宫颈癌的MRI征象与新分期价值

目的分析宫颈癌MRI征象,探讨MRI对宫颈癌诊断和新分期的价值。方法 57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,采用双盲法,描述肿瘤的MRI征象特点,将MRI影像学分期结果,与宫颈癌2009FIGO分期标准相比较。结果 57例宫颈癌中,Ⅰ期28例,Ⅱ期22例,Ⅲ期4例,Ⅳ期3例。除2例Ⅰa期漏诊外,其余55例病灶MRI均显示清晰,总显示率达96.5%,肿瘤T1WI呈中低信号,T2WI呈中高信号,与低信号的宫颈间质和高信号的宫旁脂肪有良好的对比,增强扫描呈中等不均匀强化,部分中心坏死区无强化。T2WI低信号的宫颈间质部分或完全中断是判断宫旁侵犯和分期的主要征象,MRI对宫颈癌分期准确率为89.5%（51/57）,与FIGO新分期、手术病理结果对照,差异无统计学意义（P〉0.05）。结论 MRI可准确评价原发肿瘤、宫旁侵犯和肿瘤分期,是临床选择治疗方案和预后评估的重要依据,是评价宫颈癌可靠的影像学检查方法。

MRI features and value of new staging in cervical carcinoma

Objective To analyze the MRI signs of cervical carcinoma,and investigate the MRI value in diagnosis and new staging of this disease.Methods 57 patients with complete clinical and surgical pathological data were performed preoperative MRI examination.In a double-blind manner,the MRI features of this tumor were described,and MRI staging results were compared with the FIGO 2009 staging criterion for cervical carcinoma.Results 57 cases with cervical carcinoma were composed of 28 cases with stage I,22 cases with stage II,4 cases with stage III,3 cases with stage IV.With the exception of only 2 cases with stage Ia,all of the lesions in the other 55 cases were identified by MRI,the total showing accuracy of MRI was 96.5%.With isointensity or hypointensity on T1WI,the tumor lesions were moderate hyperintensity on T2WI.There was excellent contrast between tumor lesions and hypointense cervical matrices,hyperintense parauterine fat on T2WI.After bolus intravenous Gd-DTPA injection,the lesions were moderately heterogeneous enhancement,but non enhancement in centre necrotic area for some lesions.The partial or complete interruption of cervical matrices with low signal on T2WI was the main sign to assess parametrial invasion and MRI staging.The accuracy of MRI staging for cervical carcinoma was 89.5% （51/57）,and there was no significant difference compared with the new FIGO staging.Conclusion MRI can accurately evaluate the primary tumor,parametrial invasion and tumor staging.MRI is the important basis for selecting the optimal therapeutic protoco1 and prognosis estimation,and is a reliable imaging method for evaluating cervical carcinoma.