摘要
目的探讨磁共振扩散加权成像(diffusion weighted imaging, DWI)在鉴别宫颈癌患者首次治疗前盆腔转移性淋巴结和反应性增生淋巴结的诊断价值。
资料与方法对53例宫颈癌初诊患者治疗前行盆腔磁共振常规和DWI扫描。所有患者均行盆腔淋巴结清扫术,切除盆腔淋巴结共计1178枚,全部送病理检查。将其中短径≥0.5cm的108枚淋巴结分成转移性淋巴结(49枚)和反应性增生淋巴结(59枚)两组,观察它们在DWI图、ADC图及eADC图上的信号特征并分别测量两组淋巴结的表观扩散系数(apparent diffusion coefficient,ADC)及指数化表观扩散系数(exponential apparent diffusion coefficient,eADC) ,对其进行统计学分析。
结果宫颈癌转移性淋巴结的平均ADC值[(1.072±0.185)×10~(-3)mm~2/s]明显低于反应性增生淋巴结[(1.281±0.253)×10~(-3)mm~2/s] (P = 0. 000);最大ADC值[(1.488±0.263)×10~(-3)mm~2/s]亦低于反应性增生淋巴结[(2.024±0.445)×10~(-3)mm~2/s] (P = 0. 000);平均eADC值[(0.351±0.059)×10~(-3)mm~2/s]明显高于反应性增生淋巴结[(0.297±0.076)×10~(-3)mm~2/s] (P = 0. 000);最小eADC值[(0.231±0.054)×10~(-3)mm~2/s]亦高于反应性增生淋巴结[(0.145±0.065)×10~(-3)mm~2/s] (P = 0. 000)。两组淋巴结间的最小ADC值(P = 0. 061)与最大eADC值(P = 0. 180)无明显性统计学差异。当我们以平均ADC值<1.11×10~(-3)mm~2/s为阈值诊断宫颈癌患者短径≥0.5cm的盆腔淋巴结有无转移的敏感度、特异度和准确度分别为71%、78%和75%,以最大ADC值<1.83×10~(-3)mm~2/s为阈值诊断宫颈癌患者短径≥0.5cm的盆腔淋巴结有无转移的敏感度、特异度和准确度分别为92%、75%和82%。
结论本研究结果表明:1、DWI可作为淋巴结MR成像的一种新手段,为宫颈癌盆腔淋巴结转移的检出提供新的方法。2、ADC值与eADC值测量对鉴别宫颈癌患者首次治疗前盆腔转移性淋巴结和反应性增生淋巴结有意义。3、最大ADC值较平均ADC值对诊断宫颈癌患者盆腔转移性淋巴结更敏感。
Objective: To evaluate the diagnositic value of diffusion-weighted Imaging (DWI) to differentiate malignant and reactive hyperplasia pelvic lymph node in patients with cervical carcinoma before the first treatment.
Materials and Methods: 53 untreated patients with cervical carcinoma were performed with both conventional MR and DWI. The bilateral pelvic lymphadenectomy was performed in all patients. Of the total dissected and histopathologically evaluated 1178 pelvic lymph nodes, nodes(108 nodes) with short-axis diameter larger than 0.5cm were divided into metastatic (49 nodes) and reactive hyperplasia(59 nodes) groups. The signal intensity of the lymph nodes was assessed on images obtained at b=0 or 800s/mm2 and from the ADC maps and the eADC maps. The ADC value and eADC value of lymph nodes were also measured and respectively compared between metastatic and reactive hyperplasia lymph nodes.
Rusults: The mean ADC value of malignant [(1.072±0.185)×10~(-3)mm~2/s] lymph nodes was significantly lower than that of reactive hyperplasia [(1.281±0.253)×10~(-3)mm~2/s] lymph nodes (P = 0. 000).The maximum ADC value of malignant [(1.488±0.263)×10~(-3)mm~2/s] lymph nodes was significantly lower than that of reactive hyperplasia [(2.024±0.445)×10~(-3)mm~2/s] lymph nodes (P = 0. 000).The mean eADC value of malignant [(0.351±0.059)×10~(-3)mm~2/s] lymph nodes was significantly higher than that of reactive hyperplasia [(0.297±0.076)×10~(-3)mm~2/s] lymph nodes (P = 0. 000).The minimum eADC value of malignant [(0.231±0.054)×10~(-3)mm~2/s] lymph nodes was significantly higher than that of reactive hyperplasia [(0.145±0.065)×10~(-3)mm~2/s] lymph nodes (P = 0. 000).The minimum ADC value between malignant and reactive hyperplasia lymph nodes showed no statistical significance (P = 0. 061). The maximum eADC value between malignant and reactive hyperplasia lymph nodes showed no statistical significance (P = 0. 180).
When a mean ADC value of 1.11×10~(-3)mm~2/s was used as a threshold value for differentiating metastatic from reactive hyperplasia lymph nodes with short-axis diameter larger than 0.5cm, the best results were obtained with a sensitivity of 71%, specificity of 78% and accuracy of 75%. When a maximum ADC value of 1.83×10~(-3)mm~2/s was used as a threshold value for differentiating metastatic from reactive hyperplasia lymph nodes with short-axis diameter larger than 0.5cm, the best results were obtained with a sensitivity of 92%, specificity of 75% and accuracy of 82%.
Conclosion:
1 DWI provides a new method for detection of malignant lymph node in patients with cervical carcinoma.
2 The calculation of ADC value and eADC value is signinficant for differntiating malignant and reacitive hyperplasia pelvic lymph nodes in patients with cervical carcinoma.
3 The maximum ADC value is more sensitive for differntiating malignant and reacitive hyperplasia pelvic lymph nodes in patients with cervical carcinoma than the mean ADC value.
引文
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