本文選題：宮頸癌分期　切入點：彌散加權成像　出處：《蘭州大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的探討常規(guī)MRI檢查聯(lián)合DWI. DCE-MRI在宮頸癌診斷、分期及新輔助化療療效評估中的價值。 方法宮頸癌30例、正常宮頸10例,30例宮頸癌中10例手術切除、20例行新輔助化療,所有患者均經(jīng)病理證實。 1、MRI成像及圖像分析應用Siemens3.0T磁共振掃描儀成像,掃描序列包括矢狀位T1WI、T2WI、T2WI-FS.橫軸位T2WI-FS、冠狀位T2WI-FS、DWI及DCE-MRI。新輔助化療組分別于化療前、化療后1月各進行1次MRI掃描(常規(guī)MRI、DWI及DCE-MRI);而手術組則于術前進行1次MRI掃描(常規(guī)MRI、DWI及DCE-MRI)。MRI掃描后將數(shù)據(jù)傳輸至后處理工作站(Siemens Verio),分析病變的MRI特征,如病變大小、內(nèi)部信號、浸潤范圍、淋巴結、ADC值及TIC曲線類型等。 2、病理學檢查、分析手術組術后進行病理學檢查,評價病變侵犯范圍(上下、深度、宮旁及淋巴結轉移)；同時免疫組化檢測VEGF、nm23-H1的表達。 3、統(tǒng)計學分析采用SPSS18.0統(tǒng)計分析軟件分析數(shù)據(jù)：(1)宮頸癌組織與正常組織ADC值(t檢驗)、TIC曲線類型(卡方檢驗)；(2)新輔助化療前后ADC值(t檢驗)、TIC曲線類型(卡方檢驗)；(3)宮頸癌VEGF、nm23-Hl表達與ADC值、TIC曲線類型表達關系(t檢驗和卡方檢驗)。 結果 1、宮頸癌組對比正常宮頸組,ADC值分別為(0.891±0.10)×10-3mm2/s和(1.893±0.25)×10-3mm2/s,兩者差異具有統(tǒng)計學意義。宮頸癌化療前后ADC值分別為(0.90±0.10)×10-3mm2/s,(1.24±0.13)×10-3mm2/s,兩者差異顯著(P0.05)。 2、常規(guī)MRI分期過高6例,分期過低1例,常規(guī)MRI聯(lián)合DWI、DCE-MRI過高分期3例,常規(guī)MRI和常規(guī)MRI聯(lián)合DWI、DCE-MRI誤診率分別為23.3%(7/30)、10%(3/30),分期準確率分別為53.3%(16/30)、83.3%(25/30)。 3、宮頸癌TIC曲線Ⅰ型17例、Ⅱ型13例,正常宮頸組TIC曲線Ⅰ型2例、Ⅳ型8例,宮頸癌與正常宮頸TIC類型各組比較均具有統(tǒng)計學差異；宮頸癌化療前TIC曲線Ⅰ型14例、Ⅱ型6例,化療后TIC曲線Ⅰ型2例、Ⅱ型12例、Ⅲ型6例,宮頸癌化療前后TIC類型Ⅰ型、Ⅱ工型比較差異顯著。 4、隨著宮頸癌病理分級的增加,其對應的ADC值逐漸減低,VEGF、nm23-H1表達增高。VEGF的陽性表達與相應的ADC值無相關性；而與TIC曲線呈正性相關。nm23-H1的陽性表達與對應的ADC值和TIC曲線無相關性。 結論 1、常規(guī)MRI聯(lián)合FMRI (DWI、DCE-MRI)相比常規(guī)MRI,提高了宮頸癌的分期準確性,有助于指導臨床分期、制定治療方案。 2、DWI除可鑒別宮頸癌與正常宮頸之外,還可判斷宮旁浸潤范圍及淋巴結轉移情況；ADC值能一定程度地評估宮頸癌放化療效果,可指導后續(xù)治療方案的調(diào)整。 3、VEGF與TIC曲線類型具有一定相關性。宮頸癌TIC曲線類型有助于宮頸癌的診斷與鑒別,且可一定程度地間接反映宮頸癌生物學行為、組織血供變化及治療反應性。
[Abstract]:Objective to evaluate the value of routine MRI combined with DWI. DCE-MRI in the diagnosis, staging and neoadjuvant chemotherapy of cervical cancer. Methods 30 cases of cervical cancer and 10 cases of normal cervix were treated with neoadjuvant chemotherapy. 1MRI imaging and image analysis were performed with Siemens3.0T magnetic resonance scanner. The scanning sequences included sagittal T1WIX T2WIT2WI-FS.Transaxial T2WI-FS, coronal T2WI-FSWI and DCE-MRI.Neoadjuvant chemotherapy group was treated before chemotherapy. On January after chemotherapy, one MRI scan (conventional MRII-DWI and DCE-MRIWI) was performed respectively, while the operation group underwent MRI scan before operation (conventional MRII-DWI and DCE-MRI).MRI scan). The data were transmitted to the post-processing workstation MRI to analyze the MRI features of the lesion, such as the size of the lesion and the internal signal. Area of invasion, ADC value of lymph node and type of TIC curve, etc. (2) pathological examination, pathological examination after operation was performed in the operation group to evaluate the extent of invasion (upper and lower, depth, para-uterine and lymph node metastasis), and the expression of VEGF nm23-H1 was detected by immunohistochemistry. Statistical analysis using SPSS18.0 statistical analysis software data analysis data: 1) the ADC value of cervical cancer tissue and normal tissue were measured by t test (chi-square test) ADC value test before and after neoadjuvant chemotherapy was used to determine the type of TIC curve (chi-square test). The relationship between the expression of VEGF nm23-Hl and the type of ADC curve in cervical carcinoma was determined by t test and chi-square test. Results. 1. The ADC values of cervical cancer group were 0.891 鹵0.10 脳 10 -3 mm 2 / s and 1.893 鹵0.25 脳 10 -3 mm 2 / s, respectively. The ADC values of cervical cancer before and after chemotherapy were 0.90 鹵0.10) 脳 10 -3 mm 2 / s (1.24 鹵0.13) 脳 10 -3 mm 2 / s, respectively (P 0.05). 2. The misdiagnosis rate of routine MRI staging was too high in 6 cases, low in 1 case, high staging in 3 cases with conventional MRI combined with DWIIC-DCE-MRI. The misdiagnosis rate of conventional MRI and conventional MRI combined with DWICE-MRI was 23.33 / 30, respectively. The accuracy of staging was 53.316 / 30 / 83.33 / 30 respectively. 3. There were 17 cases of TIC curve type 鈪，

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