磁共振弥散加权成像在宫颈癌诊断和分期中的价值

目的 探讨磁共振弥散加权成像(DWI)及表观弥散系数(ADC)值对于宫颈癌检测的敏感性及分期的准确性.方法 对经病理证实的67例宫颈癌患者(宫颈癌组)、20名女性健康志愿者(对照组)行常规MRI及DWI检查;比较DWI结合MR常规序列与单纯MR常规序列对宫颈癌分期诊断的差异;分析正常志愿者宫颈三层(颈管内膜、结合带、肌层)与宫颈癌的ADC值差异.结果 DWI结合MRI常规序列检出全部病例,单纯MRI常规序列检测出64例,漏诊3例,准确率为95.52%.对于各期宫颈癌及全部病例分期诊断中,DWI结合MRI常规序列与单纯MRI常规序列之间差异均无统计学意义.对照组宫颈三层平均ADC值分别为颈管内膜(1.54±0.15)×10-3 mm2/s,结合带(1.56±0.16)×10-3 mm2/s,肌层(1.81±0.16)×10-3 mm2/s;宫颈内膜与结合带间差异无统计学意义,二者与肌层之间差异有统计学意义;颈管癌平均ADC值为(1.05±0.20)×10-3 mm2/s,正常颈管内膜与宫颈癌之间差异有统计学意义.结论 相对于MRI常规序列,DWI结合常规MRI序列对于检测宫颈癌更敏感;DWI对于区分正常宫颈与宫颈癌有重要价值.

Value of MR diffusion weighted imaging in diagnosisand staging of uterine cervical cancer

Objective To investigate the sensitivity of detection and accuracy of staging in uterine cervical cancer (UCC) with MR diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) value. Methods Totally 67 UCC patients confirmed pathologically (UCC group) and 20 healthy female subjects (control group) underwent routine pelvic MRI sequences and DWI. ADC values of normal uterine cervix (cervical endometrial, junctional zone and myometrium) and cervical carcinoma were compared. Results All patients were detected using DWI with routine MRI sequences. With only routine MRI sequences, 64 cases were detected, while 3 cases were missed diagnosed. No difference was found between these two methods in staging of UUC. In control group, the average ADC value of three-layer structure of normal cervix was as follows: ADC of cervical endometrial was (1.54±0.15)×10^-3 mm²/s, of junctional zone was (1.56±0.16)×10^-3 mm²/s, while or myometrium was(1.81±0.16)×10^-3 mm²/s. There was no significant difference between cervical endometrial and junctional zone, while the difference was found between myometrium with cervical endometrial and junctional zone. The average ADC value of cervical endometrial in UCC group was (1.05±0.20)×10^-3 mm²/s, and there was statistically significant difference between UCC and normal cervical endometrial. Conclusion UCCs can be detected more sensitively with DWI combined with routine MRI sequences than only with routine MRI sequences. DWI has great clinical significance in distinguishing cervical carcinoma from normal uterine.