子宫内膜癌MRI动态增强和DWI表现与VEGF-C的相关性分析

发布时间：2018-11-11 13:47

【摘要】：背景和目的子宫内膜癌为常见的好发生于子宫内膜上皮层的女性生殖系统肿瘤疾病,发病率和复发率较高,占女性妇科肿瘤疾病的比例接近20%~30%,多发生于50~60岁的绝经期女性,而绝经前的女性发病所占比例较低,约占25%。近年来,伴随人民生活水的提高以及生活方式和习惯的改变,女性的内分泌代谢疾病的发生率也在增加,并导致子宫内膜癌呈现年轻化的趋势。子宫内膜癌术前准确的判断尤其重要,通过对患者的病理分期、肌层浸润以及淋巴结转移的正确诊断选择放疗、化疗、手术等治疗方式,尤其子宫肌层浸润的深度的判断,对患者选择的手术范围以及术后辅助治疗影响较大。目前,子宫内膜癌的诊断和评估的手段较多,包括MRI、B超、CT和PET,而MRI发展最快,诊断准确度较高,对子宫内膜癌的术前诊断具有较高的价值。VEGF-C为血管新生的标记物,与恶性肿瘤侵袭、浸润以及转移密切有关,能促进新生血管的生成,并改变血管的通透性。本研究的目的在于研究子宫内膜癌的肌层浸润、宫颈受累情况与病理学、分子生物学特性之间的关系,通过术前分期推测子宫内膜癌的恶性程度,并结合肿瘤生物学指标VEGF-C的表达情况,增加临床评估和预后的科学性,为肿瘤治疗提供参考信息。材料与方法回顾性分析2011年1月-2013年1月漯河市中心医院收治62例子宫内膜癌患者的资料,术后均经手术病理证实。患者术前主要接受上海通用电气(GE)1.5T磁共振扫描仪进行的MRI常规平扫、动态持续增强扫描(DCE-MRI)和弥散加权成像(DWI,b=0,1000mm2/s)扫描检查。另选择同期在漯河市中心医院接受治疗的10例正常子宫内膜患者为对照组。术后病理按照FIGO2009分期。所有扫描图像均在ADW4.2工作站进行分析处理,由2名病理医师采用双盲法进行阅片观察。肿瘤组织采用HE染色,并采用免疫组化SP法检测VEGF-C在子宫内膜癌中的表达。选用SPSS19.0统计学软件进行数据分析和处理,以P0.05为有显著性差异。结果DEC-MRI检查结果和手术病理分期相符49例,准确度79.0%。其中Ia期31例,诊断符合27例,诊断准确率87.1%,Ib期10例,诊断符合7例,诊断准确率70.0%。II期12例,诊断符合10例,诊断准确率83.3%。III期9例,诊断符合5例,诊断准确率55.6%。DEC-MRI+DWI检查结果和手术病理分期相符56例,准确度90.3%。其中Ia期34例,诊断符合31例,诊断准确率91.2%,Ib期11例,诊断符合9例,诊断准确率81.8%。II期12例,诊断符合11例,诊断准确率91.7%。III期5例,诊断符合5例,诊断准确率100%。MRI检查子宫内膜癌对肌层浸润、宫颈间质浸润以及淋巴结转移具有较高的准确度,分别为83.9%、96.8%和91.9%。62例腺癌患者中,子宫内膜样腺癌59例,其中子宫内膜癌患者闭孔内肌的三组信号强度、ADC值两两比较,差异无统计学意义(P0.05)。而高分化、中分化和低分化三组信号强度、AD值两两比较,低中、低高两两比较,差异均有统计学意义(P0.05),中高组比较,差异无统计学差异(P0.05)。子宫内膜癌MRI分期与子宫内膜癌的VEGF-C的表达呈正相关。结论1、DCE-MRI联合DWI成像具有多方位、多角度成像及对软组织分辨率高等优点,能清晰地显示子宫内膜癌病灶的位置、大小及范围。2、子宫内膜癌VEGF-C的表达与子宫内膜癌MRI分期呈正相关。3、DCE-MRI联合DWI成像对子宫内膜癌术前分期、肿瘤浸润肌层深度、宫颈有无受累、淋巴结有无转移等的判断有较高的准确度。
[Abstract]:Background and target endometrial carcinoma is a common female reproductive system tumor disease, which is common to the epithelial layer of the endometrium, and the morbidity and the recurrence rate are high, the proportion of the female gynecological tumor diseases is close to 20% to 30%, The proportion of women in pre-menopausal women is low, accounting for about 25%. In recent years, with the improvement of people's living water and the change of life style and habits, the incidence of women's endocrine-metabolic diseases is also increasing, leading to a tendency of young endometrial cancer to be young. the accurate judgment before the endometrial carcinoma is particularly important, and the judgment of the depth of the treatment such as radiotherapy, chemotherapy, operation and the like, in particular the depth of the infiltration of the uterine muscle layer, is selected through the correct diagnosis of the pathological stage, the myolayer infiltration and the lymph node metastasis of the patient, The range of surgery to be selected for the patient, as well as the postoperative adjuvant treatment, has a greater impact. At present, the method of diagnosis and evaluation of endometrial carcinoma is much more, including MRI, B-ultrasound, CT and PET, and MRI is the fastest and the diagnostic accuracy is high, and it is of high value to the pre-operative diagnosis of endometrial carcinoma. VEGF-C is a marker of angiogenesis, which is closely related to the invasion, infiltration and metastasis of malignant tumor, and can promote the generation of the new blood vessel and change the permeability of the blood vessel. The purpose of this study was to study the relationship between the invasion of the muscle layer of the endometrial carcinoma, the condition of the involvement of the cervix and the characteristics of the pathology and the molecular biology. The degree of malignancy of the endometrial carcinoma was estimated by the pre-operative stage, and the expression of VEGF-C was combined with the biological index of the tumor. the scientific nature of clinical evaluation and prognosis is increased, and the reference information is provided for the treatment of the tumor. Materials and Methods The data of 62 cases of endometrial carcinoma from January 2011 to January 2013 were analyzed retrospectively. Prior to the operation of the patient, the MRI conventional flat scan, dynamic continuous enhancement scan (DCE-MRI) and diffusion-weighted imaging (DWI, b = 0, 1000mm2/ s) were performed by the Shanghai General Electric (GE) 1. 5T magnetic resonance scanner. In the same period, 10 normal endometrial patients treated in the central hospital of the Hehe City were selected as the control group. The postoperative pathology was performed in accordance with the FIIGO2009 stage. All scanned images were analyzed in the ADW4.2 workstation and were observed by two pathologists using a double-blind method. The expression of VEGF-C in endometrial carcinoma was detected by HE staining and immunohistochemical SP method. SPSS 19.0 statistical software was used for data analysis and treatment, with a significant difference between P0.05. Results The results of DEC-MRI and the pathological stages of the operation were in accordance with 49 cases and the accuracy was 79.0%. The diagnostic accuracy was 87.1%, the accuracy of diagnosis was 87.1%, and the diagnostic accuracy was 70. 0%. In the phase II, 12 cases were diagnosed, the diagnosis was in accordance with 10 cases, the diagnostic accuracy was 83.3%, and in 9 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy was 55.6%. The result of DEC-MRI + DWI and the pathological stage of the operation were in accordance with 56 cases. The accuracy is 90.3%. Among the 34 cases, the diagnosis was in 31, the diagnostic accuracy was 91.2%, the phase Ib was 11 cases, the diagnosis was in accordance with 9 cases, the diagnostic accuracy was 81.8%, the stage II was 12 cases, the diagnosis was in accordance with 11 cases, the diagnostic accuracy was 91.7%, the stage III was 5 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy rate was 100%. In the 62 cases of adenocarcinoma, there were 59 cases of endometrial adenocarcinoma, of which there was no significant difference between the three groups of signal intensity and ADC value of the inner muscle of the patients with endometrial carcinoma (P0.05). The difference of signal intensity and AD of the three groups with high differentiation, medium differentiation and low differentiation was statistically significant (P <0.05), and there was no statistical difference between the two groups (P0.05). MRI staging of endometrial carcinoma is positively related to the expression of VEGF-C in endometrial carcinoma. Conclusion 1, DCE-MRI combined with DWI imaging has the advantages of multi-orientation, multi-angle imaging and high resolution of soft tissue, and can clearly show the position, size and range of endometrial carcinoma. DCE-MRI combined with DWI imaging had a high degree of accuracy in the pre-operative stage of endometrial carcinoma, the depth of the tumor infiltrating muscle layer, the presence or absence of the cervix, the presence or absence of lymph nodes, and the like.
【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

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