子宮內(nèi)膜癌MRI動(dòng)態(tài)增強(qiáng)和DWI表現(xiàn)與VEGF-C的相關(guān)性分析
發(fā)布時(shí)間：2018-11-11 13:47
【摘要】：背景和目的子宮內(nèi)膜癌為常見的好發(fā)生于子宮內(nèi)膜上皮層的女性生殖系統(tǒng)腫瘤疾病,發(fā)病率和復(fù)發(fā)率較高,占女性婦科腫瘤疾病的比例接近20%~30%,多發(fā)生于50~60歲的絕經(jīng)期女性,而絕經(jīng)前的女性發(fā)病所占比例較低,約占25%。近年來,伴隨人民生活水的提高以及生活方式和習(xí)慣的改變,女性的內(nèi)分泌代謝疾病的發(fā)生率也在增加,并導(dǎo)致子宮內(nèi)膜癌呈現(xiàn)年輕化的趨勢(shì)。子宮內(nèi)膜癌術(shù)前準(zhǔn)確的判斷尤其重要,通過對(duì)患者的病理分期、肌層浸潤(rùn)以及淋巴結(jié)轉(zhuǎn)移的正確診斷選擇放療、化療、手術(shù)等治療方式,尤其子宮肌層浸潤(rùn)的深度的判斷,對(duì)患者選擇的手術(shù)范圍以及術(shù)后輔助治療影響較大。目前,子宮內(nèi)膜癌的診斷和評(píng)估的手段較多,包括MRI、B超、CT和PET,而MRI發(fā)展最快,診斷準(zhǔn)確度較高,對(duì)子宮內(nèi)膜癌的術(shù)前診斷具有較高的價(jià)值。VEGF-C為血管新生的標(biāo)記物,與惡性腫瘤侵襲、浸潤(rùn)以及轉(zhuǎn)移密切有關(guān),能促進(jìn)新生血管的生成,并改變血管的通透性。本研究的目的在于研究子宮內(nèi)膜癌的肌層浸潤(rùn)、宮頸受累情況與病理學(xué)、分子生物學(xué)特性之間的關(guān)系,通過術(shù)前分期推測(cè)子宮內(nèi)膜癌的惡性程度,并結(jié)合腫瘤生物學(xué)指標(biāo)VEGF-C的表達(dá)情況,增加臨床評(píng)估和預(yù)后的科學(xué)性,為腫瘤治療提供參考信息。材料與方法回顧性分析2011年1月-2013年1月漯河市中心醫(yī)院收治62例子宮內(nèi)膜癌患者的資料,術(shù)后均經(jīng)手術(shù)病理證實(shí)�；颊咝g(shù)前主要接受上海通用電氣(GE)1.5T磁共振掃描儀進(jìn)行的MRI常規(guī)平掃、動(dòng)態(tài)持續(xù)增強(qiáng)掃描(DCE-MRI)和彌散加權(quán)成像(DWI,b=0,1000mm2/s)掃描檢查。另選擇同期在漯河市中心醫(yī)院接受治療的10例正常子宮內(nèi)膜患者為對(duì)照組。術(shù)后病理按照FIGO2009分期。所有掃描圖像均在ADW4.2工作站進(jìn)行分析處理,由2名病理醫(yī)師采用雙盲法進(jìn)行閱片觀察。腫瘤組織采用HE染色,并采用免疫組化SP法檢測(cè)VEGF-C在子宮內(nèi)膜癌中的表達(dá)。選用SPSS19.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析和處理,以P0.05為有顯著性差異。結(jié)果DEC-MRI檢查結(jié)果和手術(shù)病理分期相符49例,準(zhǔn)確度79.0%。其中Ia期31例,診斷符合27例,診斷準(zhǔn)確率87.1%,Ib期10例,診斷符合7例,診斷準(zhǔn)確率70.0%。II期12例,診斷符合10例,診斷準(zhǔn)確率83.3%。III期9例,診斷符合5例,診斷準(zhǔn)確率55.6%。DEC-MRI+DWI檢查結(jié)果和手術(shù)病理分期相符56例,準(zhǔn)確度90.3%。其中Ia期34例,診斷符合31例,診斷準(zhǔn)確率91.2%,Ib期11例,診斷符合9例,診斷準(zhǔn)確率81.8%。II期12例,診斷符合11例,診斷準(zhǔn)確率91.7%。III期5例,診斷符合5例,診斷準(zhǔn)確率100%。MRI檢查子宮內(nèi)膜癌對(duì)肌層浸潤(rùn)、宮頸間質(zhì)浸潤(rùn)以及淋巴結(jié)轉(zhuǎn)移具有較高的準(zhǔn)確度,分別為83.9%、96.8%和91.9%。62例腺癌患者中,子宮內(nèi)膜樣腺癌59例,其中子宮內(nèi)膜癌患者閉孔內(nèi)肌的三組信號(hào)強(qiáng)度、ADC值兩兩比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。而高分化、中分化和低分化三組信號(hào)強(qiáng)度、AD值兩兩比較,低中、低高兩兩比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),中高組比較,差異無統(tǒng)計(jì)學(xué)差異(P0.05)。子宮內(nèi)膜癌MRI分期與子宮內(nèi)膜癌的VEGF-C的表達(dá)呈正相關(guān)。結(jié)論1、DCE-MRI聯(lián)合DWI成像具有多方位、多角度成像及對(duì)軟組織分辨率高等優(yōu)點(diǎn),能清晰地顯示子宮內(nèi)膜癌病灶的位置、大小及范圍。2、子宮內(nèi)膜癌VEGF-C的表達(dá)與子宮內(nèi)膜癌MRI分期呈正相關(guān)。3、DCE-MRI聯(lián)合DWI成像對(duì)子宮內(nèi)膜癌術(shù)前分期、腫瘤浸潤(rùn)肌層深度、宮頸有無受累、淋巴結(jié)有無轉(zhuǎn)移等的判斷有較高的準(zhǔn)確度。
[Abstract]:Background and target endometrial carcinoma is a common female reproductive system tumor disease, which is common to the epithelial layer of the endometrium, and the morbidity and the recurrence rate are high, the proportion of the female gynecological tumor diseases is close to 20% to 30%, The proportion of women in pre-menopausal women is low, accounting for about 25%. In recent years, with the improvement of people's living water and the change of life style and habits, the incidence of women's endocrine-metabolic diseases is also increasing, leading to a tendency of young endometrial cancer to be young. the accurate judgment before the endometrial carcinoma is particularly important, and the judgment of the depth of the treatment such as radiotherapy, chemotherapy, operation and the like, in particular the depth of the infiltration of the uterine muscle layer, is selected through the correct diagnosis of the pathological stage, the myolayer infiltration and the lymph node metastasis of the patient, The range of surgery to be selected for the patient, as well as the postoperative adjuvant treatment, has a greater impact. At present, the method of diagnosis and evaluation of endometrial carcinoma is much more, including MRI, B-ultrasound, CT and PET, and MRI is the fastest and the diagnostic accuracy is high, and it is of high value to the pre-operative diagnosis of endometrial carcinoma. VEGF-C is a marker of angiogenesis, which is closely related to the invasion, infiltration and metastasis of malignant tumor, and can promote the generation of the new blood vessel and change the permeability of the blood vessel. The purpose of this study was to study the relationship between the invasion of the muscle layer of the endometrial carcinoma, the condition of the involvement of the cervix and the characteristics of the pathology and the molecular biology. The degree of malignancy of the endometrial carcinoma was estimated by the pre-operative stage, and the expression of VEGF-C was combined with the biological index of the tumor. the scientific nature of clinical evaluation and prognosis is increased, and the reference information is provided for the treatment of the tumor. Materials and Methods The data of 62 cases of endometrial carcinoma from January 2011 to January 2013 were analyzed retrospectively. Prior to the operation of the patient, the MRI conventional flat scan, dynamic continuous enhancement scan (DCE-MRI) and diffusion-weighted imaging (DWI, b = 0, 1000mm2/ s) were performed by the Shanghai General Electric (GE) 1. 5T magnetic resonance scanner. In the same period, 10 normal endometrial patients treated in the central hospital of the Hehe City were selected as the control group. The postoperative pathology was performed in accordance with the FIIGO2009 stage. All scanned images were analyzed in the ADW4.2 workstation and were observed by two pathologists using a double-blind method. The expression of VEGF-C in endometrial carcinoma was detected by HE staining and immunohistochemical SP method. SPSS 19.0 statistical software was used for data analysis and treatment, with a significant difference between P0.05. Results The results of DEC-MRI and the pathological stages of the operation were in accordance with 49 cases and the accuracy was 79.0%. The diagnostic accuracy was 87.1%, the accuracy of diagnosis was 87.1%, and the diagnostic accuracy was 70. 0%. In the phase II, 12 cases were diagnosed, the diagnosis was in accordance with 10 cases, the diagnostic accuracy was 83.3%, and in 9 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy was 55.6%. The result of DEC-MRI + DWI and the pathological stage of the operation were in accordance with 56 cases. The accuracy is 90.3%. Among the 34 cases, the diagnosis was in 31, the diagnostic accuracy was 91.2%, the phase Ib was 11 cases, the diagnosis was in accordance with 9 cases, the diagnostic accuracy was 81.8%, the stage II was 12 cases, the diagnosis was in accordance with 11 cases, the diagnostic accuracy was 91.7%, the stage III was 5 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy rate was 100%. In the 62 cases of adenocarcinoma, there were 59 cases of endometrial adenocarcinoma, of which there was no significant difference between the three groups of signal intensity and ADC value of the inner muscle of the patients with endometrial carcinoma (P0.05). The difference of signal intensity and AD of the three groups with high differentiation, medium differentiation and low differentiation was statistically significant (P <0.05), and there was no statistical difference between the two groups (P0.05). MRI staging of endometrial carcinoma is positively related to the expression of VEGF-C in endometrial carcinoma. Conclusion 1, DCE-MRI combined with DWI imaging has the advantages of multi-orientation, multi-angle imaging and high resolution of soft tissue, and can clearly show the position, size and range of endometrial carcinoma. DCE-MRI combined with DWI imaging had a high degree of accuracy in the pre-operative stage of endometrial carcinoma, the depth of the tumor infiltrating muscle layer, the presence or absence of the cervix, the presence or absence of lymph nodes, and the like.
【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
本文編號(hào)：2325012
[Abstract]:Background and target endometrial carcinoma is a common female reproductive system tumor disease, which is common to the epithelial layer of the endometrium, and the morbidity and the recurrence rate are high, the proportion of the female gynecological tumor diseases is close to 20% to 30%, The proportion of women in pre-menopausal women is low, accounting for about 25%. In recent years, with the improvement of people's living water and the change of life style and habits, the incidence of women's endocrine-metabolic diseases is also increasing, leading to a tendency of young endometrial cancer to be young. the accurate judgment before the endometrial carcinoma is particularly important, and the judgment of the depth of the treatment such as radiotherapy, chemotherapy, operation and the like, in particular the depth of the infiltration of the uterine muscle layer, is selected through the correct diagnosis of the pathological stage, the myolayer infiltration and the lymph node metastasis of the patient, The range of surgery to be selected for the patient, as well as the postoperative adjuvant treatment, has a greater impact. At present, the method of diagnosis and evaluation of endometrial carcinoma is much more, including MRI, B-ultrasound, CT and PET, and MRI is the fastest and the diagnostic accuracy is high, and it is of high value to the pre-operative diagnosis of endometrial carcinoma. VEGF-C is a marker of angiogenesis, which is closely related to the invasion, infiltration and metastasis of malignant tumor, and can promote the generation of the new blood vessel and change the permeability of the blood vessel. The purpose of this study was to study the relationship between the invasion of the muscle layer of the endometrial carcinoma, the condition of the involvement of the cervix and the characteristics of the pathology and the molecular biology. The degree of malignancy of the endometrial carcinoma was estimated by the pre-operative stage, and the expression of VEGF-C was combined with the biological index of the tumor. the scientific nature of clinical evaluation and prognosis is increased, and the reference information is provided for the treatment of the tumor. Materials and Methods The data of 62 cases of endometrial carcinoma from January 2011 to January 2013 were analyzed retrospectively. Prior to the operation of the patient, the MRI conventional flat scan, dynamic continuous enhancement scan (DCE-MRI) and diffusion-weighted imaging (DWI, b = 0, 1000mm2/ s) were performed by the Shanghai General Electric (GE) 1. 5T magnetic resonance scanner. In the same period, 10 normal endometrial patients treated in the central hospital of the Hehe City were selected as the control group. The postoperative pathology was performed in accordance with the FIIGO2009 stage. All scanned images were analyzed in the ADW4.2 workstation and were observed by two pathologists using a double-blind method. The expression of VEGF-C in endometrial carcinoma was detected by HE staining and immunohistochemical SP method. SPSS 19.0 statistical software was used for data analysis and treatment, with a significant difference between P0.05. Results The results of DEC-MRI and the pathological stages of the operation were in accordance with 49 cases and the accuracy was 79.0%. The diagnostic accuracy was 87.1%, the accuracy of diagnosis was 87.1%, and the diagnostic accuracy was 70. 0%. In the phase II, 12 cases were diagnosed, the diagnosis was in accordance with 10 cases, the diagnostic accuracy was 83.3%, and in 9 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy was 55.6%. The result of DEC-MRI + DWI and the pathological stage of the operation were in accordance with 56 cases. The accuracy is 90.3%. Among the 34 cases, the diagnosis was in 31, the diagnostic accuracy was 91.2%, the phase Ib was 11 cases, the diagnosis was in accordance with 9 cases, the diagnostic accuracy was 81.8%, the stage II was 12 cases, the diagnosis was in accordance with 11 cases, the diagnostic accuracy was 91.7%, the stage III was 5 cases, the diagnosis was in accordance with 5 cases, the diagnostic accuracy rate was 100%. In the 62 cases of adenocarcinoma, there were 59 cases of endometrial adenocarcinoma, of which there was no significant difference between the three groups of signal intensity and ADC value of the inner muscle of the patients with endometrial carcinoma (P0.05). The difference of signal intensity and AD of the three groups with high differentiation, medium differentiation and low differentiation was statistically significant (P <0.05), and there was no statistical difference between the two groups (P0.05). MRI staging of endometrial carcinoma is positively related to the expression of VEGF-C in endometrial carcinoma. Conclusion 1, DCE-MRI combined with DWI imaging has the advantages of multi-orientation, multi-angle imaging and high resolution of soft tissue, and can clearly show the position, size and range of endometrial carcinoma. DCE-MRI combined with DWI imaging had a high degree of accuracy in the pre-operative stage of endometrial carcinoma, the depth of the tumor infiltrating muscle layer, the presence or absence of the cervix, the presence or absence of lymph nodes, and the like.
【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
【共引文獻(xiàn)】
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