【作者】 文露；

【导师】 周顺科；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2010， 硕士

【摘要】 目的本研究通过对正常子宫颈结构及宫颈癌组织在3.0T磁共振弥散加权成像(DWI)的特点,探讨DWI在宫颈癌诊断、病理级别、分型及化疗疗效检测方面的应用价值。材料与方法正常对照组：15例健康女性志愿者,年龄18-38岁,平均27.60±3.851岁。所有志愿者均无妇科疾病史,常规妇科检查排除妇科疾病并行常规MRI检查未发现盆腔占位性病变及弥漫性病变。宫颈癌组：搜集2009年10月至2010年2月在本院妇科就诊的宫颈癌患者52例,年龄23-65岁,平均43.23±9.25岁。全部病例均经手术病理或宫颈活检证实,其中原位癌9例,进展癌43例(鳞癌35例,腺癌8例),MRI检查前未接受任何治疗,其中9例鳞癌患者检查后接受化疗,28天后复查MRI。对所有志愿者及宫颈癌患者行盆腔磁共振常规序列和矢状面、横断面DWI扫描,DWI的b值分别选取300s/mm2、600s/mm2、900s/mm2,对比后选取最佳b=900s/mmm2作为DWI实验b值。分析比较正常子宫颈三层结构之间ADC值差异、正常子宫颈与宫颈癌组织ADC值、宫颈鳞癌与腺癌ADC值,比较鳞癌不同病理级别的ADC值,比较9例宫颈癌患者化疗前后的ADC值。结果正常子宫颈在DWI上清晰显示其内膜、结合带和肌层三层结构,内膜平均ADC值为(1.8041±0.1074)×10-3mm2/s,结合带平均ADC值为(1.2204±0.1494)×10-3mm2/s,肌层平均ADC值为(1.8906±0.1326)×10-3mm2/s,内膜和结合带、结合带和肌层之间存在显著性差异(P<0.05),内膜和肌层之间不存在统计学差异(P>0.05)。原位癌平均ADC值为(1.6455±0.2217)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈癌平均ADC值为(0.8802±0.1304)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈鳞癌平均ADC值为(0.8985±0.1349)×10-3mm2/s,腺癌平均ADC值为(1.0375±0.1590)×103mm2/s,两者差异有显著性(P<0.05)。宫颈鳞癌中高分化平均ADC值为(1.0720±0.1308)×10-3mm2/s,中分化平均ADC值为(0.9045±0.0705)×10-3mm2/s,低分化平均ADC值为(0.7509±0.0493)×10-3mm2/s,三者之间差异有显著性。9例宫颈鳞癌患者治疗前平均ADC值为(0.8751±0.0950)×10-3mm2/s,治疗后平均ADC值为(1.2111±0.1217)×10-3mm2/s,化疗前后ADC值差异具有统计学意义(P<0.05),但化疗后ADC值仍低于正常宫颈内膜。结论DWI能够区分正常子宫颈和宫颈癌组织,其定量指标ADC值对宫颈癌的病理类型及级别有一定提示作用,并对检测宫颈癌化疗疗效有重要价值,为宫颈癌诊断、评估病理级别分型及检测其疗效方面提供一种新的方法。更多还原

【Abstract】 ObjectiveThis study was to analyze the diffusion weighted imaging(DWI) features of normal uterine cervix and cervix carcinoma,and assess the value of DWI in diagnosis and indicate the pathological type and evaluate the pathological grading and monitor of uterine cervix cancer after chemotherapy.Subjects and methodsnormal control group:15 healthy female,betweeen 18-38 years age,average age(27.60±3.851).All volunteers had no history of gyneclolgical diseases,gyneclolgical diseases were excluded by routine gyneclolgical examination parallel conventional MRI examination showed no pelvic lesions and diffuse lesions.cervical cancer group:Collection 52 patients with cervical cancer from October 2009 to February 2010 in our hospital gyneclolgical admissions,betweeen23-65years age,average age(43.23±9.25),all cases were confiremed by surgery pathology or cervical biopsy,9 cases in which were preinvasive carcinoma,and 43 cases were progressive cancer(35 case squamous carcinoma,8 case adenocarcinoma),all cases had not received any treatment before MRI examination,9 squamous carcinoma cases had received chemotherapy after examination,then reviewed MRI examination after 28 days.The Conventional and DWI of sagittal planes and axial planes were performed in 52 female patients with uterine cervix cancer and 15 healthy female. The b value of DWI were selected 300s/mm2、600s/mm2、900s/mm2.With contrast, b value of 900 s/mm2 was chose as the experiment one.Comparison the ADC value between the normal uterine cervix’s three-tier structure and the normal uterine cervix with cervical cancer, Comparison the ADC value between squamous carcinoma and adenocarcinoma, comparison the ADC value of different pathological levels of squamous carcinoma, comparison the ADC value of the nine cases of cervical cancer before and after chemotherapy.ResultsFor normal volunteers, normal uterine cervix’s cervical endometrial, junctional zone, and myometrium were clearly displayed on DWI.The mean ADC value of cervical endometrial was (1.8041±0.1074)×10-3mm2/s, junctional zone’s was (1.2204±0.1494)×10-3mm2/s, myometrium’s was (1.8906±0.1326)×10-3mm2/s. By contrast,the differences between cervical endometrial and junctional zonejunctional zone and myometrium were statistically significant P< 0.05), while the difference between cervical endometrial and myometrium was not statistically significant (P>0.05). The mean ADC value of preinvasive carcinoma was(1.6455±0.2217)×10-3mm2/s, the differences between cervical endometrial and preinvasive carcinoma were statistically significant P< 0.05). The mean ADC value of cervical cancer was (0.8802±0.1304)×10-3mm2/s, the differences between cervical endometrial and cervical cancer were statistically significant P< 0.05). The mean ADC value of squamous carcinoma cervical cancer was (0.8985±0.1349)×10-3mm2/s, The mean ADC value of adenocarcinoma cervical cancer was (1.0375±0.1590)×10-3mm2/s, the differences between cervical squamous carcinoma and adenocarcinoma of the cervical cancer were statistically significant P< 0.05). The mean ADC value of well-differentiated squamous carcinoma cervical cancer was (1.0720±0.1308)×10-3mm2/s, the moderately differentiated’s was (0.9045±0.0705)×10-3mm2/s, the poorly differentiated’s was (0.7509±0.0493)×10-3mm2/s, the differences along them were statistically significant.In nine patients treated by chemotherapy, The mean ADC value before chemotherapy was (0.8751±0.0950) x10-3mm2/s, The mean ADC value after chemotherapy was (1.2111±0.1217)×10-3mm2/s, The difference had statistic significance (P< 0.05),but was still lower than that of normal cervical endometrial.ConclusionDWI has a potential ability to differentiate between normal and cancerous tissue in the uterine cervix, and it can indicate the pathological type and evaluate the pathological grading of uterine cervix cancer as well, and has important value on monitoring of cervical cancer chemotherapy,,this providing a new method for diagnosising and evaluating the pathological grading and monitoring of uterine cervix cancer after chemotherapy.更多还原