摘要
目的 探讨磁共振扩散加权成像（MRI DWI）在宫颈癌诊断和疗效预测中的临床应用价值.方法 对28例确诊的进展期原发性宫颈癌患者及10例正常宫颈对照者进行了前瞻性MRIDWI检查,分析根据DWI图像测量的肿瘤体积与根据实体瘤疗效评价标准（RECIST）测量的肿瘤最长径之间的相关性,比较宫颈癌与正常宫颈及宫体肌层组织的表观扩散系数（ADC）值的差异,比较17例治疗前后宫颈肿瘤平均ADC值的变化.结果 MRI DWI对肿瘤边界的显示优于常规T2加权像（T2WI）及增强后T1加权像（T1WI）.高扩散敏感系数（b=2000 s/mm^2）的DWI图像具有较高的信噪比.DWI测量的肿瘤体积与RECIST标准测量的肿瘤最长径间存在明显相关性（r=0.759,P＜0.01）.b=800 s/mm^2时,宫颈癌肿瘤组织、宫体肌层组织和正常宫颈组织的ADC值分别为（9.85±1.55）×10^-3mm^2/s、（14.20±2.80）×10^-3 mm^2/s和（14.14±0.45）×10^-3 mm^2/s;b=2000 s/mm^2时,宫颈癌肿瘤组织、宫体肌层组织和正常宫颈组织的ADC值分别为（7.38 ±0.98）×10^-3 mm^2/s、（8.52 ±2.38）×10^-3 mm^2/s和（8.60±0.63）×10^-3 mm^2/s.宫颈癌肿瘤组织与正常宫颈组织、宫体肌层组织间的ADC值差异均有统计学意义（均P＜0.01）.b=800 s/mm^2时,治疗前后肿瘤组织的ADC值分别为（9.85 ±1.55）×10^-3 mm^2/s和（13.41 ±2.93）×10^-3 mm^2/s,差异有统计学意义（P＜0.001）；b=2000 s/mm^2时,治疗前后肿瘤组织的ADC值分别为（7.38 ±0.98） ×10^-3 mm^2/s和（8.93±1.92）× 10^-3mm^2/s,差异有统计学意义（P =0.008）.单因素回归分析显示,治疗前ADC值直方图比例中的不同面积（25％ ADC、50％ ADC、75％ ADC）与宫颈癌的疗效有关（均P＜0.05）.多因素分析显示,治疗前ADC值直方图比例中不同面积（25％ ADC、50％ ADC、75％ ADC）与宫颈癌的疗效无关（均P＞0.05）.绘制25％ ADC、50％ ADC、75％ ADC疗效预测的受试者工作特征曲线（ROC曲
Objective To investigate the clinical application of diffusion weighted imaging （DWI） in uterine cervical cancer and the apparent diffusion coefficient （ADC） value in diagnosis and predicting treatment response.Methods Twenty-eight patients with advanced primary cervical cancer confirmed by pathology and 10 cases of normal uterine cervix as control were recruited in this prospective clinical trial.To analyze the correlation between tumor volume measured in DWI and tumor maximum diameter measured according to the RECIST criteria.To compare the ADC value differences among the uterine cervical cancer,uterine myometrium,and normal uterine cervix.To compare the ADC values in 17 cancer patients before and after treatment.Results The illustration of tumor boundary in DWI was superior to conventional T2WI and post-enhancement T1WI.The DWI with higher b value （2000 s/mm^2） had a better signal-to-noise ratio.The tumor volume measured in DWI has good correlation with tumor maximum diameter according to RECIST criteria （r =0.759,P 〈 0.01）.When b =800 s/mm^2,the ADC values of the uterine cervical cancer,uterine myometrium,and normal uterine cervix were （9.85 ± 1.55） × 10^-3 mm^2/s,（14.20 ± 2.80） ×10^-3 mm^2/s,and （14.14 ±0.45） × 10^-3 mm^2/s.When b =2000 s/mm^2,the ADC values of the uterine cervical cancer,uterine myometrium and normal uterine cervix were （7.38 ±0.98）×10^-3 mm^2/s,（8.52 ± 2.38） × 10^-3 mm^2/s,and （8.60 ±0.63） × 10^-3 mm^2/s,respectively.There were significant differences between the cervical cancer and normal cervix or uterine myometrium （P 〈0.001 for both）.When b =800 s/mm^2,the ADC value was （9.85 ± 1.55） × 110^-3 mm^2/s before and （13.41 ± 2.93） × 10^-3 mm^2/s after treatment （P 〈 0.001）.When b =2000 s/mm^2,the ADC value was （7.38 ±0.98） × 10^-3 mm^2/s before and （8.93 ± 1.92） × 10^-3 mm^2/s after treatment （P =0.008）.Univariate logistic regression analysis showed that 25% ADC,50% ADC,and 75% ADC in the tumor ADC
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2014年第2期115-119,共5页
Chinese Journal of Oncology
基金
国家自然科学基金面上项目（30670597）
关键词
宫颈肿瘤
药物疗法
放射疗法
磁共振成像
扩散加权成像
表观扩散系
数
预测
Uterina cervical neoplasms
Drug therapy
Radiotherapy
Magnetic resonance imaging
Diffusion weighted imaging
Apparent diffusion coefficient
Forecasting
