MRI在宫颈癌诊断及术前分期中的应用

发布时间：2018-05-31 14:11

本文选题：磁共振成像 + 宫颈癌　；参考：《郑州大学》2014年硕士论文

【摘要】：背景及目的宫颈癌是全球妇女中的居第三位常见的恶性肿瘤,仅次于乳腺癌和结、直肠癌,在发展中国家是仅次于乳腺癌,是最常见的女性生殖道恶性肿瘤。宫颈癌目前的检查方法有多种,以宫颈软组织病理活检最为常见,但大多为有创性,且不能对宫颈癌所侵及的范围做出准确的判断。磁共振成像(Magnetic resonance imaging, MRI)技术有极高的软组织分辨率,可快速对是否出现恶性肿瘤做出较准确的判断。尤其适用于检查判断软组织附近的肿瘤,特别有利于肿瘤组织侵犯程度和范围的显示。MRI诊断操作方便,对子宫颈的显示全面且准确,可清晰的显示子宫内部信号差异,使各个组织间呈现较好的层次感,且可对肿瘤组织行多方位、多参数成像,可清楚显示肿瘤病变的位置以及大小及其侵及的范围,且敏感性和特异性均比较高。MRI在当前临床诊断子宫颈癌中具有优势性的诊断价值,可为临床宫颈癌的治疗提供帮助。本研究旨在探讨磁共振成像技术对宫颈癌诊断和术前分期的应用价值。材料与方法研究对象：选取2011年6月到2014年6月入住我院妇产科的宫颈癌患者60例,经宫颈活组织检查在术前诊断为鳞状细胞癌49例,小细胞癌3例,腺鳞癌3例,透明细胞腺癌2例,腺癌2例,低分化宫颈神经内分泌癌1例。年龄27～76岁,平均(56.5±13.3)岁,中位年龄55岁。其中25例ⅠB-ⅡA期患者行广泛全子宫切除加盆腔淋巴结清扫术,余35例ⅡB期及以上期患者行开腹重点部位或淋巴结活检术,术后的病理检查结果为诊断宫颈癌的金标准。60例患者均行GE 7503.0T超导磁共振仪扫描,采用8通道体部专用相控阵线圈,行盆腔常规MRI平扫序列T1WI、T2WI、DWI (b=800 s/mm2),以及静脉注射Gd-DTPA后行LAVA-Flex动态增强扫描。采用SPSS19.0对数据进行整理与统计分析。采用χ2检验,对MRI术前分期、术前临床分期及术后病理分期计数资料率比较,同时对术前MRI对宫颈癌深肌层浸润、阴道受累、宫旁浸润及淋巴结转移诊断方面和术后病理结果计数率比较。P0.05为差异有统计学意义。灵敏性：正确诊断某病的能力,Se=a/a+c;特异性：正确排除某病的能力,Sp=d/b+d。结果1.60例宫颈癌患者术前MRI检查分期、术前临床分期及术后病理分期,三者之间差异存在统计学意义(P0.05),而术前MRI分期与术后病理分期之间差异无统计学意义(P0.05),术前MRI分期与术前临床分期间差异有统计学意义(P0.05)。以术后病理分期为参照,宫颈癌术前MRI检查总体分期准确度为93.3%,而术前临床分期准确度仅为74.9%；2.术前MRI诊断与术后病理结果在宫颈癌深肌层浸润、阴道受累、宫旁浸润及淋巴结转移方面比较均有较高的灵敏性及特异性,各分别达到85.7%、98.1%,95.7%、97.4%,95.0%、90.1%,81.8%、96.1%。经χ2检验,两者之间的差异性不具有统计学意义(P0.05),即术前MRI诊断与术后病理结果存在临床一致性。结论1.MRI检查对宫颈癌术前分期有较高的准确率；2.MRI检查在对判断宫颈癌深肌层浸润、阴道受累、宫旁浸润及淋巴结转移方面有着较高的临床符合率、敏感性和特异性。3.MRI使宫颈癌分期有了更加可靠的客观依据,因此MRI可以作为评估宫颈癌术前准确分期的重要工具,以此来选择、制定合理的子宫颈癌治疗计划。
[Abstract]:Background and objective cervical cancer is the third most common malignant tumor among women in the world. It is the most common female genital malignant tumor next to breast cancer and colorectal cancer and is the most common female reproductive tract cancer in developing countries. Magnetic resonance imaging (MRI) technology has very high soft tissue resolution, and it can quickly make a more accurate judgement on whether the malignant tumor appears. It is especially suitable for checking and judging the tumor near the soft tissue, especially for the tumor tissue invasion. The degree and scope of the.MRI diagnosis is convenient, and the display of the cervix is comprehensive and accurate. It can clearly display the difference in the internal signal of the uterus, make the various tissues present a better sense of hierarchy, and can multidimensional and multi parameter imaging of the tumor tissue, and can clearly display the location and size of the tumor and the range of its invasion and sensitivity. The diagnostic value of.MRI with high specificity and high specificity in the current clinical diagnosis of cervical cancer can provide help for the treatment of cervical cancer. The purpose of this study is to explore the value of magnetic resonance imaging (MRI) on the diagnosis and preoperative staging of cervical cancer. 60 cases of cervical cancer in obstetrics and gynecology were diagnosed as 49 cases of squamous cell carcinoma, 3 cases of small cell carcinoma, 3 cases of adenosscale carcinoma, 2 cases of adenocarcinoma, 2 cases of adenocarcinoma, 1 cases of low differentiated cervical neuroendocrine carcinoma, 1 cases of low differentiated cervical neuroendocrine carcinoma. The average age of 27~76 years was (56.5 + 13.3) years, and the median age was 55 years. Among them, 25 cases of period I B- II A were widely used. Total hysterectomy plus pelvic lymph node dissection and 35 patients with stage II B and above were performed the key location or lymph node biopsy. The results of the postoperative pathological examination were the GE 7503.0T superconducting magnetic resonance imaging (SR) scan of the.60 patients with the diagnosis of cervical cancer, and the pelvic routine MRI plain scan was performed with a special phased array coil of the 8 channel body part. T1WI, T2WI, DWI (b=800 s/mm2), and LAVA-Flex dynamic enhanced scan after intravenous injection of Gd-DTPA. The data were collated and statistically analyzed with SPSS19.0. The data rate of preoperative staging of MRI, preoperative clinical staging and postoperative pathological staging were compared by x 2 test, and the preoperative MRI to the deep muscular layer of cervical cancer, vaginal involvement, and uterus. The diagnosis of parathal infiltration and lymph node metastasis was statistically significant compared with the postoperative pathological results. Sensitivity: the ability to correctly diagnose a disease, Se=a/a+c; specificity: the ability to correctly exclude a disease; Sp=d/b+d. results in 1.60 cases of cervical cancer before MRI examination and staging, preoperative clinical staging and postoperative pathological staging. There was a statistically significant difference between the three (P0.05), but there was no significant difference between preoperative MRI staging and postoperative pathological staging (P0.05). The difference between preoperative MRI staging and preoperative clinical division was statistically significant (P0.05). The accuracy of the period was only 74.9%. 2. the preoperative MRI diagnosis and postoperative pathological results were more sensitive and specific in the deep myometrium infiltration, vaginal involvement, para uterine infiltration and lymph node metastasis, each reached 85.7%, 98.1%, 95.7%, 97.4%, 95%, 90.1%, 81.8%, and 96.1%. was tested by chi 2 test, and the difference between the two was not statistically significant. The study significance (P0.05), that is, the preoperative MRI diagnosis and the postoperative pathological results have clinical consistency. Conclusion the 1.MRI examination has a high accuracy rate for the preoperative staging of cervical cancer; 2.MRI examination has a high clinical coincidence rate, sensitivity and specificity in judging the infiltration of the deep muscle layer of cervical cancer, the vagina involvement, the para uterine infiltration and lymph node metastasis. The stage of cervical cancer has a more reliable objective basis, so MRI can be used as an important tool to assess the accurate staging of cervical cancer before operation to choose a reasonable treatment plan for cervical cancer.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

【参考文献】