MRI在宫颈癌诊疗中的应用价值

目的明确MRI在宫颈癌诊疗中的应用价值。方法对我院2008年1月至2010年3月期间收治的72例宫颈癌患者于术前2周内行盆腔和腹膜后MRI扫描，直接或经新辅助治疗后行广泛子宫切除术＋盆腔淋巴结清扫术，2例病理可疑早期浸润癌患者行冷刀锥切术，将术前MRI结果与术后病理比较，评价术前MRI的诊断价值。结果人组的72例患者病理类型包括：宫颈鳞状上皮内瘤变2例（2．8％），鳞癌61例（84．7％），腺癌6例（8．3％），腺鳞癌1例（1．4％），小细胞癌2例（2．8％）。IB期以前患者4例，MRI未见明确宫颈肿物。IB1期39例，IR2期17例，ⅡA期11例，ⅡB期1例。MRI诊断淋巴结转移、宫旁扩散、阴道受累、深肌层浸润的敏感性和特异性分别为85．71％和84．92％，100％和97．01％，37．5％和89．47％，96．15％和80．00％。其中诊断困难的内生型宫颈癌2例，MRI均提示深肌层浸润。结论MRI对宫颈癌淋巴结转移和宫旁受累具有较好诊断价值，为诊断困难的内生型宫颈癌患者选择最适治疗方案提供了客观依据．

The application of MRI in treatment of early cervical carcinoma

Objective To evaluate the value of MRI for patients with cervical carcinoma. Methods 72 patients with cervical carcinoma who were treated in our hospital fi＇om Jan 2008 to Mar 2010 were included in the study. All patients were diagnosed as cmwical carcinoma by biopsy. Before 2 weeks of operation, all of them took MRI including pelvic and abdomen. 70 cases received pelvic lymph node dissection and radical hysterectomy, 2 cases received cold knife cone cut- ting operation. The MRI was evaluated by comparing pathological results with preoperative MRI. Results A total of 72 women were included in this study. Of all, 2 cases with CIN, 61 cases with squamous cell carcinoma （84. 7% ）, 6 eases with adenocarcinoma （ 8.3% ） , 1 case with adenosquamous carcinoma （ 1.4% ） and 2 cases with small cell carcinoma （2. 8% ）. In all of the patients, 4 cases were staged as before I s, without MRI-confirmed cervical tumor. And there were 39 cases of I m, 17 cases of I m, 11 cases of 1] A, and 17 cases of 1I s. Sensitivity and specificity of MRI in the diagnosis of lymph node metastasis, parametrial involvement and vaginal extension, deep stromal invasion were 85. 71% vs 84. 92%, 100% vs 97.01%, 37.5% vs 89.47% and 96. 15% vs 80. 00%, respectively. 2 patients with endogenous cervical cancer which were difficult to be confirmed preoperatively were indicated by MRI that the lesions invaded muscle layer. Conclusion MRI offers relatively high accuracy in evaluating the extent of lymph node metastasis and parametrial involvement. MRI provides an objective basis for treatment options of endogenous cervical cancer.