磁共振成像新技术在宫颈癌分期方面的研究

发布时间：2018-01-18 00:05

本文关键词：磁共振成像新技术在宫颈癌分期方面的研究　出处：《北京协和医学院》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分比较3. OT-MRI平扫及增强扫描对宫颈癌T分期的价值探讨 [目的]通过与手术病理对比,比较MRI平扫、增强扫描在I~II期宫颈癌分期评估方面的价值。 [材料与方法]收集我院2010年1月至2013年7月宫颈癌患者75例,治疗前有完整的MRI平扫及增强扫描。在本院进行了根治性子宫切除及淋巴结清扫,有详细的手术及病理资料。由2位10年以上丰富工作经验的放射科医生在未知任何临床及病理结果的情况下,共同对其MRI平扫、增强图像进行评价,包括肿瘤位置、边界清晰度、对周围组织的侵犯情况,并分别根据MRI平扫及增强表现对所有患者进行影像学分期。MRI平扫和增强的图像为分别评价,两次评价间隔一个月,以消除记忆偏差的影响。对于存在异议的病例,两位阅片者经商讨达成一致意见。所得数据运用SPSS17.0分析,采用Wilcoxon signed-ranks test比较MRI平扫及增强扫描对于肿瘤边界清晰度评分及对比噪声比(CNR)的差异。以手术病理结果为金标准,分别比较MRI平扫及增强分期的差异,采用配对资料X2检验,计算FIGOI临床分期、MRI平扫、MRI增强扫描总体分期符合率及Kappa值,比较MRI平扫、MRI增强扫描两种分期方法在宫颈癌总体分期准确性、各个期别的准确性、敏感性、特异性的差异。P0.05即有统计学意义。 [结果]MRI增强扫描显示肿瘤边界明显较平扫清晰(P0.001)。MRI增强图像的对比噪声比(CNR)明显高于MRI平扫(P0.05)。MRI增强、平扫、FIGOI临床检查宫颈癌总体分期准确性分别为85.3%、77.3%,66.7%,在Ⅰa、Ⅱa、Ⅱb各期别,MRI增强准确性为89.3%、85.3%、96%,MRI平扫准确性为84.0%、77.3%、93.3%,采用配对资料X2检验两种MRI评价宫颈癌分期的方法,P值均大于0.05,差异无统计学意义。 [结论]虽然在宫颈癌分期方面,MRI增强优于MRI平扫,但是差别统计学不显著。第二部分弥散加权成像对宫颈癌N分期的价值探讨 [目的]探讨弥散加权成像在宫颈癌转移淋巴结与非转移淋巴结鉴别诊断的价值。 [材料与方法]收集我院2010年1月至2013年7月经手术病理证实的行淋巴结清扫的宫颈癌患者81例,所有患者均在术前行盆腔常规MRI及DWI检查(b值取0、800s/mm2。我院进行了根治性子宫切除及淋巴结清扫。手术共切除淋巴结2585枚,将T2WI图像上短径≥5mm的144枚淋巴结纳入本研究。参照手术病理,将盆腔淋巴结划分为6组：左、右髂总组,左、右髂外组,左、右髂内及闭孔组。在轴位T2WI上测量淋巴结短径(S)、长径(L)及相应层面的表观弥散系数ADCmin、ADCmean和原发癌灶的ADCmin、ADCmean,并计算得出淋巴结的S/L、rADCmin、rADCmean,采用SPSS17.0软件Mann-Whitney U秩和检验,比较转移淋巴结与非转移淋巴结各形态学指标和ADC值的差异。不同指标间ROC曲线比较采用Medcalcl3.0。通过ROC曲线比较各形态学指标和ADC的最佳阈值,并计算判断淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值、准确度。 [结果]转移淋巴结的L、S、S/L均显著大于非转移淋巴结(P值均0.05),转移淋巴结的ADCmin、ADCmean、rADCmin、rADCmean均显著小于非转移淋巴结(P值均0.05),以ADCmin作为鉴别转移及非转移淋巴结Az(0.906)最大,rADCmin、 ADCmean、rADCmean的Az分别为0.865、0.832、0.830,形态学指标短径S、长径L、短径之比S/L的Az分别为0.856、0.780、0.652.当以ADCmin=0.823X10-3mm/s2作为鉴别淋巴结转移的阈值,敏感度和特异度分别为95.1%,82.5%。诊断淋巴结转移敏感度ADCmin(95.1%)、S/L(92.7%),高于ADCmean(82.9%)、rADCmean(70.7%). rADCmin (87.8%)、S (85.4%)、L (61.0%),但是S/L特异度(38.8%)最低。ADCmin准确度(86.1%)最高,判断淋巴结转移状态最佳。 [结论]DWI有助于鉴别转移淋巴结与非转移淋巴结,尤其以ADCmin为著。
[Abstract]:the first part is compared 3 . Value of OT - MRI plain scan and enhanced scan on T stage of cervical carcinoma Objective : To compare the value of MRI plain scan and enhanced scan in the stage evaluation of cervical cancer in I ~ II stage by contrast with operation and pathology . Methods : MRI plain scan and enhanced scan were performed on 75 patients with cervical cancer from January 2010 to July 2013 . The difference between MRI plain scan and contrast noise ratio ( CNR ) was evaluated by MRI plain scan and enhanced MRI . The results were analyzed by SPSS 17.0 . The accuracy , sensitivity and specificity of MRI enhanced scan were compared with MRI plain scan and MRI enhanced scan . The contrast - to - noise ratio ( CNR ) of MRI - enhanced images was 85.3 % , 77.3 % and 66.7 % respectively . Conclusion : Although MRI enhancement is superior to MRI plain scan in the stage of cervical cancer , the difference is not significant . The Value of the Second Part Diffusion Weighted Imaging in the N staging of Cervical Cancer Objective : To investigate the value of diffusion - weighted imaging in differential diagnosis of cervical cancer metastasis lymph nodes and non - metastatic lymph nodes . All patients were divided into six groups : left , right common iliac , left , right common iliac , left , right and right common iliac and obturator groups . Using SPSS 17.0 software Mann - Whitney U rank sum test , we compared the morphological indexes of lymph nodes with non - metastatic lymph nodes and ADC values . The sensitivity , specificity , positive predictive value , negative predictive value and accuracy of lymph node metastasis were calculated . The sensitivity and specificity of ADCmin , ADCmean , rADCmin and rADCmean were 95.1 % , 0.832 , 0.830 respectively . Conclusion DWI is helpful in differential diagnosis of metastatic lymph node and non - metastatic lymph nodes , especially with ADCmin .

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33;R445.2

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