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目的:探讨宫颈癌的MRI表现与分期,评价其诊断价值及临床意义。方法:由2名经验丰富的妇科肿瘤医师前瞻性地对80例宫颈活组织病理检查证实为宫颈癌或可疑早期浸润癌的患者进行妇科盆腔检查,共同决定分期和手术可行性。对可直接手术或经先期治疗后有手术可能的患者,于开始治疗前2周内(平均6.5d)行盆腔和腹膜后MRI扫描。在MRI图像上观察原发肿瘤的位置、信号特征及侵犯范围。将MRI分期与临床分期进行对比,手术病理分期为金标准,采用诊断检验方法,以敏感度、特异度、准确度3项指标分析MRI判断宫颈癌分期、宫旁侵犯和盆腔淋巴结转移的价值。结果:MRI对宫颈癌术前分期的总准确度为88.7%,对浸润性癌(Ⅱa及Ⅱa以上)诊断准确度为86.7%。MRI对宫旁侵犯的判断敏感度为85.2%,特异度为85%,准确性为85.1%,MRI预测淋巴结转移的敏感度为58%,特异度为96%,准确性为90%。结论:MRI能多方位清晰显示宫颈癌瘤灶及侵犯范围与途径,明显优于其他影像学检查方法,MRI对术前宫颈癌分期明显优于临床,可做为宫颈癌术前常规的影像检查方法。
Objective: To investigate the MRI findings and staging of cervical cancer and evaluate its diagnostic value and clinical significance. Methods: Two experienced gynecologic oncologists prospectively performed gynecological pelvic examinations in 80 patients with cervical cancer or suspicious early invasive carcinoma confirmed by cervical biopsy, and decided the staging and operative feasibility together. Pelvic and retroperitoneal MRI scans were performed within 2 weeks prior to initiation of treatment (mean, 6.5 days) for patients who were directly or pre-operatively treated for surgery. Observe the location of the primary tumor, the signal characteristics and the scope of the invasion on the MRI images. The MRI staging and clinical staging were compared. The pathological staging was the gold standard. The diagnostic test was used to evaluate the value of cervical cancer staging, parametrial invasion and pelvic lymph node metastasis by using three indexes of sensitivity, specificity and accuracy. Results: The total accuracy of MRI in preoperative staging of cervical cancer was 88.7%, and the diagnostic accuracy of invasive cancer (above Ⅱa and Ⅱa) was 86.7%. The sensitivity, specificity and accuracy of MRI were 85.2%, 85% and 85.1% respectively. The sensitivity, specificity and accuracy of MRI were 58%, 96% and 90% respectively. Conclusion: MRI can clearly show cervical cancer lesions and the extent and ways of invasion in all azimuths, which is obviously superior to other imaging methods. The staging of preoperative cervical cancer by MRI is obviously better than that of clinical diagnosis, which can be used as routine preoperative imaging examination of cervical cancer method.