CAJ | 학술논문

目的：探讨 MR-DWI 在宫颈癌新辅助化疗的反应性及其相关组织病理学变化的关系。方法22例符合手术指征宫颈癌患者分别于新辅助化疗前1d、化疗中2周(第十四天)和4周(第二十八天,术前)行 MR-DWI 扫描。分别测量记录肿瘤的最大径和多点平均 ADC 值,比较治疗前后的变化,及其组织病理学变化的相关性并行统计学评价分析。结果肿瘤最大径治疗后2周对比治疗前,无明显变化的22例；治疗后4周对比治疗前,有所缩小的12例,无明显变化的10例(P <0.05)；平均 ADC 值治疗后2周对比治疗前,明显增大的4例,相对增大的12例,变化不大的6例；治疗后四周对比治疗前,明显增大的12例,相对增大的9例,变化不大的1例(P <0.01)；术后相关组织病理显示 ADC 值明显上升的病例镜下组织炎性反应、细胞核异型性、肿瘤细胞死亡程度均显著增大,ADC 值相对增大的次之。结论传统手段检测肿瘤最大径治疗后2或4周变化不明显。对照相关组织病理学变化,DWI 能更早地监测到肿瘤治疗的反应性。DWI 可作为肿瘤治疗的早期检测指标,并可预测治疗效果。
목적：탐토 MR-DWI 재궁경암신보조화료적반응성급기상관조직병이학변화적관계。방법22례부합수술지정궁경암환자분별우신보조화료전1d、화료중2주(제십사천)화4주(제이십팔천,술전)행 MR-DWI 소묘。분별측량기록종류적최대경화다점평균 ADC 치,비교치료전후적변화,급기조직병이학변화적상관성병행통계학평개분석。결과종류최대경치료후2주대비치료전,무명현변화적22례；치료후4주대비치료전,유소축소적12례,무명현변화적10례(P <0.05)；평균 ADC 치치료후2주대비치료전,명현증대적4례,상대증대적12례,변화불대적6례；치료후사주대비치료전,명현증대적12례,상대증대적9례,변화불대적1례(P <0.01)；술후상관조직병리현시 ADC 치명현상승적병례경하조직염성반응、세포핵이형성、종류세포사망정도균현저증대,ADC 치상대증대적차지。결론전통수단검측종류최대경치료후2혹4주변화불명현。대조상관조직병이학변화,DWI 능경조지감측도종류치료적반응성。DWI 가작위종류치료적조기검측지표,병가예측치료효과。
Objective To investigate the diffusion weighted magnetic resonance imaging (DWI)in the re-sponse to preoperative cervical cancer induced by chemotherapy,and explore the correlation between DWI response and histopathologic changes.Methods Twenty-two cervical cancer patients,who had the surgi-cal indications,patients underwent conventional MRI and DWI examinations at 1 day before induced by chemotherapy,two weeks (14 days)and four weeks (28 days,preoperative)induced by chemotherapy . The maximum diameter of the tumor volume and mean value of ADC were measured before and after thera-py,the correlation between DWI response and histopathologic changes were performed with statistical anal-ysis software.Results Two weeks after treatment,the maximum diameter of the tumor volume were un-changed from all of the 22 patients compared with un-therapy patients.Four weeks after treatment,the maximum diameter of the tumor volume was decreased in 12 patients (P <0.05).two weeks after treat-ment,the mean ADC value of the tumor was increased significantly in 4 patients,was relative increased in 12 patients,was little changed in 6 patients compared with the un- therapy patients;Four weeks after treatment,the mean ADC value of the tumor was significantly increased,was relative increased in 9 pa-tients,was little changed in 1 patient(P <0.01)compared with the un-therapy patients.According to the histopathological analysis,patient after surgery showed that tissue inflammation,nuclear atypia,and de-gree of tumor cell death were significantly increased with the rise of ADC value,and the ADC values in-crease relatively inferior to ADC values increase significantly.Conclusions Traditional methods detecting tumor volume biggest diameter presented were no significant changes after two or four weeks treatment. Based on the changes of histopathology,we find that the diffusion weighted magnetic resonance imaging can detect the curative effect for tumor earlier treatment.The diffusion weighted magnetic resonance imaging can be used as the early detection of cancer therapy and the curative effect may be predicted according to the in-crease of ADC value.