【作者】 李冰；

【导师】 程敬亮；

【作者基本信息】 郑州大学 ， 影像医学与核医学（专业学位）， 2014， 硕士

【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。P<0.05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(P<0.05),而术前MRI分期与术后病理分期之间差异无统计学意义(P>0.05),术前MRI分期与术前临床分期间差异有统计学意义(P<0.05)。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(P>0.05),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。更多还原

【Abstract】 Background and PurposeCervical cancer is the most common female reproductive tract malignant tumors, which is the third in the world just behind breast cancer, rectum and colon cancer morbidity statistics.In developing countries, it only fellow behind breast cancer. At present, there are many methods to check for cervical cancer, soft tissue pathology biopsy is the most common way, however it can not reveal the range of cervical cancer invasion, and mostly with invasive. With the improvement of imaging technology and soft tissue resolution of MRI (Magnetic Resonance Imaging, MRI), which can be quick to make accurate judgment with tumors. Especially MRI is beneficial to the degree of tumor invasion and the scope of the tumors.This can also use in the cervix, which can clear show the differences signals of womb, also brings good administrative levels between various organizations and the tumor tissue. MRI can clearly show the location of the tumor lesion as well as the size and the scope of the invasion with multi-parameter imaging.MRI have a high sensitivity and specificity. In the clinical diagnosis of cervical cancer MRI has advantages of diagnostic value, which can provide help for the clinical treatment of cervical cancer. This experiment was to study magnetic resonance imaging for cervical cancer diagnosis and preoperative staging of application value.Materials and MethodsThe 60 cervical cancer patients which was selected from June 2013 to June 2014 in our hospital. There are 49 cases of squamous cell carcinoma, small cell carcinoma (3 cases),3 cases of glands squamous carcinoma,2 cases of clear cell adenocarcinoma,2 cases of adenocarcinoma,1 case of poorly differentiated cervical neuroendocrine carcinoma in. This was diagnosised by cervical biopsy before the preoperative. All of the 60 patients Age 27-76, the average (56.5+13.3) years old, the median age of 55.In the 25 patients with stage ⅠB～ⅡA period operate with total hysterectomy and extensive total hysterectomy and pelvic lymph node cleaning operation,35 patients with stage ⅡB with locality open surgery or lymph node biopsy. Ostoperative pathological examination results as the gold standard in the diagnosis of cervical cancer.All of the 60 cases were performed with 750 GE 3.0 T MRI machine scanning, which have 8 channel body dedicated phased front. All patients underwent routine pelvic MRI scan sequence T1WI, T2WI, DWI (b=800 s/was), and LAVA-Flex dynamic enhanced scan which performed after Gd-DTPA by intravenous.The data and statistical analysised by using SPSS19.0.The dates from the MRI preoperative staging, preoperative clinical staging and the postoperative pathologic staging, were compared through chi-square test, also compared the rates of preoperative MRI in cervical cancer deep muscularis infiltration, vagina involvement, beside the palace and infiltration and lymph node metastasis diagnosis with postoperative pathologic results count rates. The difference was statistically significant (P<0.05).Sensitivity:the ability to correct diagnosis of a disease, Se=a/a +c; Specificity:the right to rule out the ability of a certain disease, Sp=d/b+d.Results1. The differences have the statistical significance (P<0.05), that 60 cases of cervical cancer patients perforned with preoperative MRI staging and preoperative clinical staging and the postoperative pathologic staging. There have no statistical significance(P>0.05) between preoperative MRI staging and the postoperative pathologic staging. It exited difference between preoperative MRI staging and preoperative clinical points (P<0.05).As well as the postoperative pathological staging and cervical cancer preoperative MRI staging accuracy was 93.3%, the overall preoperative clinical staging accuracy is only 74.9%.2. It has higher sensitivity and specificity between preoperative MRI diagnosis and postoperative pathologic result in cervical cancer deep muscularis infiltration, vagina involvement, beside the palace and infiltration and lymph node metastasis, each respectively 85.7%,98.1%,95.7%,97.4%,95%,90.1%,81.8%,96.1%. The difference between the two is not statistically significant (P> 0.05) though chi-square test. So there have consistency between preoperative MRI and postoperative pathological results in clinical.Conclusion1. MRI examination of cervical cancer has a high accuracy for preoperative staging.2. MRI has high clinical coincidence rate, sensitivity and specificity in cervical cancer deep muscularis infiltration, vagina involvement, beside the palace and infiltration and lymph node metastasis.3. MRI has more reliable objective basis in making cervical cancer staging, therefore, MRI can be used to assess cervical cancer preoperative accurate staging, this can help select and formulate reasonable cervical cancer treatment plan.更多还原