磁共振DWI在宫颈癌介入栓塞早期疗效评价中的应用研究

发布时间：2018-04-14 13:21

本文选题：宫颈癌 + 介入栓塞　；参考：《宁夏医科大学》2014年硕士论文

【摘要】：目的通过检测宫颈癌介入栓塞治疗前后磁共振弥散加权成像（DWI）表观扩散系数（ADC）值的变化情况，分析肿瘤范围内病灶突出部位的ADC值及其变化率与术后肿瘤大小的关系，从而探讨磁共振DWI在宫颈癌介入栓塞术后早期疗效评价中的应用，寻求预测及监测肿瘤疗效的最佳时间点。方法筛选44例采用介入栓塞治疗的宫颈癌确诊病例，于术前及术后第2天、5天、10天及15天行常规T2加权成像（T2WI）及弥散加权成像（DWI）检查，b值选700和1500s/mm2，每次检查均测量肿瘤大小、肿瘤及正常臀大肌ADC值。观察每个监测时间点肿瘤大小与不同b值的ADC值和ADC值变化率之间的关系。结果b=700s/mm2时介入栓塞术前及术后第2天、5天、10天及15天肿瘤ADC值依次为0.97±0.11、1.07±0.18、1.24±0.13、1.35±0.12、1.41±1.17×10-3mm2/s，其中术后第15天测得病灶ADC值与第10天相比差异无统计学意义（p=0.122），其余各相邻时间点间差异均有统计学意义（P0.05）；b=1500s/mm2时ADC值依次为0.79±0.09、0.84±0.15、0.95±0.13、1.04±0.16、1.14±0.17×10-3mm2/s，，各相邻时间点间差异均有统计学意义（P0.05）。臀大肌不同b值下ADC值不同时间点间差异均无统计学意义（P0.05）。术前及术后各时间点肿瘤长径大小依次为3.86±1.15、3.36±1.12、2.94±1.12、2.45±1.08、2.25±1.00cm，术后不同时间点与术前肿瘤长径大小相比变化率为12.95%、24.54%、37.32%、43.27%。其中术后第10天及第15天肿瘤长径大小和其变化率之间无统计学差异，其余各相邻时间点间差异均有统计学意义（P0.05）。当b=1500时术后第10天肿瘤ADC值及其变化率与术后第5天、10天及15天的肿瘤长径大小均存在线性相关（P0.05），其中第10天肿瘤ADC值变化率与第15天肿瘤长径间关系程度最强（p=0.001，r=-0.726）。结论介入栓塞治疗对宫颈癌患者具有明显疗效，DWI具有评价宫颈癌介入栓塞术后疗效观察与判定的潜在价值，通过对ADC值的观察初步发现术后第10天复查磁共振临床价值最大，可以做为评价早期疗效的最佳监测点。
[Abstract]:Objective to investigate the changes of apparent diffusion coefficient (ADC) of diffusion weighted Mr imaging (DWI) before and after interventional embolization of cervical cancer, and to analyze the relationship between the ADC value and the postoperative tumor size.The purpose of this study was to explore the application of magnetic resonance (DWI) in the evaluation of early curative effect after interventional embolization of cervical cancer, and to find the best time point to predict and monitor the curative effect of cervical cancer.Methods 44 cases of cervical cancer diagnosed by interventional embolization were selected. T2WI and DWI were performed before and after operation. The tumor size was measured by T2-weighted T2WI and DWI. The tumor size was measured at each time.ADC of tumor and normal gluteus maximus muscle.The relationship between tumor size and ADC value and ADC value of different b value at each monitoring time point was observed.Results the ADC values were 0.97 卤0.111.07 卤0.181.24 卤0.131.35 卤0.121.41 卤1.17 脳 10 ~ (-3) mm ~ (-2) / s before and on the second day after b=700s/mm2, respectively. There was no significant difference in ADC between the 15th day and the 10th day after b=700s/mm2, and there was no significant difference between the other adjacent time points.The ADC values were 0.79 卤0.09 卤0.84 卤0.15 ~ 0.95 卤0.13 卤1.04 卤0.16 卤1.14 卤0.17 脳 10 ~ (-3) mm ~ 2 路s ~ (-2 / s) respectively. There were significant differences among the adjacent time points (P < 0.05).There was no significant difference in ADC value between different time points under different b value of gluteus maximus muscle (P 0.05).The size of tumor long diameter was 3.86 卤1.15t 3.36 卤1.12C 2.94 卤1.12C 2.45 卤1.08U 2.25 卤1.00 cm before and after operation, and the change rate was 12.95 ~ 24.54 ~ 37.32 ~ 37.32 卤43.27 cm at different time points after operation.There was no statistical difference between the tumor length and the rate of change on the 10th and 15th day after operation, but there was significant difference between the other adjacent time points (P 0.05).There was a linear correlation between the tumor ADC value and the tumor length on the 5th and 15th day after operation, and the relationship between the ADC value on the 10th day and the tumor length diameter on the 15th day was the strongest.Conclusion the interventional embolization therapy has obvious curative effect on cervical cancer patients. DWI has potential value in evaluating the curative effect of cervical cancer after interventional embolization. The clinical value of magnetic resonance imaging is the most significant on the 10th day after operation through the observation of ADC value.It can be used as the best monitoring point to evaluate the early curative effect.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R737.33

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