月 经 状 态 对 不 同 病 理 类 型 宫 颈 癌 表 观 弥 散 系 数 值 的 影 响

目的 观察月经状态对不同病理类型宫颈癌表观弥散系数（ADC）值的影响。方法 回顾性分析352例经病理证实的宫颈癌患者的MRI及DWI资料，其中317例鳞癌和35例腺癌；177例未绝经，175例已绝经。于ADC图像宫颈癌病灶最大层面测量并记录病灶的ADC最大值（ADC_max）、最小值（ADC_min）和平均值（ADC_mean）。比较宫颈鳞癌与腺癌ADC值差异、绝经与未绝经患者宫颈鳞癌和腺癌ADC值差异；分别比较宫颈鳞癌及腺癌中绝经与未绝经患者ADC值差异。结果 宫颈鳞癌ADC_mean和ADC_min均低于腺癌（t=-2.05，-2.28，P均<0.05）。未绝经患者中，宫颈鳞癌ADC_mean和ADC_min均低于腺癌（t=-4.40，-5.40，P均<0.05）；而绝经患者中，宫颈鳞癌ADC_mean、ADC_min和ADC_max均与腺癌差异无统计学意义（t=0.82，1.57，0.45，P均>0.05）。宫颈鳞癌及腺癌中，未绝经患者的ADC_mean、ADC_max和ADC_min均高于绝经患者（t=-3.96，-2.53，-2.78及t=-3.71，-1.15，-5.01，P均<0.05）。结论 不同病理类型宫颈癌的ADC值不同，且受患者月经状态影响；未绝经患者中腺癌的ADC值高于鳞癌，绝经患者中腺癌ADC值与鳞癌相仿。未绝经患者宫颈癌病灶ADC值均高于绝经患者。

Impact of menstrual status on the apparent diffusion coefficient of different pathological types of cervical cancer

Objective To explore the impact of menstrual status on the apparent diffusion coefficient (ADC) of cervical squamous cell carcinoma and adenocarcinoma. Methods MRI and DWI data of 352 patients with pathologically confirmed cervical cancer were retrospectively analyzed, including 317 cases of cervical squamous cell carcinoma and 35 with cervical adenocarcinoma. Among 352 patients, 177 were premenopausal and 175 were menopausal. The maximum ADC (ADC_max), minimum ADC (ADC_min) and mean ADC (ADC_mean) values of the lesions were measured and recorded at the maximum level of cervical carcinoma on ADC images. ADC values were compared between cervical squamous cell carcinoma and adenocarcinoma, also between postmenopausal and pre-menopausal patients, further between cervical squamous cell carcinoma and adenocarcinoma in postmenopausal and pre-menopausal patients. Results The ADC_min and ADC_mean values of cervical squamous cell carcinoma were lower than those of adenocarcinoma (t=-2.05, -2.28, both P<0.05). For pre-menopausal patients, the ADC_mean and ADC_min values of cervical squamous cell carcinoma were lower than those of adenocarcinoma (t=-4.40, -5.40, both P<0.05), while for menopausal patients, the ADC_mean, ADC_min and ADC_max of cervical squamous cell carcinoma were similar to those of adenocarcinoma (t=0.82, 1.57, 0.45, all P>0.05). The ADC_min, ADC_mean and ADC_max values of premenopausal patients with cervical squamous cell carcinoma or adenocarcinoma were higher than those of postmenopausal patients (t=-3.96, -2.53, -2.78 and t=-3.71, -1.15, -5.01, all P<0.05). Conclusion ADC values of cervical cancers are different with different pathologic types, which affected by the menstrual statue of patients. ADC value of adenocarcinoma is higher than that of squamous cell carcinoma in pre-menopausal patients, while is similar in post-menopausal patients. ADC values of cervical cancers in pre-menopausal patients are higher than those in post-menopausal patients.