磁共振扩散加权成像在宫颈癌诊断和疗效预测中的价值
자공진확산가권성상재궁경암진단화료효예측중적개치
Value of MR diffusion-weighted imaging in diagnosis and outcome prediction for uterine cervical cancer
  • 万方数据
    中华肿瘤杂志 중화종류잡지
    CHINESE JOURNAL OF ONCOLOGY
    2014年 2期 115-119 ,共5页

    吴斌%黄啸%彭卫军%顾雅佳%杨天锡%毛健%柯桂好%吴小华

    오빈%황소%팽위군%고아가%양천석%모건%가계호%오소화

    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 宮頸腫瘤%藥物療法%放射療法%磁共振成像%擴散加權成像%錶觀擴散繫數%預測
    궁경종류%약물요법%방사요법%자공진성상%확산가권성상%표관확산계수%예측
    Uterina cervical neoplasms%Drug therapy%Radiotherapy%Magnetic resonance imaging%Diffusion weighted imaging%Apparent diffusion coefficient%Forecasting
    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/mm2)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/mm2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)×10-3mm2/s、(14.20±2.80)×10-3 mm2/s和(14.14±0.45)×10-3 mm2/s;b=2000 s/mm2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 mm2/s、(8.52 ±2.38)×10-3 mm2/s和(8.60±0.63)×10-3 mm2/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/mm2时,治疗前后肿瘤组织的ADC值分别为(9.85 ±1.55)×10-3 mm2/s和(13.41 ±2.93)×10-3 mm2/s,差异有统计学意义(P＜0.001)；b=2000 s/mm2时,治疗前后肿瘤组织的ADC值分别为(7.38 ±0.98) ×10-3 mm2/s和(8.93±1.92)× 10-3mm2/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曲线),其曲线下面积分别为0.818、0.775、0.716,差异无统计学意义(P＞0.05),但代表肿瘤扩散受限明显的25％ ADC相对更有价值.结论 MRI DWI能清楚显示宫颈癌的形态与边界；DWI的体积测量与RECIST标准相关性好,更适用于不规则肿瘤的体积测量；ADC值可以定量监测治疗反应并预测疗效.
    목적 탐토자공진확산가권성상(MRI DWI)재궁경암진단화료효예측중적림상응용개치.방법 대28례학진적진전기원발성궁경암환자급10례정상궁경대조자진행료전첨성MRIDWI검사,분석근거DWI도상측량적종류체적여근거실체류료효평개표준(RECIST)측량적종류최장경지간적상관성,비교궁경암여정상궁경급궁체기층조직적표관확산계수(ADC)치적차이,비교17례치료전후궁경종류평균ADC치적변화.결과 MRI DWI대종류변계적현시우우상규T2가권상(T2WI)급증강후T1가권상(T1WI).고확산민감계수(b=2000 s/mm2)적DWI도상구유교고적신조비.DWI측량적종류체적여RECIST표준측량적종류최장경간존재명현상관성(r=0.759,P＜0.01).b=800 s/mm2시,궁경암종류조직、궁체기층조직화정상궁경조직적ADC치분별위(9.85±1.55)×10-3mm2/s、(14.20±2.80)×10-3 mm2/s화(14.14±0.45)×10-3 mm2/s;b=2000 s/mm2시,궁경암종류조직、궁체기층조직화정상궁경조직적ADC치분별위(7.38 ±0.98)×10-3 mm2/s、(8.52 ±2.38)×10-3 mm2/s화(8.60±0.63)×10-3 mm2/s.궁경암종류조직여정상궁경조직、궁체기층조직간적ADC치차이균유통계학의의(균P＜0.01).b=800 s/mm2시,치료전후종류조직적ADC치분별위(9.85 ±1.55)×10-3 mm2/s화(13.41 ±2.93)×10-3 mm2/s,차이유통계학의의(P＜0.001)；b=2000 s/mm2시,치료전후종류조직적ADC치분별위(7.38 ±0.98) ×10-3 mm2/s화(8.93±1.92)× 10-3mm2/s,차이유통계학의의(P =0.008).단인소회귀분석현시,치료전ADC치직방도비례중적불동면적(25％ ADC、50％ ADC、75％ ADC)여궁경암적료효유관(균P＜0.05).다인소분석현시,치료전ADC치직방도비례중불동면적(25％ ADC、50％ ADC、75％ ADC)여궁경암적료효무관(균P＞0.05).회제25％ ADC、50％ ADC、75％ ADC료효예측적수시자공작특정곡선(ROC곡선),기곡선하면적분별위0.818、0.775、0.716,차이무통계학의의(P＞0.05),단대표종류확산수한명현적25％ ADC상대경유개치.결론 MRI DWI능청초현시궁경암적형태여변계；DWI적체적측량여RECIST표준상관성호,경괄용우불규칙종류적체적측량；ADC치가이정량감측치료반응병예측료효.
    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/mm2) 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/mm2,the ADC values of the uterine cervical cancer,uterine myometrium,and normal uterine cervix were (9.85 ± 1.55) × 10-3 mm2/s,(14.20 ± 2.80) ×10-3 mm2/s,and (14.14 ±0.45) × 10-3 mm2/s.When b =2000 s/mm2,the ADC values of the uterine cervical cancer,uterine myometrium and normal uterine cervix were (7.38 ±0.98) × 10-3 mm2/s,(8.52 ± 2.38) × 10-3 mm2/s,and (8.60 ±0.63) × 10-3 mm2/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/mm2,the ADC value was (9.85 ± 1.55) × 110-3 mm2/s before and (13.41 ± 2.93) × 10-3 mm2/s after treatment (P ＜ 0.001).When b =2000 s/mm2,the ADC value was (7.38 ±0.98) × 10-3 mm2/s before and (8.93 ± 1.92) × 10-3 mm2/s after treatment (P =0.008).Univariate logistic regression analysis showed that 25％ ADC,50％ ADC,and 75％ ADC in the tumor ADC value histogram before treatment were significantly correlated to the treatment outcome of cervical cancer (P ＜ 0.05 for all).Multivariate regression analysis showed that 25％ ADC,50％ ADC,and 75％ ADC in the tumor ADC value histogram before treatment were not significantly correlated to the treatment outcome of cervical cancer (P ＞ 0.05 for all).The values of ROC curves were 25％ADC =0.818,50％ADC =0.775,and 75％ADC =0.716 (P ＞0.05),however,the 25％ ADC showed a relatively stronger statistical power.Conclusions DWI helps to confirm the morphology and exact target zone of the tumor for radiotherapy.DWI volume measurement is well correlated with RECIST criteria,particularly in volume measurement of irregular tumors.ADC value has a potential in quantitatively monitoring treatment response and predicting outcome of cervical cancers.
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