【作者】 王飞；

【导师】 范丽梅；

【作者基本信息】 吉林大学 ， 妇产科学（专业学位）， 2016， 硕士

【摘要】 目的:宫颈癌是女性最常见的恶性肿瘤之一,严重威胁着女性的身心健康。目前检查宫颈癌的方法有多种,以宫颈软组织病理活检最为准确,但大多为有创性检查,而且只能定性诊断,并不能确定侵及的范围。磁共振成像(Magneticresonanceimaging,MRI)技术凭借其对软组织的分辨率极高这一优点能够很好的显示肿瘤组织侵犯程度和范围。MRI诊断操作方便,对子宫颈的显示准确而且全面,可对肿瘤组织行多参数、多方位成像,可清楚显示肿瘤病变的大小、位置以及其侵及的范围,且敏感性和特异性均比较高。MRI对于子宫颈癌具有优势性的诊断价值,可为临床宫颈癌的诊断及治疗提供帮助。本文旨在探讨磁共振成像技术对宫颈癌的诊断价值,包括术前分期、阴道受累及淋巴结转移。方法:选取2013年1月到2015年11月入住我院妇产科的宫颈癌患者58例。所有患者术前均行GE 750 3.0T超导磁共振仪扫描,行T1WI、T2WI、DWI(b=800s/mm2),以及静脉注射Gd-DTPA后行LAVA-Flex动态増强扫描。所有患者最终均行手术治疗。采用SPSS19.0软件对所有患者的MRI结果进行分析,以术后病理检查结果为诊断宫颈癌的金标准进行诊断试验。采用X2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,采用Mcnemar X2检验对术前MRI对宫颈癌阴道受累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。结果:1、58例宫颈癌患者术前临床分期、MRI检查分期及术后病理分期,三者之间差异有统计学意义(P<0.05),MRI分期与术前临床分期的差异有统计学意义(P<0.05),而MRI分期与术后病理分期的差异无统计学意义(P>0.05)。以术后病理分期结果为参照,术前临床分期准确度仅为69%,而宫颈癌术前MRI检查总体分期准确度为96.5%;2、术前MRI诊断与术后病理结果在宫颈癌阴道受累及淋己结转移方面比较均有较高的灵敏性及特异性,各分别达到97.0%、96.1%,76.9%、93.4%。经Mcnemar X2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检查对宫颈癌术前临床分期有较高的准确率;2、MRI检查对于判断宫颈癌阴道受累及淋巴结转移方面有着较高敏感性和特异性,可以指导临床治疗;3、MRI检查联合FIGO临床分期可以使宫颈癌分期更加准确,MRI可以作为评估宫颈癌术前准确分期的重要工具,并以此来选择、制定合理的子宫颈癌治疗计划。更多还原

【Abstract】 Objective:Cervical cancer(Carcinoma of Cervix) is the second malignant tumor, which is a serious threaten to the women’s health. At present there are many types of detection methods to detect cervical cancer.The cervical soft tissue pathological biopsy is the most accurate, but it is mostly invasive, and can only qualitatively diagnos, can not determine the scope of the invasion. MRI technology has a high resolution of soft tissue, especially beneficial to tumor invasion degree and scope of the display. MRI diagnosis is easy to operate and can accurately display the cervix.It can display the tumor tissue of multiparameter and multi-dimensional imaging, can clearly display the size of the tumor lesion, the scope of the position and the invasion and of high sensitivity and specificity. The diagnostic value of MRI in cervical cancer has many advantages,so it can be used to diagnosis UCC and is beneficial to the treatment of cervical cancerr. Investigating the diagnostic value of MRI for cervical cancer,including preoperative staging, vagina involvement and lymph node metastasis is the aim of this pape.Methods:Select 58 patients with UCC of the second hospital of Ji Lin University from January 2013 to November 2015. All patients accept GE 750 lines 3.0 T superconducting MRI machine scanning before operation, routine pelvic MRI scan sequence T1 WI, T2 WI, DWI(b = 800 s/mm2) scan, and intravenous Gd- DTPA LAVA- Flex dynamic raised after scanning. Ultimately, all patients accept surgical treatment. Use SPSS19.0 software to analyze MRI results of all the patients.Using the postoperative pathological results as the gold standard in the diagnosis of cervical cancer,diagnosis experiment was carried out. The dates from the MRI preoperative staging, preoperative clinical staging and the postoperative pathologic staging, werecompared through chi-square test. And the dates of preoperative MRI in cervical cancer vagina involvement and lymph node metastasis diagnosis and postoperative pathological results were compared through Mcnemar chi-square test. The difference was statistically significant(P<0.05).Results:1,The differences of the preoperative clinical staging and MRI staging and the postoperative pathologic staging are statistical significant(P < 0.05), while differences between MRI staging and the postoperative pathologic staging have no statistical significance(P > 0.05), the difference between MRI staging and preoperative clinical staging during was statistically significant(P < 0.05). Using the postoperative pathological staging as the examination standards, the accuracy of preoperative clinical staging is only 69%, and cervical cancer overall preoperative MRI staging accuracy was 96.5%;2, Preoperative MRI diagnosis and postoperative pathologic results in cervical vaginal involvement and lymph node metastasis has high sensitivity and specificity,were 97.0%, 97.0%, 76.9%, 93.4%. Checked by Mcnemar chi-square test, the differences between them have no statistical significance(P>0.05), namely the preoperative MRI diagnosis and postoperative pathological results have consistency in clinical.Conclusion:1.MRI has a high accuracy in the preoperative staging of cervical cancer;2.MRI has a higher sensitivity and specificity in diagnosing vaginal involvement and lymph node metastasis of cervical cancer, can guide the clinical treatment;3.The combination of MRI and FIGO clinical stage can impro the accuracy of clinical staging of cervical cancer.MRI can be used as the important tool to assess cervical cancer preoperative staging, and to choose and formulate reasonable cervical cancer treatment plan.更多还原