宫颈癌放射治疗疗效的MRI分析
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| 时间：2009-01-16 21:00:03 来源： 作者： |
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MRI evaluation of treatment effect of radiotherapy for cancer of uterine cervix
ZHANG Si-jia. Department of Radiology, The Fifth People’ Hospital, zheng Zhou 450003, China
[Abstract] Objectives To present the findings of cervical carcinoma before,during and after radiation therapy by magnetic resonance (MR) imaging and to investigate MR images in the evaluation of certvical carcinoma response to radiation therapy. Methods Pelvic MR imaging was performed before, during, and at different intervals after radiation therapy in 18 patients with cervical carcinoma. The changes of carcinoma lesion in size and signal were evaluated on MR images. Results (1)During the radiation therapy, the extent of tumor volume shrinkage was less than 50% in 3 patients and more than 50% in 14 patients. Tumor disappeared in 1 patient. After radiation therapy, the extent of tumor volume shrinkage was less than 50% in 1patient and more than 50%in 10 patients. Tumor disappeared in 7 patients. (2) During the radiation therapy, the tumor signals disappeared in 3 patients and had no changes in 15 patients. After the radiation therapy, the tumor signals disappeared in 11 patients. In 2 to 3 monthes after the radiation therapy, the tumor signals disappeared in 14 tumors and showed hypointense signal on T2WI. (3)Acute changes during radiation therapy, “No enhancement carcinoma lesion was observed in 6 patients. When the radiation therapy was finished, slight or no enhancement was observed in 11 patients. In 2 to 3 monthes after radiotion therapy, slight or no enhancement was observed in 15 patients and 14 patients of them the extent of tumor volume shrinkage was more than 50%. Moreover, only 1 partient was demonstracted as having tumor residual after radiation treatment. (4)After the radiation therapy, signal of parametrium tumor obvious lower, lymphoid knots contrast. Conclusion MRI imaging is helpful in evaluating cervical carcinoma response to radiation therapy and making the therapeutic plan .
[Key words] cervical cancer; radiation therapy; magnetic resonance imaging
子宫颈癌约占女性生殖道恶性肿瘤的2/3，其死亡率居女性生殖道恶性肿瘤的首位。放射治疗是宫颈癌的主要治疗手段之一，是中晚期（ⅡB～ⅢB期）宫颈癌的首选治疗方法。MRI由于具有高组织分辨率、多方位、多序列成像等特点，使其在宫颈癌放疗疗效的评估方面明显优于临床诊断、超声及CT检查，日益受到重视。本研究分析本院1999年01～2007年10病理证实为宫颈癌并单纯放射治疗的18例患者放疗后的MRI表现，探讨MRI在宫颈癌放射治疗后的诊断价值。
材料与方法
1.临床资料 患者18例，年龄28～65岁，平均46.5岁,均经病理确诊为宫颈癌后行MRI检查，其心肺功能正常，既往无癌症、手术史及放射治疗史。入院后在我院放疗中心做单纯全程放射治疗，并在放疗术后24个月内行MRI复查，有完整的病例资料和随访资料；均为鳞癌，病理分级高分化2例，中分化13例，低分化3例。治疗前分期采用国际妇产科协会（FIGO）分类法，结合MRI表现判定。本组18例中Ⅱb7例，Ⅲa5例，Ⅲb4例，Ⅳa期2例。
2.检查方法、检查前去除体内金属避孕环，膀胱适度充盈，使用GE Signa 0.2T超导磁共振扫描仪，体线圈，行盆腔MRI扫描。扫描参数：1、轴位 SE T1WI(TR/TE=500ms/14ms, AC3次)。2、轴位、冠位、矢状位TSET2WI（TR/TE＝3400ms/121ｍｓ，AC4次）。3、矢状位TSE T2WI脂肪抑制扫描。4、经静脉注射对比剂钆喷替酸葡甲胺（Gd－DTPA）0.01mmol/kg体重后，SET1WI增强轴位、矢状位、冠状位扫描。所有序列的扫描视野FOV350～400mm,层厚6～8mm,矩阵256×256，重建矩阵512×512。
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