FMRI成像在宫颈癌诊断及疗效评价中的临床研究

发布时间：2018-03-13 23:07

  本文选题：宫颈癌分期　切入点：弥散加权成像　出处：《兰州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的探讨常规MRI检查联合DWI. DCE-MRI在宫颈癌诊断、分期及新辅助化疗疗效评估中的价值。 方法宫颈癌30例、正常宫颈10例,30例宫颈癌中10例手术切除、20例行新辅助化疗,所有患者均经病理证实。 1、MRI成像及图像分析应用Siemens3.0T磁共振扫描仪成像,扫描序列包括矢状位T1WI、T2WI、T2WI-FS.横轴位T2WI-FS、冠状位T2WI-FS、DWI及DCE-MRI。新辅助化疗组分别于化疗前、化疗后1月各进行1次MRI扫描(常规MRI、DWI及DCE-MRI);而手术组则于术前进行1次MRI扫描(常规MRI、DWI及DCE-MRI)。MRI扫描后将数据传输至后处理工作站(Siemens Verio),分析病变的MRI特征,如病变大小、内部信号、浸润范围、淋巴结、ADC值及TIC曲线类型等。 2、病理学检查、分析手术组术后进行病理学检查,评价病变侵犯范围(上下、深度、宫旁及淋巴结转移)；同时免疫组化检测VEGF、nm23-H1的表达。 3、统计学分析采用SPSS18.0统计分析软件分析数据：(1)宫颈癌组织与正常组织ADC值(t检验)、TIC曲线类型(卡方检验)；(2)新辅助化疗前后ADC值(t检验)、TIC曲线类型(卡方检验)；(3)宫颈癌VEGF、nm23-Hl表达与ADC值、TIC曲线类型表达关系(t检验和卡方检验)。 结果 1、宫颈癌组对比正常宫颈组,ADC值分别为(0.891±0.10)×10-3mm2/s和(1.893±0.25)×10-3mm2/s,两者差异具有统计学意义。宫颈癌化疗前后ADC值分别为(0.90±0.10)×10-3mm2/s,(1.24±0.13)×10-3mm2/s,两者差异显著(P0.05)。 2、常规MRI分期过高6例,分期过低1例,常规MRI联合DWI、DCE-MRI过高分期3例,常规MRI和常规MRI联合DWI、DCE-MRI误诊率分别为23.3%(7/30)、10%(3/30),分期准确率分别为53.3%(16/30)、83.3%(25/30)。 3、宫颈癌TIC曲线Ⅰ型17例、Ⅱ型13例,正常宫颈组TIC曲线Ⅰ型2例、Ⅳ型8例,宫颈癌与正常宫颈TIC类型各组比较均具有统计学差异；宫颈癌化疗前TIC曲线Ⅰ型14例、Ⅱ型6例,化疗后TIC曲线Ⅰ型2例、Ⅱ型12例、Ⅲ型6例,宫颈癌化疗前后TIC类型Ⅰ型、Ⅱ工型比较差异显著。 4、随着宫颈癌病理分级的增加,其对应的ADC值逐渐减低,VEGF、nm23-H1表达增高。VEGF的阳性表达与相应的ADC值无相关性；而与TIC曲线呈正性相关。nm23-H1的阳性表达与对应的ADC值和TIC曲线无相关性。 结论 1、常规MRI联合FMRI (DWI、DCE-MRI)相比常规MRI,提高了宫颈癌的分期准确性,有助于指导临床分期、制定治疗方案。 2、DWI除可鉴别宫颈癌与正常宫颈之外,还可判断宫旁浸润范围及淋巴结转移情况；ADC值能一定程度地评估宫颈癌放化疗效果,可指导后续治疗方案的调整。 3、VEGF与TIC曲线类型具有一定相关性。宫颈癌TIC曲线类型有助于宫颈癌的诊断与鉴别,且可一定程度地间接反映宫颈癌生物学行为、组织血供变化及治疗反应性。
[Abstract]:Objective to evaluate the value of routine MRI combined with DWI. DCE-MRI in the diagnosis, staging and neoadjuvant chemotherapy of cervical cancer. Methods 30 cases of cervical cancer and 10 cases of normal cervix were treated with neoadjuvant chemotherapy. 1MRI imaging and image analysis were performed with Siemens3.0T magnetic resonance scanner. The scanning sequences included sagittal T1WIX T2WIT2WI-FS.Transaxial T2WI-FS, coronal T2WI-FSWI and DCE-MRI.Neoadjuvant chemotherapy group was treated before chemotherapy. On January after chemotherapy, one MRI scan (conventional MRII-DWI and DCE-MRIWI) was performed respectively, while the operation group underwent MRI scan before operation (conventional MRII-DWI and DCE-MRI).MRI scan). The data were transmitted to the post-processing workstation MRI to analyze the MRI features of the lesion, such as the size of the lesion and the internal signal. Area of invasion, ADC value of lymph node and type of TIC curve, etc. (2) pathological examination, pathological examination after operation was performed in the operation group to evaluate the extent of invasion (upper and lower, depth, para-uterine and lymph node metastasis), and the expression of VEGF nm23-H1 was detected by immunohistochemistry. Statistical analysis using SPSS18.0 statistical analysis software data analysis data: 1) the ADC value of cervical cancer tissue and normal tissue were measured by t test (chi-square test) ADC value test before and after neoadjuvant chemotherapy was used to determine the type of TIC curve (chi-square test). The relationship between the expression of VEGF nm23-Hl and the type of ADC curve in cervical carcinoma was determined by t test and chi-square test. Results. 1. The ADC values of cervical cancer group were 0.891 卤0.10 脳 10 -3 mm 2 / s and 1.893 卤0.25 脳 10 -3 mm 2 / s, respectively. The ADC values of cervical cancer before and after chemotherapy were 0.90 卤0.10) 脳 10 -3 mm 2 / s (1.24 卤0.13) 脳 10 -3 mm 2 / s, respectively (P 0.05). 2. The misdiagnosis rate of routine MRI staging was too high in 6 cases, low in 1 case, high staging in 3 cases with conventional MRI combined with DWIIC-DCE-MRI. The misdiagnosis rate of conventional MRI and conventional MRI combined with DWICE-MRI was 23.33 / 30, respectively. The accuracy of staging was 53.316 / 30 / 83.33 / 30 respectively. 3. There were 17 cases of TIC curve type 鈪，

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