MR动态增强成像和DWI对宫颈癌诊断临床价值
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摘要
目的宫颈癌是妇女最常见的恶性肿瘤之一,死亡率占女性癌症死亡率的第2位,是威胁妇女健康与生命的严重疾病,对其进行准确诊断及早发现病情,辅助临床干预,对于挽救患者生命具有重要意义。本研究探讨MR动态增强扫描和扩散加权成像(diffusion-weighted imaing,DWI)对宫颈癌诊断的临床价值。方法选择2017-08-01-2018-04-30鹤壁市中医院收治的88例宫颈癌患者作为观察组。选取同期同院进行健康体检的志愿者88名作为对照组。所有研究对象均行术前MR及DWI核磁共振检查。比较观察组与对照组MR动态增强扫描相关参数,即转运系数(Ktrans)、速率常数(K_(ep))、容积分数(Ve)及DWI相关参数〔扩散系数(ADC)〕水平差异,分析MR动态增强扫描与DWI诊断宫颈癌的灵敏度、特异度、准确率、阳性预测值和阴性预测值。结果观察组K~(trans)和K_(ep)水平分别为(2.67±0.48)和(4.18±1.02)min,均高于对照组的(0.85±0.17)和(1.35±0.33)min,t值分别为33.528和24.776,均P<0.001;ADC水平为(0.85±0.12)×10~(-3) mm~2/s,低于对照组的(1.34±0.20)×10~(-3) mm~2/s,差异有统计学意义,t=19.708,P<0.001。MR动态增强扫描诊断宫颈癌的特异度和准确率分别为90.91%和90.34%,均高于DWI的79.55%和82.39%,差异有统计学意义,均P<0.05。MR动态增强扫描诊断宫颈癌的约登指数和Kapaa系数均高于DWI。结论 MR动态增强扫描诊断宫颈癌的结果与病例诊断结果具有高度一致性,临床应用价值优于DWI。
OBJECTIVE Cervical cancer is one of the most common malignant tumors in women.Mortality accounts for the second place in female cancer mortality.It is a serious disease that threatens women′s health and life.Accurate diagnosis,early detection of disease,and clinical intervention are of great significance for saving the lives of patients.This article compares the clinical value of MR dynamic contrast-enhanced scanning and DWI in the diagnosis of cervical cancer.METHODS The clinical data of 88 patients with cervical cancer who were treated in our hospital from August 1,2017 to April 30,2018 were collected as observation group.Eighty-eight volunteers who had a healthy physical examination at the same hospital in the same period were selected as the control group.All subjects underwent preoperative dynamic enhancement and diffusion-weighted imaging(DWI)MRI.The MR dynamic contrast-enhanced scan parameters[transport coefficient(Ktrans),rate constant(K_(ep)),volume fraction(Ve)]and DWI related parameters[Diffusion coefficient(ADC)]were compared in the observation group and the control group.And there was analysis of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of cervical cancer diagnosed with MR dynamic enhanced scan and DWI.RESULTS The levels of K~(trans) and K_(ep)in the observation group were(2.67±0.48)and(4.18±1.02)min,respectively,which were higher than that of the control group(0.85±0.17)and(1.35±0.33)min,and the t values were 33.528 and24.776,respectively,both P<0.001.The ADC level was(0.85±0.12)×10~(-3) mm~2/s,which was lower than that of the control group(1.34±0.20)×10~(-3) mm~2/s,the difference was significant,t=19.708,P<0.001.The specificity and accuracy of MR dynamic enhanced scan for cervical cancer were 90.91% and 90.34%,respectively,which were higher than79.55% and 82.39% of DWI,and the difference was significant,all P<0.05.CONCLUSION The results of diagnosis of cervical carcinoma by MR dynamic contrast scan are highly consistent with the results of case diagnosis,and the clinical application value is superior to that of DWI.
OBJECTIVE Cervical cancer is one of the most common malignant tumors in women.Mortality accounts for the second place in female cancer mortality.It is a serious disease that threatens women′s health and life.Accurate diagnosis,early detection of disease,and clinical intervention are of great significance for saving the lives of patients.This article compares the clinical value of MR dynamic contrast-enhanced scanning and DWI in the diagnosis of cervical cancer.METHODS The clinical data of 88 patients with cervical cancer who were treated in our hospital from August 1,2017 to April 30,2018 were collected as observation group.Eighty-eight volunteers who had a healthy physical examination at the same hospital in the same period were selected as the control group.All subjects underwent preoperative dynamic enhancement and diffusion-weighted imaging(DWI)MRI.The MR dynamic contrast-enhanced scan parameters[transport coefficient(Ktrans),rate constant(K_(ep)),volume fraction(Ve)]and DWI related parameters[Diffusion coefficient(ADC)]were compared in the observation group and the control group.And there was analysis of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of cervical cancer diagnosed with MR dynamic enhanced scan and DWI.RESULTS The levels of K~(trans) and K_(ep)in the observation group were(2.67±0.48)and(4.18±1.02)min,respectively,which were higher than that of the control group(0.85±0.17)and(1.35±0.33)min,and the t values were 33.528 and24.776,respectively,both P<0.001.The ADC level was(0.85±0.12)×10~(-3) mm~2/s,which was lower than that of the control group(1.34±0.20)×10~(-3) mm~2/s,the difference was significant,t=19.708,P<0.001.The specificity and accuracy of MR dynamic enhanced scan for cervical cancer were 90.91% and 90.34%,respectively,which were higher than79.55% and 82.39% of DWI,and the difference was significant,all P<0.05.CONCLUSION The results of diagnosis of cervical carcinoma by MR dynamic contrast scan are highly consistent with the results of case diagnosis,and the clinical application value is superior to that of DWI.
引文
[1]李俊俐,戴莘悦,王毓莉,等.年轻女性宫颈癌诊治新进展[J].国际妇产科学杂志,2017,44(5):490-493.
[2]杨锦旭.不同年龄段宫颈癌患者的临床病理特点及分析[J].中国医药指南,2018,16(28):175-176.
[3]王君,刘月合.365例宫颈癌相关治疗的临床分析[J].检验医学与临床,2018,15(20):3124-3126.
[4]王涛,严雪娇,闵智乾.磁共振T2WI联合DWI对宫颈癌宫旁浸润的诊断价值[J].中国妇幼健康研究,2018,29(11):1427-1430.
[5]张庆,徐香玖,周星,等.3.0T MR动态对比增强对宫颈癌组织学特性和临床分期的分析[J].临床放射学杂志,2015,34(10):1607-1610.
[6]王辉成.MR动态增强扫描对宫颈癌的诊断价值分析[J].中国处方药,2015,13(9):114-115.
[7]柏林.浸润性宫颈癌术前CT及MRI诊断的临床价值研究[J].中国医疗器械信息,2018,24(20):76-77.
[8]高歌.DWI和MR动态增强扫描诊断宫颈癌的临床价值分析[J].中国CT和MRI杂志,2018,16(6):97-99,107.
[9] Tchounzou R,Simo Wambo AG,Njamen TN,et al.Patients lost to follow-up for cervical cancer in the limbe regional hospital[J].J Glob Oncol,2019,4:1-5.
[10] Ferreira da Silva I,Ferreira da Silva I,Koifman RJ.Cervical cancer treatment delays and associated factors in a cohort of women from a developing country[J].J Glob Oncol,2019,5:1-11.
[11] Singh J,Roy B,Yadav A,et al.Cervical cancer awareness and HPV vaccine acceptability among females in Delhi:A cross-sectional study[J].Indian J Cancer,2018,55(3):233-237.
[12] Zhang SS,Ding T,Cui ZH,et al.Efficacy of robotic radical hysterectomy for cervical cancer compared with that of open and laparoscopic surgery:A separate meta-analysis of high-quality studies[J/CD].Medicine(Baltimore),2019,98(4):e14171.
[13] Pesola F,Sasieni P.Impact of screening on cervical cancer incidence in England:A time trend analysis[J/CD].BMJ Open,2019,9(1):e026292.
[14] Jeong MH,Kim H,Kim TH,et al.Prognostic significance of pretreatment lymphocyte percentage and age at diagnosis in patients with locally advanced cervical cancer treated with definite radiotherapy[J].Obstet Gynecol Sci,2019,62(1):35-45.
[15] Nartey Y,Hill P,Amo-Antwi K,et al.Recommendations for cervical cancer prevention and control in Ghana:Public education and human papillomavirus vaccination[J].Ghana Med J,2018,52(2):94-102.
[2]杨锦旭.不同年龄段宫颈癌患者的临床病理特点及分析[J].中国医药指南,2018,16(28):175-176.
[3]王君,刘月合.365例宫颈癌相关治疗的临床分析[J].检验医学与临床,2018,15(20):3124-3126.
[4]王涛,严雪娇,闵智乾.磁共振T2WI联合DWI对宫颈癌宫旁浸润的诊断价值[J].中国妇幼健康研究,2018,29(11):1427-1430.
[5]张庆,徐香玖,周星,等.3.0T MR动态对比增强对宫颈癌组织学特性和临床分期的分析[J].临床放射学杂志,2015,34(10):1607-1610.
[6]王辉成.MR动态增强扫描对宫颈癌的诊断价值分析[J].中国处方药,2015,13(9):114-115.
[7]柏林.浸润性宫颈癌术前CT及MRI诊断的临床价值研究[J].中国医疗器械信息,2018,24(20):76-77.
[8]高歌.DWI和MR动态增强扫描诊断宫颈癌的临床价值分析[J].中国CT和MRI杂志,2018,16(6):97-99,107.
[9] Tchounzou R,Simo Wambo AG,Njamen TN,et al.Patients lost to follow-up for cervical cancer in the limbe regional hospital[J].J Glob Oncol,2019,4:1-5.
[10] Ferreira da Silva I,Ferreira da Silva I,Koifman RJ.Cervical cancer treatment delays and associated factors in a cohort of women from a developing country[J].J Glob Oncol,2019,5:1-11.
[11] Singh J,Roy B,Yadav A,et al.Cervical cancer awareness and HPV vaccine acceptability among females in Delhi:A cross-sectional study[J].Indian J Cancer,2018,55(3):233-237.
[12] Zhang SS,Ding T,Cui ZH,et al.Efficacy of robotic radical hysterectomy for cervical cancer compared with that of open and laparoscopic surgery:A separate meta-analysis of high-quality studies[J/CD].Medicine(Baltimore),2019,98(4):e14171.
[13] Pesola F,Sasieni P.Impact of screening on cervical cancer incidence in England:A time trend analysis[J/CD].BMJ Open,2019,9(1):e026292.
[14] Jeong MH,Kim H,Kim TH,et al.Prognostic significance of pretreatment lymphocyte percentage and age at diagnosis in patients with locally advanced cervical cancer treated with definite radiotherapy[J].Obstet Gynecol Sci,2019,62(1):35-45.
[15] Nartey Y,Hill P,Amo-Antwi K,et al.Recommendations for cervical cancer prevention and control in Ghana:Public education and human papillomavirus vaccination[J].Ghana Med J,2018,52(2):94-102.