本文選題：磁共振成像 + 宮頸癌　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景及目的宮頸癌是全球婦女中的居第三位常見(jiàn)的惡性腫瘤,僅次于乳腺癌和結(jié)、直腸癌,在發(fā)展中國(guó)家是僅次于乳腺癌,是最常見(jiàn)的女性生殖道惡性腫瘤。宮頸癌目前的檢查方法有多種,以宮頸軟組織病理活檢最為常見(jiàn),但大多為有創(chuàng)性,且不能對(duì)宮頸癌所侵及的范圍做出準(zhǔn)確的判斷。磁共振成像(Magnetic resonance imaging, MRI)技術(shù)有極高的軟組織分辨率,可快速對(duì)是否出現(xiàn)惡性腫瘤做出較準(zhǔn)確的判斷。尤其適用于檢查判斷軟組織附近的腫瘤,特別有利于腫瘤組織侵犯程度和范圍的顯示。MRI診斷操作方便,對(duì)子宮頸的顯示全面且準(zhǔn)確,可清晰的顯示子宮內(nèi)部信號(hào)差異,使各個(gè)組織間呈現(xiàn)較好的層次感,且可對(duì)腫瘤組織行多方位、多參數(shù)成像,可清楚顯示腫瘤病變的位置以及大小及其侵及的范圍,且敏感性和特異性均比較高。MRI在當(dāng)前臨床診斷子宮頸癌中具有優(yōu)勢(shì)性的診斷價(jià)值,可為臨床宮頸癌的治療提供幫助。本研究旨在探討磁共振成像技術(shù)對(duì)宮頸癌診斷和術(shù)前分期的應(yīng)用價(jià)值。材料與方法研究對(duì)象：選取2011年6月到2014年6月入住我院婦產(chǎn)科的宮頸癌患者60例,經(jīng)宮頸活組織檢查在術(shù)前診斷為鱗狀細(xì)胞癌49例,小細(xì)胞癌3例,腺鱗癌3例,透明細(xì)胞腺癌2例,腺癌2例,低分化宮頸神經(jīng)內(nèi)分泌癌1例。年齡27～76歲,平均(56.5±13.3)歲,中位年齡55歲。其中25例ⅠB-ⅡA期患者行廣泛全子宮切除加盆腔淋巴結(jié)清掃術(shù),余35例ⅡB期及以上期患者行開(kāi)腹重點(diǎn)部位或淋巴結(jié)活檢術(shù),術(shù)后的病理檢查結(jié)果為診斷宮頸癌的金標(biāo)準(zhǔn)。60例患者均行GE 7503.0T超導(dǎo)磁共振儀掃描,采用8通道體部專用相控陣線圈,行盆腔常規(guī)MRI平掃序列T1WI、T2WI、DWI (b=800 s/mm2),以及靜脈注射Gd-DTPA后行LAVA-Flex動(dòng)態(tài)增強(qiáng)掃描。采用SPSS19.0對(duì)數(shù)據(jù)進(jìn)行整理與統(tǒng)計(jì)分析。采用χ2檢驗(yàn),對(duì)MRI術(shù)前分期、術(shù)前臨床分期及術(shù)后病理分期計(jì)數(shù)資料率比較,同時(shí)對(duì)術(shù)前MRI對(duì)宮頸癌深肌層浸潤(rùn)、陰道受累、宮旁浸潤(rùn)及淋巴結(jié)轉(zhuǎn)移診斷方面和術(shù)后病理結(jié)果計(jì)數(shù)率比較。P0.05為差異有統(tǒng)計(jì)學(xué)意義。靈敏性：正確診斷某病的能力,Se=a/a+c;特異性：正確排除某病的能力,Sp=d/b+d。結(jié)果1.60例宮頸癌患者術(shù)前MRI檢查分期、術(shù)前臨床分期及術(shù)后病理分期,三者之間差異存在統(tǒng)計(jì)學(xué)意義(P0.05),而術(shù)前MRI分期與術(shù)后病理分期之間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)前MRI分期與術(shù)前臨床分期間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。以術(shù)后病理分期為參照,宮頸癌術(shù)前MRI檢查總體分期準(zhǔn)確度為93.3%,而術(shù)前臨床分期準(zhǔn)確度僅為74.9%；2.術(shù)前MRI診斷與術(shù)后病理結(jié)果在宮頸癌深肌層浸潤(rùn)、陰道受累、宮旁浸潤(rùn)及淋巴結(jié)轉(zhuǎn)移方面比較均有較高的靈敏性及特異性,各分別達(dá)到85.7%、98.1%,95.7%、97.4%,95.0%、90.1%,81.8%、96.1%。經(jīng)χ2檢驗(yàn),兩者之間的差異性不具有統(tǒng)計(jì)學(xué)意義(P0.05),即術(shù)前MRI診斷與術(shù)后病理結(jié)果存在臨床一致性。結(jié)論1.MRI檢查對(duì)宮頸癌術(shù)前分期有較高的準(zhǔn)確率；2.MRI檢查在對(duì)判斷宮頸癌深肌層浸潤(rùn)、陰道受累、宮旁浸潤(rùn)及淋巴結(jié)轉(zhuǎn)移方面有著較高的臨床符合率、敏感性和特異性。3.MRI使宮頸癌分期有了更加可靠的客觀依據(jù),因此MRI可以作為評(píng)估宮頸癌術(shù)前準(zhǔn)確分期的重要工具,以此來(lái)選擇、制定合理的子宮頸癌治療計(jì)劃。
[Abstract]:Background and objective cervical cancer is the third most common malignant tumor among women in the world. It is the most common female genital malignant tumor next to breast cancer and colorectal cancer and is the most common female reproductive tract cancer in developing countries. Magnetic resonance imaging (MRI) technology has very high soft tissue resolution, and it can quickly make a more accurate judgement on whether the malignant tumor appears. It is especially suitable for checking and judging the tumor near the soft tissue, especially for the tumor tissue invasion. The degree and scope of the.MRI diagnosis is convenient, and the display of the cervix is comprehensive and accurate. It can clearly display the difference in the internal signal of the uterus, make the various tissues present a better sense of hierarchy, and can multidimensional and multi parameter imaging of the tumor tissue, and can clearly display the location and size of the tumor and the range of its invasion and sensitivity. The diagnostic value of.MRI with high specificity and high specificity in the current clinical diagnosis of cervical cancer can provide help for the treatment of cervical cancer. The purpose of this study is to explore the value of magnetic resonance imaging (MRI) on the diagnosis and preoperative staging of cervical cancer. 60 cases of cervical cancer in obstetrics and gynecology were diagnosed as 49 cases of squamous cell carcinoma, 3 cases of small cell carcinoma, 3 cases of adenosscale carcinoma, 2 cases of adenocarcinoma, 2 cases of adenocarcinoma, 1 cases of low differentiated cervical neuroendocrine carcinoma, 1 cases of low differentiated cervical neuroendocrine carcinoma. The average age of 27~76 years was (56.5 + 13.3) years, and the median age was 55 years. Among them, 25 cases of period I B- II A were widely used. Total hysterectomy plus pelvic lymph node dissection and 35 patients with stage II B and above were performed the key location or lymph node biopsy. The results of the postoperative pathological examination were the GE 7503.0T superconducting magnetic resonance imaging (SR) scan of the.60 patients with the diagnosis of cervical cancer, and the pelvic routine MRI plain scan was performed with a special phased array coil of the 8 channel body part. T1WI, T2WI, DWI (b=800 s/mm2), and LAVA-Flex dynamic enhanced scan after intravenous injection of Gd-DTPA. The data were collated and statistically analyzed with SPSS19.0. The data rate of preoperative staging of MRI, preoperative clinical staging and postoperative pathological staging were compared by x 2 test, and the preoperative MRI to the deep muscular layer of cervical cancer, vaginal involvement, and uterus. The diagnosis of parathal infiltration and lymph node metastasis was statistically significant compared with the postoperative pathological results. Sensitivity: the ability to correctly diagnose a disease, Se=a/a+c; specificity: the ability to correctly exclude a disease; Sp=d/b+d. results in 1.60 cases of cervical cancer before MRI examination and staging, preoperative clinical staging and postoperative pathological staging. There was a statistically significant difference between the three (P0.05), but there was no significant difference between preoperative MRI staging and postoperative pathological staging (P0.05). The difference between preoperative MRI staging and preoperative clinical division was statistically significant (P0.05). The accuracy of the period was only 74.9%. 2. the preoperative MRI diagnosis and postoperative pathological results were more sensitive and specific in the deep myometrium infiltration, vaginal involvement, para uterine infiltration and lymph node metastasis, each reached 85.7%, 98.1%, 95.7%, 97.4%, 95%, 90.1%, 81.8%, and 96.1%. was tested by chi 2 test, and the difference between the two was not statistically significant. The study significance (P0.05), that is, the preoperative MRI diagnosis and the postoperative pathological results have clinical consistency. Conclusion the 1.MRI examination has a high accuracy rate for the preoperative staging of cervical cancer; 2.MRI examination has a high clinical coincidence rate, sensitivity and specificity in judging the infiltration of the deep muscle layer of cervical cancer, the vagina involvement, the para uterine infiltration and lymph node metastasis. The stage of cervical cancer has a more reliable objective basis, so MRI can be used as an important tool to assess the accurate staging of cervical cancer before operation to choose a reasonable treatment plan for cervical cancer.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33;R445.2

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本文編號(hào)：1960016