目的：探讨双指数模型DWI在宫颈癌分期、分级诊断中的应用价值。方法：对经手术病理证实的65例宫颈癌患者的临床影像学资料进行回顾分析，就表观扩散系数（ADC）、慢速表观扩散系数（ADCslow）、快速表观扩散系数（ADCfast）、快速扩散成分所占比（Ffast）等单指数模型及双指数模型DWI参数在宫颈癌分期、分级中的差异进行比较。结果：65例宫颈癌中，Ⅱa期以上出现宫旁浸润患者的ADCslow及ADC均小于Ⅱa期及以下无宫旁浸润患者（包括Ⅱa期），差异具有统计学意义（P＜0.05）。ADCfast及Ffast均高于非浸润组，差异无统计学意义（P＞0.05）。宫颈高分化鳞癌或腺癌的ADCslow及ADC均高于中、低分化鳞癌或腺癌，差异均具有统计学意义（P＜0.05）。而各种级别宫颈鳞癌或腺癌的ADCfast、Ffast均无明显差异。ROC曲线分析显示ADCslow在宫颈癌分期、分级诊断中效能最高。结论：ADCslow有助于评估宫颈癌的分期与分级。
Abstract
Objective: To investigate the value of bi-exponential model of intravoxel incoherent motion(IVIM) in diagnosis of different stages, pathological types and subtypes of cervical cancer. Methods: Sixty-five patients with pathological diagnosis of cervical cancer were collected. Apparent diffusion coefficient(ADC), slow apparent diffusion coefficient(ADCslow), fast apparent diffusion coefficient(ADCfast) and fraction of ADCfast(Ffast) were recorded using mono-exponential signal decay model and bi-exponential signal decay model, which were then compared statistically between different stages, pathological types and subtypes. Results: In cervical cancer group, ADCslow of infiltration group was lower than non infiltration group, with statistically significant difference(P<0.05). ADCfast and Ffast of infiltration group were higher than non infiltration group, and the difference were not statistically significant(P>0.05). ADCslow of squamous cell carcinoma was lower than adenocarcinoma cell carcinoma. ADCfast and Ffast of squamous cell carcinoma were higher than adenocarcinoma cell carcinoma, and the difference was statistically significant(P<0.05). ADCslow of cases of high differentiation was higher than cases of middle～low differentiation, with statistically significant difference(P<0.05), while ADCfast and Ffast were not statistically significant(P>0.05). Receiver operating characteristic curve analysis showed that ADCslow was the most effective in diagnosis cervical cancer of different pathological types and subtypes. Conclusion: ADCslow has a high value in diagnostic cervical cancer of different stages and subtypes.
关键词
宫颈肿瘤 /
磁共振成像
Key words
Cervix neoplasms /
Magnetic resonance imaging
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参考文献
[1]Lei T, Mao WM, Lei TH, et al. Incidence and mortality trend of cervical cancer in 11 cancer registries of China[J]. Chin J Cancer Res, 2011, 23(1): 10-14.
[2]曹崑，张晓鹏，唐磊，等. 磁共振扩散加权成像应用于子宫肿瘤研究价值的初步探讨[J]. 中国医学影像技术，2008，24（8）：1231-1235.
[3]Kuang F, Ren J, Zhong Q, et al. The value of apparent diffusion coefficient in the assessment of cervical cancer[J]. Eur Radiol, 2013, 23(4): 1050-1058.
[4]鲁雪红，肖虎，刘文亚，等. 宫颈癌大小和病理分化程度与ADC值的相关性[J]. 中国医学影像技术，2012，28（10）：1882-1885.
[5]刘颖，白人驹，刘海东，等. DWI评估宫颈癌盆腔淋巴结转移的应用价值[J]. 临床放射学杂志，2011，30（6）：834-838.
[6]张晓磊，彭娟，郑建华. 宫颈癌FIGO分期的修订及治疗[J]. 国际生殖健康/计划生育杂志，2011，30（2）：153-154.
[7]廖秋玲，赵继泉，朱新进，等. DWI联合常规MRI在宫颈癌诊断分期和治疗方式选择中的应用价值[J]. 肿瘤，2015，35（6）：660-665.
[8]Mainenti PP, Pizzuti LM, Segreto S, et al. Diffusion volume(DV) measurement in endometrial and cervical cancer: a new MRI parameter in the evaluation of the tumor grading and the risk classification[J]. Eur J Radiol, 2016, 85(1): 113-124.
[9]Kraljevic Z, Viskovc K, Ledinsky M, et al. Primary cervical cancer: conelation of preoperative magnetic resonnance imaging and clinical staging(FIGO) with histopathology findings[J]. Coll Antropol, 2013, 37(2): 561-568.
[10]张洁，薛华丹，张玮，等. 多b值DWI与宫颈癌病理学特征的相关性研究[J]. 放射学实践，2014，29（2）：127-130.
[11]Lakhman Y, Akin O, Park KJ. Stage ⅠB1 cervical cancer: role of preoperative MR imaging in selection of patients for fertility-sparing radical trachelectomy[J]. Radiology, 2013, 269(1): 149-158.
[12]欧阳汉，余小多. MRI在宫颈癌的应用进展[J]. 放射学实践，2014，29（2）：124-126.
[13]Liu Y, Bai R, Sun H, et al. Diffusion-weighred magnetic resonance imaging of uterine cervical cancer[J]. J Comput Assist Tomogr, 2009, 33(6): 858-862.
[14]Pinker K, Brader P, Karanikas G, et al. Functional and molecular imaging of breast tumors[J]. Radiologe, 2010, 50(11): 1030-1038.
[15]Gruber S, Debski BK, Pinker K, et al. Three-dimensional proton MR spectroscopic imaging at 3T for the differentiation of benign and malignant breast lesions[J]. Radiology, 2011, 261(3): 752-761.
[16]Nilsen LB, Fangberget A, Geier O, et al. Quantitative analysis of diffusion-weighted magnetic resonance imaging in malignant breast lesions using different b value combinations[J]. Eur radiol, 2013, 23(4): 1027-1033.
