盆腔磁共振增强扫描联合弥散加权成像对宫颈癌临床分期的评估价值

Value of pelvic contrast-enhanced magnetic resonance imaging combined with diffusion-weighted imaging in clinical staging of cervical cancer

摘要:

目的 探讨盆腔磁共振（MRI）增强扫描对宫颈癌患者病情严重程度的评估价值。方法 回顾性分析2021年1月—2024年3月在扬州大学医学院附属扬州妇幼保健院接受治疗的95例宫颈癌患者的病历资料（宫颈癌病灶组）。另取同期该院95例无宫颈癌女性作为对照（正常子宫肌层组）。所有受试者行盆腔MRI弥散加权成像（DWI）和动态增强检查，观察宫颈癌病变与正常子宫肌层的表观弥散系数（ADC）和动态强化特征的变化。以病理诊断结果为金标准，评价盆腔MRI动态增强检查对宫颈癌症分期的诊断准确性。结果 95例宫颈癌患者经病理诊断：ⅠA期2例、ⅠB期8例、ⅡA期22例、ⅡB期26例、ⅢA期14例、ⅢB期8例、ⅢC期12例、ⅣA期3例；经盆腔MRI动态增强扫描诊断：ⅠA期0例、ⅠB期7例、ⅡA期21例、ⅡB期28例、ⅢA期12例、ⅢB期10例、ⅢC期11例、ⅣA期4例。病理诊断2例ⅠA期宫颈癌，盆腔MRI动态增强扫描未检出。盆腔MRI动态增强扫描诊断ⅠB期、ⅡA期、ⅡB期、ⅢA期、ⅢB期、ⅢC期、ⅣA期宫颈癌的敏感性分别为87.5%、90.9%、100.0%、85.7%、100.0%、91.7%和100.0%，特异性分别为91.9%、91.8%、88.4%、92.6%、90.8%、91.6%和91.3%，诊断准确率为91.6%。宫颈癌病灶组病灶的最小ADC值低于正常子宫肌层组（P <0.05）；宫颈癌病灶组时间-信号强化曲线类型以Ⅱ型、Ⅲ型为主（P <0.05），正常子宫肌层组以Ⅰ型为主（P <0.05）。结论 盆腔MRI动态增强扫描可用于评估宫颈癌分期，诊断准确率较高。

Abstract:

Objective To explore the value of pelvic contrast-enhanced magnetic resonance imaging (MRI) in assessing the disease severity in patients with cervical cancer.Methods A retrospective analysis was conducted on the medical records of 95 patients with cervical cancer (cervical cancer lesions group) who received treatment in our hospital from January 2021 to March 2024. Another 95 women without cervical cancer in our hospital during the same period were included as controls (normal myometrium group). All subjects underwent pelvic diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI to observe the changes in apparent diffusion coefficient (ADC) and dynamic contrast-enhanced MRI features of cervical cancer lesions and normal myometrium. The diagnostic accuracy of pelvic dynamic contrast-enhanced MRI for the clinical stages of cervical cancer was evaluated using pathological findings as the gold standard.Results Pathological diagnosis of 95 cervical cancer patients showed 2 cases in stage IA, 8 cases in stage IB, 22 cases in stage IIA, 26 cases in stage IIB, 14 cases in stage IIIA, 8 cases in stage IIIB, 12 cases in stage IIIC, and 3 cases in stage IVA. Pelvic dynamic contrast-enhanced MRI identified 0 cases in stage IA, 7 cases in stage IB, 21 cases in stage IIA, 28 cases in stage IIB, 12 cases in stage IIIA, 10 cases in stage IIIB, 11 cases in stage IIIC, and 4 cases in stage IVA. Two cases diagnosed pathologically as stage ⅠA cervical cancer were not detected by pelvic dynamic contrast-enhanced MRI. The sensitivities of pelvic dynamic contrast-enhanced MRI in diagnosing cervical cancer in stages ⅠB, ⅡA, ⅡB, ⅢA, ⅢB, ⅢC, and ⅣA were 87.5%, 90.9%, 100.0%, 85.7%, 100.0%, 91.7%, and 100.0%, with the specificities being 91.9%, 91.8%, 88.4%, 92.6%, 90.8%, 91.6%, and 91.3%, and the overall diagnostic accuracy being 91.6%. The minimum ADC value of the cervical cancer lesion group was lower than that of the normal myometrium group (P < 0.05). Regarding the time-signal intensity curve, types II and III were predominant in cervical cancer lesions (P < 0.05), whereas type I was predominant in the normal myometrium (P < 0.05).Conclusions Pelvic dynamic contrast-enhanced MRI can be utilized for assessing the stages of cervical cancer with high diagnostic accuracy.