy. RESULTS: Preradiotherapy squamous cell carcinoma antigen levels correlated significantly with preradiotherapy tumor volumes. Recurrence was identified in 27 patients as distant (n = 19), distant and local (n = 1), local (n = 5), or regional (n = 2). Of 51 patients with elevated preradiotherapy squamous cell carcinoma antigen levels, 33 achieved normalized levels after radiotherapy. Squamous cell carcinoma antigen normalization was associated with a higher recurrence-free survival rate at 2 years (74.3%) than that associated with nonnormalization of squamous cell carcinoma antigen (5.6%, P <.001). The extent of shrinkage ranged from 61% to 100%, and there was no local recurrence. CONCLUSION: Postradiotherapy squamous cell carcinoma antigen status is a useful indicator of clinical outcome, particularly about tumor recurrence. It is not, however, useful for assessing response to radiotherapy. Magnetic resonance imaging is useful for obtaining an objective assessment of radioresponse.     

Evaluation of endometrial carcinoma on magnetic resonance imaging

Our aims were to assess diagnostic performance of T2-weighted (T2W) and dynamic gadolinium-enhanced T1-weighted (T1W) magnetic resonance imaging (MRI) in the preoperative assessment of myometrial and cervical invasion by endometrial carcinoma and to identify imaging features that predict nodal metastases. Two radiologists retrospectively reviewed MR images of 96 patients with endometrial carcinoma. Tumor size, depth of myometrial and cervical invasion, and nodal enlargement were recorded and then correlated with histology. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the identification of any myometrial invasion (superficial or deep) were 0.94, 0.50, 0.93, 0.55 on T2W and 0.92, 0.50, 0.92, 0.50 on dynamic T1W, and for deep myometrial invasion were 0.84, 0.78, 0.65, 0.91 on T2W and 0.72, 0.88, 0.72, 0.88 on dynamic T1W. The sensitivity, specificity, PPV and NPV for any cervical invasion (endocervical or stromal) were 0.65, 0.87, 0.57, 0.90 on T2W and 0.50, 0.90, 0.46, 0.92 on dynamic T1W, and for cervical stromal involvement were 0.69, 0.95, 0.69, 0.95 on T2W and 0.50, 0.96, 0.57, 0.95 on dynamic T1W. Leiomyoma or adenomyosis were seen in 73% of misdiagnosed cases. Sensitivity and specificity for the detection of nodal metastases was 66% and 73%, respectively. Fifty percent of patients with cervical invasion on MRI had nodal metastases. In conclusion, MRI has a high sensitivity for detecting myometrial invasion and a high NPV for deep invasion. MRI has a high specificity and NPV for detecting cervical invasion. Dynamic enhancement did not improve diagnostic performance. MRI may allow accurate categorization of cases into low- or high-risk groups ensuring suitable extent of surgery and adjuvant therapy.     

Fetal brain magnetic resonance imaging and long-term neurodevelopmental impairment

Objective

To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long-term neurodevelopmental outcome.

Methods

Between February 2007 and January 2009, high-risk pregnancies were analyzed by MRI at 1.5 Tesla after 24 weeks of gestation at the Clinical Hospital Center Zagreb, Croatia. Long-term outcome was defined as neurodevelopmental outcome at 24 months.

Results

Among 70 pregnancies analyzed, 40.0% had abnormal fetal brain MRI. The highest incidence occurred in the PL group. There was no correlation between abnormal MRI and fetal surveillance methods (ultrasound, Doppler blood flow analysis, cardiotocography, biophysical profile) or immediate neonatal outcome (1-minute Apgar score, umbilical cord pH). Via MRI, fetal brain injury would have been diagnosed for 45.7% of fetuses with a long-term neurodevelopmental handicap. Binary logistic regression showed that, as compared with other surveillance methods, fetal brain MRI was the best predictor of long-term neurodevelopmental disability.

Conclusion

PL, IUGR, and PPROM were associated with an early intrauterine CNS insult that was not accurately detected by existing prenatal testing options.     

The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer

OBJECTIVES: The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting cervical involvement by endometrial cancer. METHODS: A retrospective accuracy study of 135 consecutive women who underwent preoperative MRI and surgery for endometrial cancer at a single gynaecological cancer centre between 1st February 2003 and 30th November 2004. RESULTS: For the detection of any cervical involvement by MRI, the sensitivity was 72%, specificity 93.2%, positive predictive value (PPV) 89.8%, negative predictive value (NPV) 80.2%, positive likelihood ratio (+LR) 10.7 and negative likelihood ratio (-LR) 0.3. When cervical stromal invasion was considered alone, the sensitivity was 84.4%, specificity 87.4%, PPV 67.5%, NPV 94.7%, +LR 6.7 and -LR 0.18. CONCLUSION: We believe that MRI is able to accurately predict cervical involvement in endometrial cancer and allows a decision to be made on the type of hysterectomy to be offered.     

Fetal magnetic resonance imaging: a review

PURPOSE OF REVIEW: To describe advances in magnetic resonance technology and the current indications and advantages of magnetic resonance imaging that have led to increased utilization in fetal medicine. RECENT FINDINGS: The article covers the most common uses of magnetic resonance imaging in fetal medicine. The advantages of magnetic resonance imaging for the diagnosis of fetal malformations are described, in particular the advantages of magnetic resonance imaging in central nervous system malformations not optimally diagnosed by ultrasound are described. These cases include malformations of migration, malformations of development, such as agenesis of the corpus callosum, and destructive lesions. Noncentral nervous system lesions include chest abnormalities, abdominal wall defects, gastrointestinal and genitourinary abnormalities and fetal neoplasms. Abnormalities of placentation and other maternal factors affecting pregnancy are shown. SUMMARY: Recent studies have shown that magnetic resonance imaging can add significantly to the prenatal diagnosis and management of congenital abnormalities. In addition, placental abnormalities have been diagnosed with greater accuracy.     

Usefulness of magnetic resonance imaging (MRI) in pre-treatment evaluation of the extension of uterine cervical carcinoma

Fifty-four patients with primary carcinoma of the cervix were examined by magnetic resonance imaging (MRI). Different pulse sequences with T1 and T2 weighting were employed to determine optimum tissue contrast. The tumor had a uniform signal intensity similar to the myometrium on the T1 weighted image. In contrast, the tumor signal intensity increased on the T2 weighted image. In our series the primary tumor was clearly defined in nine of twenty patients with stage 0 and I disease and thirty-three of thirty-four patients with stage II, III and IV disease. In addition, the primary tumor was clearly defined in four patients who had unsatisfactory colposcopic findings (UCF). Parametrial invasion of the tumor was well depicted on transverse planes in four of twelve sides with stage IIb disease and twenty-eight of thirty-four sides with stage III and IV disease. T1 weighted images provided excellent tissue contrast between the high signal from pelvic fat and the low intensity of tumor tissue enabling demonstration of involvement of the pelvic side wall. Vaginal invasion was also clearly seen on T2 weighted sagittal images in seventeen of twenty-six patients. In conclusion, MRI is not only useful but is also a non-invasive method of detecting primary tumor and extra-uterine extension of cervical carcinoma.     

Potential role of fetal cardiac evaluation with magnetic resonance imaging: preliminary experience

OBJECTIVE: To report our experience with magnetic resonance imaging (MRI) in fetal heart evaluation. METHOD: Two radiologists examined 31 MRI of fetuses with no ultrasound (US) evidence of cardio-thoracic anomalies. T2-weighted half-Fourier single-shot turbo spin-echo sequences were acquired for anatomic evaluation; fast imaging with steady-state free precession (TrueFISP) and cine-MR sequences with real-time steady-state free precession oriented like standard fetal echocardiographic projections were acquired for the characterization of cardiovascular morphology and function. RESULTS: In every case, MRI assessed the viscero-atrial situs. The four-chamber view and the short-axis view of the left ventricle were obtained in all fetuses, the long-axis view of the aortic arch in 28, the long-axis view of the ductus arteriosus in 17, the five-chamber view in 12, the long-axis of the left ventricle in 9, the three-vessel view in 7, the tricuspid-aortic view in 3, and the transverse view of the aortic arch and the angulated view of the arch and the ductus arteriosus simultaneously in 2 fetuses. CONCLUSION: Our preliminary experience demonstrates the feasibility to visualize the fetal heart with routine fetal MRI protocols in particular, by means of acquisition of TrueFISP imaging (morphological study) and real-time cine-MRI (dynamic study), potentially making MRI a second-level tool to add to fetal echocardiography in the prenatal study of congenital cardiac malformations.     

磁共振成像对子宫内膜癌术前评估的价值

目的 探讨磁共振成像(MRI)在子宫内膜癌术前评估中的价值.方法 对2004年12月至2007年5月在北京大学临床肿瘤学院初次治疗的43例子宫内膜癌患者术前行MRI检查,并与术后手术病理分期进行对照研究.结果 MRI正确评估肿瘤浸润深度35例,错误评估8例,诊断准确率为81.4%.MRI对于肿瘤局限于子宫内膜层、浸润浅肌层及深肌层的诊断敏感性、特异性、准确性分别为100.0%,91.9%和93.0%;76.5%,96.2%和88.4%;80.0%,97.5%和95.3%.对于宫颈受累、侵犯浆膜层及淋巴结转移的诊断敏感性、特异性、准确性分别为:100%,97.5%和95.3%;85.7%,97.2%和95.3%;60%,97.4%和93.0%.MRI区分ⅠA、ⅠB、ⅠC期的准确性为82.1%,鉴别深肌层浸润(ⅠC)和浅表浸润(ⅠA+ⅠB)的准确性为92.9%.结论 MRI在判断子宫内膜癌肌层浸润深度及宫颈有无受累方面具有很高价值.是一种较为准确的术前评估方法.     

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection

Abstract. Cunha TM, Félix A, Cabral I. Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection.
This study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of deep myometrial invasion and cervical extension by endometrial carcinoma. We also aimed to compare MRI results to surgical staging of endometrial carcinoma. Forty women with a histologic diagnosis of endometrial carcinoma underwent a preoperative pelvic MRI. In 33 cases intraoperative gross visual inspection (GVI) of the surgical specimen was also evaluated. The results obtained were compared with the histologic diagnosis. Pathologic evaluation of the myometrium determined that superficial invasion was present in 25 patients and deep invasion in 15. The uterine cervix was found to be involved in 12 cases. The accuracy, sensitivity, and specificity of MRI and GVI were 93%/91%, 80%/77%, and 100%/100%, respectively, in detecting deep myometrial invasion and 80%/79%, 33%/36% and 100%/100%, respectively, in determining cervical invasion. When the Kappa statistical measurement was applied, the results from each technique, MRI and GVI, showed an agreement on the evaluation of myometrial and cervical invasion by endometrial carcinoma. In conclusion, MRI, in this series, was demonstrated to be a reliable method for preoperative endometrial carcinoma "imagiological staging". The high accuracy achieved by MRI and GVI suggests that they may be used interchangeably.     

Prenatal imaging: ultrasonography and magnetic resonance imaging

The Eunice Kennedy Shriver National Institute of Child Health and Human Development held a workshop on September 18-19, 2006, to summarize the available evidence on the role and performance of current fetal imaging technology and to establish a research agenda. Ultrasonography is the imaging modality of choice for pregnancy evaluation due to its relatively low cost, real-time capability, safety, and operator comfort and experience. First-trimester ultrasonography extends the available window for fetal observation and raises the possibility of performing an early anatomic survey. Three-dimensional ultrasonography has the potential to expand the clinical application of ultrasonography by permitting local acquisition of volumes and remote review and interpretation at specialized centers. New advances allow performance of fetal magnetic resonance imaging (MRI) without maternal or fetal sedation, with improved characterization and prediction of prognosis of certain fetal central nervous system anomalies such as ventriculomegaly when compared with ultrasonography. Fewer data exist on the usefulness of fetal MRI for non-central nervous system anomalies.