多模态MRI在子宫内膜癌术前分期的应用价值

发布时间：2018-01-02 07:37

本文关键词：多模态MRI在子宫内膜癌术前分期的应用价值　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的探讨多模态MRI在子宫内膜癌术前分期的应用价值。材料与方法1.研究对象收集于2014年6月至2016年12月在广西医科大学第一附属医院行盆腔MRI的子宫内膜癌患者30例,患者年龄28~63岁,平均(50.2±8.3)岁。30例患者均于1周内行全子宫切除术+双侧附件切除术+盆腔淋巴结清扫术。术后病理分型:内膜样腺癌28例,腺鳞癌2例。2.MRI检查采用Siemens Magnetom Verio 3.0T超导型磁共振扫描仪。扫描序列为盆腔常规扫描:T1WI、T2WI;子宫高分辨扫描序列:T1WI、T2WI的横断位、矢状位,以及脂肪抑制序列;DWI序列(b=1000s/mm~2)、动态增强扫描序列。3.研究项目以手术病理分期诊断为金标准,评估多模态MRI,即MRI常规扫描、DWI结合动态增强扫描对子宫内膜癌术前分期的诊断价值。4.统计学分析采用SPSS 17.0统计学软件,以手术病理分期诊断为金标准,分别计算T1WI+T2WI、T1WI+T2WI+DWI、T1WI+T2WI+DWI+DCE-MRI对子宫内膜癌各期的敏感度、特异度、阳性预测值、阴性预测值和准确率。T1WI+T2WI和T1WI+T2WI+DWI、T1WI+T2WI+DWI和T1WI+T2WI+DWI+DCE-MRI对子宫内膜癌分期准确率的比较用配对卡方检验。结果30例子宫内膜癌中,病理分期(2009年FIGO分期):Ⅰa期18例,Ⅰb期8例,Ⅱ期1例,Ⅲ期3例。子宫内膜癌肿瘤在Tl WI上呈等信号,T2WI及T2WI压脂上呈稍高或高信号,在b值为1000s/mm2的DWI图上表现为低信号背景中的高信号肿块,ADC图表现为低信号。增强扫描病灶强化程度低于正常子宫肌层,以延迟期较明显。T1WI+T2WI正确判断16例,高估8例,低估6例;T1WI+T2WI+DWI正确判断19例,高估6例,低估5例;T1WI+T2WI+DWI+DCE-MRI正确判断25例,高估2例,低估3例。T1WI+T2WI评估子宫内膜癌术前分期准确率为53.3%,T1WI+T2WI+DWI为63.3%,T1WI+T2WI+DWI+DCE-MRI为83.3%。应用配对卡方检验,T1WI+T2WI与T1WI+T2WI+DWI评估子宫内膜癌分期的准确性不具有统计学差异(P=0.250.05),而T1WI+T2WI+DWI与T1WI+T2WI+DWI+DCE-MRI具有统计学差异(P=0.0310.05)。结论多模态MRI,即联合应用MRI常规扫描、DWI结合动态增强扫描能提高子宫内膜癌术前分期的准确率,有助于子宫内膜癌的治疗及预后的评估。
[Abstract]:Objective to investigate the application value of multi modality MRI staging in endometrial carcinoma before operation. Materials and methods 1. subjects collected from June 2014 to December 2016 in the First Affiliated Hospital of Guangxi Medical University underwent pelvic MRI in patients with endometrial carcinoma in 30 cases, age 28~63 years old, the average age of.30 (50.2 + 8.3) in all cases within 1 week hysterectomy + bilateral oophorectomy and pelvic lymphadenectomy. Postoperative pathological type: 28 cases of endometrial adenocarcinoma, 2 cases of adenosquamous carcinoma were examined by.2.MRI Siemens Magnetom Verio 3.0T superconducting magnetic resonance scanner. The scanning sequence is: T1WI, T2WI scanning routine pelvic uterus; high resolution scanning sequence: T1WI T2WI, transverse, sagittal, and fat suppression sequence; DWI sequence (b=1000s/mm~2), dynamic enhanced scanning sequence of.3. projects to study the surgical pathological diagnosis as the gold standard, evaluation of multimode state MRI, MRI routine scan Description DWI combined with dynamic enhanced scan of the endometrial cancer preoperative staging and diagnosis value of.4. was analyzed by SPSS 17 statistical software, with surgical pathological diagnosis as the gold standard, T1WI+T2WI T1WI+T2WI+DWI, T1WI+T2WI+DWI+DCE-MRI were calculated, the specific sensitivity of endometrial cancer stages, positive predictive value, negative predictive value and accuracy the rate of.T1WI+T2WI and T1WI+T2WI+DWI, compared with T1WI+T2WI+DWI and T1WI+T2WI+DWI+DCE-MRI in endometrial carcinoma staging accuracy of paired chi square test. Results in 30 cases of endometrial carcinoma, pathological stage (2009 FIGO staging): 1 a 18 cases, type B 8 cases, 1 cases of stage II, 3 cases of stage III endometrial carcinoma tumor. The uterus was isointense on Tl WI, T2WI and T2WI FATSAT showed slightly higher or high signal in the b value of 1000s/mm2 DWI on the map showed high signal and low signal mass in the background, the ADC chart is low signal enhancement scan. Description of lesion degree of enhancement was lower than normal myometrium, with obvious delay of.T1WI+T2WI correctly in 16 cases, 8 cases of 6 cases of overvalued, undervalued; T1WI+T2WI+DWI correctly in 19 cases, 6 cases of 5 cases of overvalued, undervalued; T1WI+T2WI+DWI+DCE-MRI correctly in 25 cases, 2 cases of 3 cases of overvalued, undervalued.T1WI+ T2WI assessment of preoperative endometrial carcinoma staging accuracy rate is 53.3%, T1WI+T2WI+DWI is 63.3%, T1WI+T2WI+DWI+DCE-MRI chi square test for the application of 83.3%., T1WI+T2WI and T1WI+T2WI+DWI staging accuracy assessment of endometrial cancer has no statistical difference (P=0.250.05), T1WI+ T2WI+DWI and T1WI+T2WI+DWI+DCE-MRI have significant difference (P=0.0310.05). Conclusion: Combined Application of multi mode MRI, conventional MRI scanning, combined with dynamic DWI the enhanced scan can improve the accuracy of staging of endometrial carcinoma preoperative assessment, treatment and prognosis in endometrial carcinoma.

【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33;R445.2

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