宫颈癌MR分期与临床分期及病理对照的研究

【作者】 刘洋； 周洋； 张修石； 尚乃舰；

【机构】 哈尔滨医科大学附属肿瘤医院放射诊断科；

【摘要】 目的:通过对宫颈癌患者MR影像表现的分析,探讨宫颈癌的MR表现,评价MR在宫颈癌分期中的重要价值。方法:研究对象为2004年1月至2005年1月的60例经病理证实的宫颈癌患者,年龄29～80岁,平均年龄为50．13岁, 40～50岁之间的患者有28例(包括40岁和50岁),占全部病例的46．67％。临床表现为阴道不规则流血者15例(其中包括1例阴道血性分泌物),接触性出血者43例(其中包括1 例接触性出血伴右下肢肿胀),阴道分泌物增多者1例,自己发现肿物者1例。病理诊断为鳞状细胞癌59例,小细胞癌1 例。患者出现症状到MR检查的时间间隔为0．5～18个月,平均为9．8个月。进行手术治疗者,手术与MR检查间隔时间为2～14天,平均为5．68天。本组60例中有35例行手术治疗,其中3例先行化疗后行手术,1例先行放疗结合化疗后再行手术,并具有完整的手术记录及病理检查记录,术后病理诊断均为鳞状细胞癌,24例行放射治疗结合局部或全身化疗,1 例未入院治疗。均在治疗前行盆腔的轴面(SE)T1WI,轴面及矢状面快速自旋回波(TSE)T2WI扫描。在MR图像上观察肿瘤的位置、大小、信号特征、侵犯范围及累及宫旁的情况,并将MR所见进行影像学分期,同时与临床及病理分期进行对比分析。结果:本组研究显示,MR在判断宫颈癌发生部位的准确度为100%,判断宫旁浸润的准确度为92． 31％,判断宫颈癌分期总的准确度为96．67％,对宫旁浸润的特异性和敏感性分别为97．87％和92．31％。结论:MR能多方位高分辨率显示宫颈癌病灶的位置、大小及向宫旁浸润的程度。因此MR对宫颈癌的分期具有极高的诊断价值。临床检查结合MR扫描可以较为准确地评价宫颈癌的分期,使其更接近于病理分期,从而对宫颈癌的治疗起到指导性的作用。更多还原

【Abstract】 Objective: Through analyzing and exploring the MR features of uterine cervical carcinoma,evalu-ate the important value of MR imaging in staging of uterine cervical carcinoma. Methods: Pelvic MR imaging was performed in 60 patients with cervical carcinoma proved by pathology during 2004. Jan to 2005.Jan.The MRI scanning included axial SE T1WI,axial and sagittal TSE T2WI. MR images were analyzed for location,size,signal characteristics,extension of the primary tumor and implication the parametrial tissue.MR findings were compared with clinical staging and surgical-pathologic findings. Results: MR Our experiment show that the accuracy of MR imaging in determination of tumor location was100%, implication the parametrial tissue was 92.31%.The specificity and sensitivity for parametrial extension were 97.87% and 92.31%,respectively.Overall,the accuracy of MR imaging staging was 96.67%.Conclusion: MR imaging can show the location,size of tumors and extension of the cervical carcinoma clearly on multi planes and angles.The value of MRI diagnosis is very high.The clinical examination combined with MRI scanning may evaluate the staging of cervical carcinoma accurately ,and may guide the cure of the cervical carcinoma.更多还原