磁共振扩散加权成像在宫颈癌诊断及新辅助化疗中的动态监测价值

摘要

Objective To explore the dynamic monitoring value of magnetic resonance diffusion weigh-ted imaging(DWI) in diagnosis and neoadjuvant chemotherapy(NCT) of cervical cancer.Methods A ret-rospective analysis on the clinical data of 126 patients with pathological confirmed cervical cancer in Jingmen Second People′s Hospital from Jan.2012 to Jun.2014 was done,all of which received multi-plane magnetic resonance imaging ( MRI) and DWI examination,including 52 cases receiving surgery,and 74 cases receiv-ing NCT.Another 20 cases healthy volunteers for medical routine MRI scans and DWI during the same period were included as control group.Results 126 cases of cervical cancer showed high DWI signal,the mean apparent diffusion coefficient (ADC) was (0.87 ±0.09) ×10 -3 mm2/s.ADC mean for the control group was (1.20 ±0.05) ×10 -3 mm2/s,the difference was statistically significant(t =15.243,P <0.01).74 cases receiving NCT were divided into CR group of 20 cases,PR group of 42 cases,SD group of 12 cases according to the therapeutic effect.With the progression of NCT, ADC value of the CR group gradually increased after 8 weeks of treatment compared with before treatment,the difference was statistically significant (P<0.05).ADC value of the PR group after one week of treatment did not change significantly,and during 1 to 4 weeks was significantly higher(P<0.05).ADC value of the SD group did not increase significantly (P>0.05).Conclusion DWI can realize the dynamic monitoring cervical ADC changes before and after NCT and can distinguish cervical canceration,thus has a certain value for the diagnosis of cervical cancer and prediction of the effect of NCT.%目的：探讨磁共振扩散加权成像（ DWI）在宫颈癌诊断及新辅助化疗（ NCT）中的动态监测价值。方法回顾性分析2012年1月至2014年6月在荆门市第二人民医院住院且经临床病理检查确认为宫颈癌的126例患者的临床资料，均行MRI多平面扫描和DWI检查，其中手术治疗者52例，74例接受NCT。另外选择同期行常规MRI扫描及 DWI检查并无宫颈癌变的20例健康志愿者为对照组。结果126例宫颈癌患者 DWI 表现为明显的高信号，表观扩散系数（ ADC ）均值为（0．87±0．09）×10－3 mm2／s，对照组ADC均值为（1．20±0．05）×10－3 mm2／s，两组比较差异有统计学意义（t＝15．243，P＜0．01）。74例NCT的病例依据治疗效果分为完全消失（CR）20例、部分有效（PR）42例、疾病稳定（ SD）12例，随着NCT的进行，CR组ADC值逐渐升高，治疗8周后与治疗前比较，差异有统计学意义（P＜0．05）；PR组治疗1周后，ADC值变化不明显，而1～4周明显升高（P＜0．05）；SD组各时间点ADC值升高趋势不明显（P＞0．05）。结论 DWI能动态监测 NCT前后宫颈癌 ADC变化并可区分宫颈是否发生癌变，对诊断宫颈癌及对NCT效果的预测具有一定价值。