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目的探讨扩散加权成像(DWI)对于鉴别宫颈癌转移与非转移淋巴结的诊断价值。资料与方法 36例宫颈癌初诊患者于治疗前行常规MRI及DWI检查,观察并比较宫颈癌转移淋巴结与非转移淋巴结常规MRI及表观扩散系数(ADC)图表现,测量各淋巴结的长径(L)、短径(S)、T2信号强度、平均ADC值和最小ADC值,利用受试者工作特征(ROC)曲线下面积(Az)评价上述各项指标鉴别宫颈癌转移与非转移淋巴结的诊断效能。结果转移淋巴结短径和长径的平均秩次均大于非转移淋巴结,且两者差异具有统计学意义(均为P=0.000),而转移淋巴结与非转移淋巴结的L/S、S/L以及T2信号强度差异均无统计学意义(P=0.261;P=0.157;P=0.166);转移淋巴结的平均ADC值和最小ADC值均低于非转移淋巴结,且差异均具有统计学意义(均为P=0.000);短径、长径、平均ADC值和最小ADC值对鉴别宫颈癌转移与非转移淋巴结均有诊断意义(Az>0.5),其中最小ADC值的诊断效能最高,选取最小ADC阈值为0.983×10-3mm2/s时,其敏感性和特异性分别为94.6%和91.8%。结论 DWI有助于宫颈癌转移和非转移淋巴结的检出,最小ADC值对鉴别宫颈癌转移与非转移淋巴结最敏感,其诊断效能高于平均ADC值和形态学指标。
Objective To investigate the diagnostic value of diffusion-weighted imaging (DWI) in differentiating metastatic cervical lymph nodes from non-metastatic lymph nodes. Materials and Methods 36 cases of newly diagnosed cervical cancer patients underwent routine MRI and DWI before treatment. The MRI and ADC findings of cervical lymph node metastasis and non-metastatic lymph node metastasis were observed and compared. The long diameter of each lymph node L), short axis (S), T2 signal intensity, average ADC value and minimum ADC value. The area under the receiver operating characteristic (ROC) curve was used to evaluate the above indexes to distinguish cervical metastasis from non-metastatic lymph nodes Diagnostic efficiency. Results The average length of short and long diameters of metastatic lymph nodes were higher than that of non-metastatic lymph nodes (P = 0.000), but L / S and S / L of metastatic lymph nodes and non-metastatic lymph nodes (P = 0.261; P = 0.157; P = 0.166). The mean ADC value and minimum ADC value of metastatic lymph nodes were lower than those of non-metastatic lymph nodes (all P <0.05), and the difference was statistically significant P = 0.000). The short axis, long axis, average ADC value and minimum ADC value were of diagnostic value for differentiating cervical metastasis from non-metastatic lymph node (Az> 0.5), and the smallest ADC value had the highest diagnostic efficiency. With the sensitivity and specificity of 94.6% and 91.8% at 0.983 × 10-3mm2 / s, respectively. Conclusions DWI is helpful to detect cervical metastasis and non-metastatic lymph node. The minimum ADC value is most sensitive to differentiate cervical metastasis from non-metastatic lymph node, and its diagnostic efficiency is higher than average ADC value and morphological index.