多模态MRI在宫颈癌放疗后疗效评估中的价值

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摘要目的：探讨多模态MRI在宫颈癌放疗后疗效评价中的价值。方法：选取经宫颈活检确诊的宫颈癌患者44例进行放射治疗作为观察组，同时选取15例宫颈无病变者（妇科及超声检查均未发现宫颈病变）作为对照组进行对照分析。所有患者均行常规MRI、DWI（b值为800 s/mm2）及动态增强MRI扫描，分析其动态曲线、早期增强率、平均ADC值及最小ADC值。结果：放疗组平均ADC值为（1.078±0.242）×10-3 mm2/s，最小ADC值为（0.939±0.093）×10-3 mm2/s，两组测量结果间差异有统计学意义（P<0.05）。放疗后无残瘤组（放疗前）最小ADC值为（1.002±0.011）×10-3 mm2/s，放疗后有残瘤组（放疗前）最小ADC值为（0.863±0.078）×10-3 mm2/s，两组间差异有统计学意义（P<0.05）。放疗组最小ADC值为（0.939±0.093）×103 mm2/s，放疗后最小ADC值为（1.368±0.113）×10-3 mm2/s，两者间差异有显著统计学意义（P<0.05）。正常组平均ADC值为（1.873±0.027 4）×10-3 mm2/s，放疗组放疗后最小ADC值为（1.368±0.113）×10-3 mm2/s，两者间差异有显著统计学意义（P<0.05）。正常宫颈早期增强率约为3%，宫颈癌放射治疗组早期增强率约为55.57%，两组间差异有显著统计学意义（P<0.05）。放射治疗后早期增强率约为10.46%，与放射治疗前两者间差异有显著统计学意义（P<0.05）。正常组宫颈时间-信号曲线（TIC）呈流入型。宫颈癌放疗组TIC多为平台型（40/44），放疗后TIC多为流入型（38/44），两组间差异有统计学意义（P<0.05）。结论：多模态下MRI通过最小ADC值、早期增强率、TIC曲线半定量分析对宫颈癌放疗前后对照研究，在宫颈癌的诊断及疗效评价中有非常重要的临床意义和价值。

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	王维青1
	武霞1
	伏宝成1
	黄勇2
	曹光辉1

关键词 ：宫颈肿瘤, 放射疗法, 磁共振成像

Abstract：Objective: To investigate the value of multimodal MRI in the evaluation of the efficacy of radiotherapy for cervical cancer. Methods: We selected 44 cases of biopsy confirmed cervical cancer patients with radiation therapy as observation group, and 15 cases of healthy women(cervical lesions were not found in gynecological and ultrasound) as control group. All patients underwent conventional MRI, DWI(b value of 800 s/mm2) and dynamic enhanced MRI. Then we analyzed the dynamic curve, early enhancement rate, average ADC value and minimum ADC value. Results: The average ADC value of observation group was (1.078±0.242)×10-3 mm2/s, minimum ADC value was (0.939±0.093)×10-3 mm2/s. The results of two groups were statistically significant(P<0.05). After radiotherapy, the minimal ADC value was (1.002±0.011)×10-3 mm2/s of the residual tumor group(before radiotherapy), and the minimum ADC value was (0.863±0.078)×10-3 mm2/s of the residual tumor group(before radiotherapy) were statistically significant(P<0.05) in the two groups. The minimum ADC value of radiotherapy group was (0.939±0.093)×10-3 mm2/s, the minimum ADC value was (1.368±0.113)×10-3 mm2/s after radiotherapy, there was significant difference between the two groups(P<0.05). The mean ADC value of the normal group was (1.873±0.027 4)×10-3 mm2/s, and the minimum ADC value was (1.368±0.113)×10-3 mm2/s after radiotherapy in the radiotherapy group, the difference was statistically significant(P<0.05). The early enhancement rate of normal cervix was about 3%, and the early enhancement rate of cervical cancer radiotherapy group was about 55.57%, the difference between the two groups was statistically significant(P<0.05). The early enhancement rate after radiotherapy was about 10.46%, which was significantly different from that before radiotherapy(P<0.05). The time-signal intensity curve(TIC) of the normal group showed an inflow pattern. The TIC of cervical cancer radiotherapy group was mostly platform type(40/44), and most of them were inflow type(38/44) after radiotherapy. The difference between the two groups was statistically significant(P<0.05). Conclusion: The minimum ADC value, early enhancement rate analysis, semi quantitative TIC curve of cervical cancer before and after radiotherapy by multimodal MRI have very important clinical significance and value in the evaluation of diagnosis and treatment of cervical cancer.

Key words： Cervix neoplasms Radiotherapy Magnetic resonance imaging

收稿日期: 2017-03-10

PACS:	Ｒ737.33
	Ｒ730.55
	Ｒ445.2

通讯作者: 王维青，临沂市第三人民医院，276000。E-mail：doctorwangwq@163.com

作者简介: 王维青（1977-），男，山东临沂人，主治医师。E-mail：doctorwangwq@163.com

引用本文:

王维青1，武霞1，伏宝成1，黄勇2，曹光辉1. 多模态MRI在宫颈癌放疗后疗效评估中的价值[J]. 中国临床医学影像杂志, 2017, 28(12): 872-876.
WANG Wei-qing1, WU Xia1, FU Bao-cheng1, HUANG Yong2, CAO Guang-hui1. The value of multimodal MRI in evaluating the efficacy of radiotherapy for cervical cancer. JOURNAL OF CHINA MEDICAL IMAGING, 2017, 28(12): 872-876.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2017/V28/I12/872

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