扩散加权成像及动态增强磁共振成像在诊断子宫颈癌分期中的应用
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摘要
目的:分析扩散加权成像(diffusionweightedimaging,DWI)及动态增强磁共振成像(dynamic contrast-enhancedmagneticresonanceimaging,DCE-MRI)下子宫颈癌的影像表现并与常规MRI比较。方法:回顾性分析本院经组织病理证实为子宫颈癌的45例患者影像资料,治疗前均行MRI常规平扫、DWI和DCE-MRI。结果:常规MRI诊断子宫颈癌的准确率为77.8%,DCE-MRI结合DWI在宫颈癌分期中的准确率达93%。正常子宫颈的ADC值大于宫颈癌ADC值。宫颈癌的分期程度与平均ADC呈负相关,即分期程度越高平均ADC值越低,并且在I期与II期、I期与III期及II期与III期两两比较差异均有统计学意义(P<0.05)。43例子宫颈癌时间-信号曲线(time-signal intensity curves,TIC)呈平台型,2例呈流入型。DCE-MRI定量参数K_(trans),V_e,K_(ep)三者值均随宫颈癌分期的增高而增高,且各期之间差异均有统计学意义(P<0.05)。结论:DWI及其ADC值与DCE-MRI及其TIC曲线、定量参数K_(trans),V_e,K_(ep)在宫颈癌术前诊断及分期中具有重要作用。
Objective: The imaging features of cervical cancer on diffusion weighted imaging(DWI) and dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) were analyzed and compared with conventional MRI.Methods: The imaging data of 45 patients with cervical cancer confirmed by histopathology were retrospectively analyzed. Routine plain scan, DWI and DCE-MRI were performed before operation. Results: The diagnostic accuracy of cervical cancer by routine MRI was 77.8%, and DCE-MRI combined with DWI was 93%. The ADC value of normal cervix is larger than that of cervical cancer ADC. The degree of staging of cervical cancer was negatively correlated with the average ADC, that is, the higher the degree of staging, the lower the average ADC value, and there were differences in P value between the two groups(P<0.05). Forty-three cases of time-signal curve(TIC) of cervical cancer were plateau type and 2 cases were inflow type. DCE-MRI quantitative parameters K_(trans), V_e and K_(ep) increased with the increase of stage of cervical cancer, and there were differences among stages.Conclusion: DWI and its ADC value, DCE-MRI and its TIC curve, quantitative parameters K_(trans), V_e and K_(ep) play an important role in preoperative diagnosis and staging of cervical cancer.
Objective: The imaging features of cervical cancer on diffusion weighted imaging(DWI) and dynamic contrastenhanced magnetic resonance imaging(DCE-MRI) were analyzed and compared with conventional MRI.Methods: The imaging data of 45 patients with cervical cancer confirmed by histopathology were retrospectively analyzed. Routine plain scan, DWI and DCE-MRI were performed before operation. Results: The diagnostic accuracy of cervical cancer by routine MRI was 77.8%, and DCE-MRI combined with DWI was 93%. The ADC value of normal cervix is larger than that of cervical cancer ADC. The degree of staging of cervical cancer was negatively correlated with the average ADC, that is, the higher the degree of staging, the lower the average ADC value, and there were differences in P value between the two groups(P<0.05). Forty-three cases of time-signal curve(TIC) of cervical cancer were plateau type and 2 cases were inflow type. DCE-MRI quantitative parameters K_(trans), V_e and K_(ep) increased with the increase of stage of cervical cancer, and there were differences among stages.Conclusion: DWI and its ADC value, DCE-MRI and its TIC curve, quantitative parameters K_(trans), V_e and K_(ep) play an important role in preoperative diagnosis and staging of cervical cancer.
引文
1.陈万青,李贺,孙可欣,等.2014年中国恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2018,40(1):5-11.CHEN Wanqing,LI He,SUN Kexin,et al.Report of cancer incidence and mortality in China,2014[J].Chinese Journal of Oncology,2018,40(1):5-11.
2.顾秀瑛,郑荣寿,孙可欣,等.2014年中国女性子宫颈癌发病与死亡分析[J].中华肿瘤杂志,2018,40(4):241-245.GU Xiuying,ZHENG Rongshou,SUN Kexin,et al.Incidence and mortality of cervical cancer in China 2014[J].Chinese Journal of Oncology,2018,40(4):241-245.
3.Thomeer MG,Vandecaveye V,Braun L,et al.Evaluation of T2-W MRimaging and diffusion-weighted imaging for the early post-treatment local response assessment of patients treated conservatively for cervical cancer:a multicentre study[J].Eur Radiol,2019,29(1):309-318.
4.Yoshida S,Takahara T,Kwee TC,et al.DWI as an imaging biomarker for bladder cancer[J].AJR Am J Roentgenol,2017,208(6):1218-1228.
5.Surov A,Meyer HJ,Wienke A.Correlation between apparent diffusion coefficient(ADC)and cellularity is different in several tumors:a metaanalysis[J].Oncotarget,2017,8(35):59492-59499.
6.韦洁勤,陆力坚,白杨,等.DWI在宫颈癌诊断中的应用及其与病理相关性研究[J].中国临床新医学,2018,11(1):10-13.WEI Jieqin,LU Lijian,BAI Yang,et al.Application value of diffusion weighted image in diagnosing cervical carcinoma and its correlation with pathology[J].Chinese Journal of New Clinical Medicine,2018,11(1):10-13.
7.杨蔚,强金伟,陈兵,等.DWI评估宫颈鳞状细胞癌增值和侵袭性[J].中国医学影像技术,2018,34(5):709-714.YANG Wei,QIANG Jinwei,CHEN Bing,et al.DWI in prediction of proliferation and invasiveness of cervical squamous cell carcinoma[J].Chinese Journal of Medical Imaging Technology,2018,34(5):709-714.
8.韦树华,李乃玉,韦超,等.3.0T MR DWI在子宫颈癌病理分级及分期中的应用价值[J].实用放射学杂志,2017,33(7):1062-1064.WEI Shuhua,LI Naiyu,WEI Chao,et al.The value of 3.0T MR DWI in pathological grading and staging for cervical carcinoma[J].Journal of Practical Radiology,2017,33(7):1062-1064.
9.Meyer HJ,Purz S,Sabri O,et al.Cervical cancer:associations between metabolic parameters and whole lesion histogram analysis derived from simultaneous(18)F-FDG-PET/MRI[J].Contrast Media Mol Imaging,2018,2018:5063285.
10.Song J,Hu Q,Huang J,et al.Combining tumor size and diffusionweighted imaging to diagnose normal-sized metastatic pelvic lymph nodes in cervical cancers[EB/OL].Acta Radiol,2018,[Epub ahead of print].
11.蒯玉娴,葛继元,王振,等.影像定量分析预测直肠癌淋巴结转移的价值[J].中华核医学与分子影像杂志,2018,38(6):390-394.KUAI Yuxian,GE Jiyuan,WANG Zhen,et al.Predictive value of quantitative image analysis for lymph node metastasis in patients with rectal cancer[J].Chinese Journal of Nuclear Medicine,2018,38(6):390-394.
12.张效杰,唐上坤,陈敬佩,等.DWI在盆腔淋巴结转移瘤诊断中的临床应用[J].中国中西医结合影像学杂志,2018,16(3):267-269.ZHANG Xiaojie,TANG Shangkun,CHEN Jingpei,et al.Clinical application of DWI in diagnosis of pelvic lymph nodes metastases[J].Chinese Imaging Journal of Integrated Traditional and Western Medicine,2018,16(3):267-269.
13.李琳琳,朱绍成,务森,等.动态增强MRI定量参数与食管鳞癌病理分级的相关性研究[J].中华放射性杂志,2018,52(3):204-208.LI Linlin,ZHU Shaocheng,WU Sen,et al.Correlation of quantitative parameters from dynamic contrast-enhanced MRI with pathological grades of esophageal squamous cell carcinoma[J].Chinese Journal of Radiology,2018,52(3):204-208.
14.李志森,张继斌,许建铭,等.3.0T DCE-MRI定量参数对宫颈癌病理学特征及临床分期的研究[J].实用放射学杂志,2018,34(4):609-612.LI Zhisen,ZHANG Jibin,XU Jianming,et al.The study of DCE-MRIquantitative parameters for the pathologic characteristics and clinical stage of cervical cancer at 3.0T[J].Journal of Practical Radiology,2018,34(4):609-612.
15.Wu Q,Shi D,Dou S,et al.Radiomics analysis of multiparametric MRI evaluates the pathological features of cervical squamous cell carcinoma[J].J Magn Reson Imaging,2018.[Epub ahead of print].
16.Dijkhoff RAP,Beets-Tan RGH,Lambregts DMJ,et al.Value of DCE-MRI for staging and response evaluation in rectal cancer:a systematic review[J].Eur J Radiol,2017,95:155-168.
17.Ye ZM,Dai SJ,Yan FQ,et al.DCE-MRI-derived volume transfer constant(Ktrans)and DWI apparent diffusion coefficient as predictive markers of short-and long-term efficacy of chemoradiotherapy in patients with esophageal cancer[J].Technol Cancer Res Treat,2018,17:1533034618765254.
18.Gupta PK,Saini J,Sahoo P,et al.Role of dynamic contrast-enhanced perfusion magnetic resonance imaging in grading of pediatric brain tumors on 3T[J].Pediatr Neurosurg,2017,52(5):298-305.
19.冯煜森,丁莹莹,张娅,等.动态增强磁共振成像在宫颈癌新辅助化疗疗效评估中的价值[J].实用放射学杂志,2018,34(5):725-729.FENG Yusen,DING Yingying,ZHANG Ya,et al.Dynamic contrastenhanced MRI predicts the neoadjuvant chemotherapy short-term effect in patients with cervical cancer[J].Journal of Practical Radiology,2018,34(5):725-729.
20.An YY,Kim SH,Kang BJ,et al.Differentiation of malignant and benign breast lesions:Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging(DWI)using readout-segmented echoplanar imaging at 3.0T[J].PLoS One,2017,12(3):e0174681.
2.顾秀瑛,郑荣寿,孙可欣,等.2014年中国女性子宫颈癌发病与死亡分析[J].中华肿瘤杂志,2018,40(4):241-245.GU Xiuying,ZHENG Rongshou,SUN Kexin,et al.Incidence and mortality of cervical cancer in China 2014[J].Chinese Journal of Oncology,2018,40(4):241-245.
3.Thomeer MG,Vandecaveye V,Braun L,et al.Evaluation of T2-W MRimaging and diffusion-weighted imaging for the early post-treatment local response assessment of patients treated conservatively for cervical cancer:a multicentre study[J].Eur Radiol,2019,29(1):309-318.
4.Yoshida S,Takahara T,Kwee TC,et al.DWI as an imaging biomarker for bladder cancer[J].AJR Am J Roentgenol,2017,208(6):1218-1228.
5.Surov A,Meyer HJ,Wienke A.Correlation between apparent diffusion coefficient(ADC)and cellularity is different in several tumors:a metaanalysis[J].Oncotarget,2017,8(35):59492-59499.
6.韦洁勤,陆力坚,白杨,等.DWI在宫颈癌诊断中的应用及其与病理相关性研究[J].中国临床新医学,2018,11(1):10-13.WEI Jieqin,LU Lijian,BAI Yang,et al.Application value of diffusion weighted image in diagnosing cervical carcinoma and its correlation with pathology[J].Chinese Journal of New Clinical Medicine,2018,11(1):10-13.
7.杨蔚,强金伟,陈兵,等.DWI评估宫颈鳞状细胞癌增值和侵袭性[J].中国医学影像技术,2018,34(5):709-714.YANG Wei,QIANG Jinwei,CHEN Bing,et al.DWI in prediction of proliferation and invasiveness of cervical squamous cell carcinoma[J].Chinese Journal of Medical Imaging Technology,2018,34(5):709-714.
8.韦树华,李乃玉,韦超,等.3.0T MR DWI在子宫颈癌病理分级及分期中的应用价值[J].实用放射学杂志,2017,33(7):1062-1064.WEI Shuhua,LI Naiyu,WEI Chao,et al.The value of 3.0T MR DWI in pathological grading and staging for cervical carcinoma[J].Journal of Practical Radiology,2017,33(7):1062-1064.
9.Meyer HJ,Purz S,Sabri O,et al.Cervical cancer:associations between metabolic parameters and whole lesion histogram analysis derived from simultaneous(18)F-FDG-PET/MRI[J].Contrast Media Mol Imaging,2018,2018:5063285.
10.Song J,Hu Q,Huang J,et al.Combining tumor size and diffusionweighted imaging to diagnose normal-sized metastatic pelvic lymph nodes in cervical cancers[EB/OL].Acta Radiol,2018,[Epub ahead of print].
11.蒯玉娴,葛继元,王振,等.影像定量分析预测直肠癌淋巴结转移的价值[J].中华核医学与分子影像杂志,2018,38(6):390-394.KUAI Yuxian,GE Jiyuan,WANG Zhen,et al.Predictive value of quantitative image analysis for lymph node metastasis in patients with rectal cancer[J].Chinese Journal of Nuclear Medicine,2018,38(6):390-394.
12.张效杰,唐上坤,陈敬佩,等.DWI在盆腔淋巴结转移瘤诊断中的临床应用[J].中国中西医结合影像学杂志,2018,16(3):267-269.ZHANG Xiaojie,TANG Shangkun,CHEN Jingpei,et al.Clinical application of DWI in diagnosis of pelvic lymph nodes metastases[J].Chinese Imaging Journal of Integrated Traditional and Western Medicine,2018,16(3):267-269.
13.李琳琳,朱绍成,务森,等.动态增强MRI定量参数与食管鳞癌病理分级的相关性研究[J].中华放射性杂志,2018,52(3):204-208.LI Linlin,ZHU Shaocheng,WU Sen,et al.Correlation of quantitative parameters from dynamic contrast-enhanced MRI with pathological grades of esophageal squamous cell carcinoma[J].Chinese Journal of Radiology,2018,52(3):204-208.
14.李志森,张继斌,许建铭,等.3.0T DCE-MRI定量参数对宫颈癌病理学特征及临床分期的研究[J].实用放射学杂志,2018,34(4):609-612.LI Zhisen,ZHANG Jibin,XU Jianming,et al.The study of DCE-MRIquantitative parameters for the pathologic characteristics and clinical stage of cervical cancer at 3.0T[J].Journal of Practical Radiology,2018,34(4):609-612.
15.Wu Q,Shi D,Dou S,et al.Radiomics analysis of multiparametric MRI evaluates the pathological features of cervical squamous cell carcinoma[J].J Magn Reson Imaging,2018.[Epub ahead of print].
16.Dijkhoff RAP,Beets-Tan RGH,Lambregts DMJ,et al.Value of DCE-MRI for staging and response evaluation in rectal cancer:a systematic review[J].Eur J Radiol,2017,95:155-168.
17.Ye ZM,Dai SJ,Yan FQ,et al.DCE-MRI-derived volume transfer constant(Ktrans)and DWI apparent diffusion coefficient as predictive markers of short-and long-term efficacy of chemoradiotherapy in patients with esophageal cancer[J].Technol Cancer Res Treat,2018,17:1533034618765254.
18.Gupta PK,Saini J,Sahoo P,et al.Role of dynamic contrast-enhanced perfusion magnetic resonance imaging in grading of pediatric brain tumors on 3T[J].Pediatr Neurosurg,2017,52(5):298-305.
19.冯煜森,丁莹莹,张娅,等.动态增强磁共振成像在宫颈癌新辅助化疗疗效评估中的价值[J].实用放射学杂志,2018,34(5):725-729.FENG Yusen,DING Yingying,ZHANG Ya,et al.Dynamic contrastenhanced MRI predicts the neoadjuvant chemotherapy short-term effect in patients with cervical cancer[J].Journal of Practical Radiology,2018,34(5):725-729.
20.An YY,Kim SH,Kang BJ,et al.Differentiation of malignant and benign breast lesions:Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging(DWI)using readout-segmented echoplanar imaging at 3.0T[J].PLoS One,2017,12(3):e0174681.