3.0T磁共振弥散加权成像在宫颈癌诊断及静脉化疗疗效评价中价值的初步探讨
|
摘要
目的
本研究通过对正常子宫颈结构及宫颈癌组织在3.0T磁共振弥散加权成像(DWI)的特点,探讨DWI在宫颈癌诊断、病理级别、分型及化疗疗效检测方面的应用价值。
材料与方法
正常对照组：15例健康女性志愿者,年龄18-38岁,平均27.60±3.851岁。所有志愿者均无妇科疾病史,常规妇科检查排除妇科疾病并行常规MRI检查未发现盆腔占位性病变及弥漫性病变。宫颈癌组：搜集2009年10月至2010年2月在本院妇科就诊的宫颈癌患者52例,年龄23-65岁,平均43.23±9.25岁。全部病例均经手术病理或宫颈活检证实,其中原位癌9例,进展癌43例(鳞癌35例,腺癌8例),MRI检查前未接受任何治疗,其中9例鳞癌患者检查后接受化疗,28天后复查MRI。对所有志愿者及宫颈癌患者行盆腔磁共振常规序列和矢状面、横断面DWI扫描,DWI的b值分别选取300s/mm2、600s/mm2、900s/mm2,对比后选取最佳b=900s/mmm2作为DWI实验b值。分析比较正常子宫颈三层结构之间ADC值差异、正常子宫颈与宫颈癌组织ADC值、宫颈鳞癌与腺癌ADC值,比较鳞癌不同病理级别的ADC值,比较9例宫颈癌患者化疗前后的ADC值。
结果
正常子宫颈在DWI上清晰显示其内膜、结合带和肌层三层结构,内膜平均ADC值为(1.8041±0.1074)×10-3mm2/s,结合带平均ADC值为(1.2204±0.1494)×10-3mm2/s,肌层平均ADC值为(1.8906±0.1326)×10-3mm2/s,内膜和结合带、结合带和肌层之间存在显著性差异(P<0.05),内膜和肌层之间不存在统计学差异(P>0.05)。原位癌平均ADC值为(1.6455±0.2217)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈癌平均ADC值为(0.8802±0.1304)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈鳞癌平均ADC值为(0.8985±0.1349)×10-3mm2/s,腺癌平均ADC值为(1.0375±0.1590)×103mm2/s,两者差异有显著性(P<0.05)。宫颈鳞癌中高分化平均ADC值为(1.0720±0.1308)×10-3mm2/s,中分化平均ADC值为(0.9045±0.0705)×10-3mm2/s,低分化平均ADC值为(0.7509±0.0493)×10-3mm2/s,三者之间差异有显著性。9例宫颈鳞癌患者治疗前平均ADC值为(0.8751±0.0950)×10-3mm2/s,治疗后平均ADC值为(1.2111±0.1217)×10-3mm2/s,化疗前后ADC值差异具有统计学意义(P<0.05),但化疗后ADC值仍低于正常宫颈内膜。
结论
DWI能够区分正常子宫颈和宫颈癌组织,其定量指标ADC值对宫颈癌的病理类型及级别有一定提示作用,并对检测宫颈癌化疗疗效有重要价值,为宫颈癌诊断、评估病理级别分型及检测其疗效方面提供一种新的方法。
Objective
This study was to analyze the diffusion weighted imaging(DWI) features of normal uterine cervix and cervix carcinoma,and assess the value of DWI in diagnosis and indicate the pathological type and evaluate the pathological grading and monitor of uterine cervix cancer after chemotherapy.
Subjects and methods
normal control group:15 healthy female,betweeen 18-38 years age,average age(27.60±3.851).All volunteers had no history of gyneclolgical diseases,gyneclolgical diseases were excluded by routine gyneclolgical examination parallel conventional MRI examination showed no pelvic lesions and diffuse lesions.cervical cancer group:Collection 52 patients with cervical cancer from October 2009 to February 2010 in our hospital gyneclolgical admissions,betweeen23-65years age,average age(43.23±9.25),all cases were confiremed by surgery pathology or cervical biopsy,9 cases in which were preinvasive carcinoma,and 43 cases were progressive cancer(35 case squamous carcinoma,8 case adenocarcinoma),all cases had not received any treatment before MRI examination,9 squamous carcinoma cases had received chemotherapy after examination,then reviewed MRI examination after 28 days.The Conventional and DWI of sagittal planes and axial planes were performed in 52 female patients with uterine cervix cancer and 15 healthy female. The b value of DWI were selected 300s/mm2、600s/mm2、900s/mm2.With contrast, b value of 900 s/mm2 was chose as the experiment one.Comparison the ADC value between the normal uterine cervix's three-tier structure and the normal uterine cervix with cervical cancer, Comparison the ADC value between squamous carcinoma and adenocarcinoma, comparison the ADC value of different pathological levels of squamous carcinoma, comparison the ADC value of the nine cases of cervical cancer before and after chemotherapy.
Results
For normal volunteers, normal uterine cervix's cervical endometrial, junctional zone, and myometrium were clearly displayed on DWI.The mean ADC value of cervical endometrial was (1.8041±0.1074)×10-3mm2/s, junctional zone's was (1.2204±0.1494)×10-3mm2/s, myometrium's was (1.8906±0.1326)×10-3mm2/s. By contrast,the differences between cervical endometrial and junctional zonejunctional zone and myometrium were statistically significant P< 0.05), while the difference between cervical endometrial and myometrium was not statistically significant (P>0.05). The mean ADC value of preinvasive carcinoma was(1.6455±0.2217)×10-3mm2/s, the differences between cervical endometrial and preinvasive carcinoma were statistically significant P< 0.05). The mean ADC value of cervical cancer was (0.8802±0.1304)×10-3mm2/s, the differences between cervical endometrial and cervical cancer were statistically significant P< 0.05). The mean ADC value of squamous carcinoma cervical cancer was (0.8985±0.1349)×10-3mm2/s, The mean ADC value of adenocarcinoma cervical cancer was (1.0375±0.1590)×10-3mm2/s, the differences between cervical squamous carcinoma and adenocarcinoma of the cervical cancer were statistically significant P< 0.05). The mean ADC value of well-differentiated squamous carcinoma cervical cancer was (1.0720±0.1308)×10-3mm2/s, the moderately differentiated's was (0.9045±0.0705)×10-3mm2/s, the poorly differentiated's was (0.7509±0.0493)×10-3mm2/s, the differences along them were statistically significant.In nine patients treated by chemotherapy, The mean ADC value before chemotherapy was (0.8751±0.0950) x10-3mm2/s, The mean ADC value after chemotherapy was (1.2111±0.1217)×10-3mm2/s, The difference had statistic significance (P< 0.05),but was still lower than that of normal cervical endometrial.
Conclusion
DWI has a potential ability to differentiate between normal and cancerous tissue in the uterine cervix, and it can indicate the pathological type and evaluate the pathological grading of uterine cervix cancer as well, and has important value on monitoring of cervical cancer chemotherapy,,this providing a new method for diagnosising and evaluating the pathological grading and monitoring of uterine cervix cancer after chemotherapy.
本研究通过对正常子宫颈结构及宫颈癌组织在3.0T磁共振弥散加权成像(DWI)的特点,探讨DWI在宫颈癌诊断、病理级别、分型及化疗疗效检测方面的应用价值。
材料与方法
正常对照组：15例健康女性志愿者,年龄18-38岁,平均27.60±3.851岁。所有志愿者均无妇科疾病史,常规妇科检查排除妇科疾病并行常规MRI检查未发现盆腔占位性病变及弥漫性病变。宫颈癌组：搜集2009年10月至2010年2月在本院妇科就诊的宫颈癌患者52例,年龄23-65岁,平均43.23±9.25岁。全部病例均经手术病理或宫颈活检证实,其中原位癌9例,进展癌43例(鳞癌35例,腺癌8例),MRI检查前未接受任何治疗,其中9例鳞癌患者检查后接受化疗,28天后复查MRI。对所有志愿者及宫颈癌患者行盆腔磁共振常规序列和矢状面、横断面DWI扫描,DWI的b值分别选取300s/mm2、600s/mm2、900s/mm2,对比后选取最佳b=900s/mmm2作为DWI实验b值。分析比较正常子宫颈三层结构之间ADC值差异、正常子宫颈与宫颈癌组织ADC值、宫颈鳞癌与腺癌ADC值,比较鳞癌不同病理级别的ADC值,比较9例宫颈癌患者化疗前后的ADC值。
结果
正常子宫颈在DWI上清晰显示其内膜、结合带和肌层三层结构,内膜平均ADC值为(1.8041±0.1074)×10-3mm2/s,结合带平均ADC值为(1.2204±0.1494)×10-3mm2/s,肌层平均ADC值为(1.8906±0.1326)×10-3mm2/s,内膜和结合带、结合带和肌层之间存在显著性差异(P<0.05),内膜和肌层之间不存在统计学差异(P>0.05)。原位癌平均ADC值为(1.6455±0.2217)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈癌平均ADC值为(0.8802±0.1304)×10-3mm2/s,与正常宫颈内膜之间差异有显著性(P<0.05)。宫颈鳞癌平均ADC值为(0.8985±0.1349)×10-3mm2/s,腺癌平均ADC值为(1.0375±0.1590)×103mm2/s,两者差异有显著性(P<0.05)。宫颈鳞癌中高分化平均ADC值为(1.0720±0.1308)×10-3mm2/s,中分化平均ADC值为(0.9045±0.0705)×10-3mm2/s,低分化平均ADC值为(0.7509±0.0493)×10-3mm2/s,三者之间差异有显著性。9例宫颈鳞癌患者治疗前平均ADC值为(0.8751±0.0950)×10-3mm2/s,治疗后平均ADC值为(1.2111±0.1217)×10-3mm2/s,化疗前后ADC值差异具有统计学意义(P<0.05),但化疗后ADC值仍低于正常宫颈内膜。
结论
DWI能够区分正常子宫颈和宫颈癌组织,其定量指标ADC值对宫颈癌的病理类型及级别有一定提示作用,并对检测宫颈癌化疗疗效有重要价值,为宫颈癌诊断、评估病理级别分型及检测其疗效方面提供一种新的方法。
Objective
This study was to analyze the diffusion weighted imaging(DWI) features of normal uterine cervix and cervix carcinoma,and assess the value of DWI in diagnosis and indicate the pathological type and evaluate the pathological grading and monitor of uterine cervix cancer after chemotherapy.
Subjects and methods
normal control group:15 healthy female,betweeen 18-38 years age,average age(27.60±3.851).All volunteers had no history of gyneclolgical diseases,gyneclolgical diseases were excluded by routine gyneclolgical examination parallel conventional MRI examination showed no pelvic lesions and diffuse lesions.cervical cancer group:Collection 52 patients with cervical cancer from October 2009 to February 2010 in our hospital gyneclolgical admissions,betweeen23-65years age,average age(43.23±9.25),all cases were confiremed by surgery pathology or cervical biopsy,9 cases in which were preinvasive carcinoma,and 43 cases were progressive cancer(35 case squamous carcinoma,8 case adenocarcinoma),all cases had not received any treatment before MRI examination,9 squamous carcinoma cases had received chemotherapy after examination,then reviewed MRI examination after 28 days.The Conventional and DWI of sagittal planes and axial planes were performed in 52 female patients with uterine cervix cancer and 15 healthy female. The b value of DWI were selected 300s/mm2、600s/mm2、900s/mm2.With contrast, b value of 900 s/mm2 was chose as the experiment one.Comparison the ADC value between the normal uterine cervix's three-tier structure and the normal uterine cervix with cervical cancer, Comparison the ADC value between squamous carcinoma and adenocarcinoma, comparison the ADC value of different pathological levels of squamous carcinoma, comparison the ADC value of the nine cases of cervical cancer before and after chemotherapy.
Results
For normal volunteers, normal uterine cervix's cervical endometrial, junctional zone, and myometrium were clearly displayed on DWI.The mean ADC value of cervical endometrial was (1.8041±0.1074)×10-3mm2/s, junctional zone's was (1.2204±0.1494)×10-3mm2/s, myometrium's was (1.8906±0.1326)×10-3mm2/s. By contrast,the differences between cervical endometrial and junctional zonejunctional zone and myometrium were statistically significant P< 0.05), while the difference between cervical endometrial and myometrium was not statistically significant (P>0.05). The mean ADC value of preinvasive carcinoma was(1.6455±0.2217)×10-3mm2/s, the differences between cervical endometrial and preinvasive carcinoma were statistically significant P< 0.05). The mean ADC value of cervical cancer was (0.8802±0.1304)×10-3mm2/s, the differences between cervical endometrial and cervical cancer were statistically significant P< 0.05). The mean ADC value of squamous carcinoma cervical cancer was (0.8985±0.1349)×10-3mm2/s, The mean ADC value of adenocarcinoma cervical cancer was (1.0375±0.1590)×10-3mm2/s, the differences between cervical squamous carcinoma and adenocarcinoma of the cervical cancer were statistically significant P< 0.05). The mean ADC value of well-differentiated squamous carcinoma cervical cancer was (1.0720±0.1308)×10-3mm2/s, the moderately differentiated's was (0.9045±0.0705)×10-3mm2/s, the poorly differentiated's was (0.7509±0.0493)×10-3mm2/s, the differences along them were statistically significant.In nine patients treated by chemotherapy, The mean ADC value before chemotherapy was (0.8751±0.0950) x10-3mm2/s, The mean ADC value after chemotherapy was (1.2111±0.1217)×10-3mm2/s, The difference had statistic significance (P< 0.05),but was still lower than that of normal cervical endometrial.
Conclusion
DWI has a potential ability to differentiate between normal and cancerous tissue in the uterine cervix, and it can indicate the pathological type and evaluate the pathological grading of uterine cervix cancer as well, and has important value on monitoring of cervical cancer chemotherapy,,this providing a new method for diagnosising and evaluating the pathological grading and monitoring of uterine cervix cancer after chemotherapy.
引文
[1]李连弟,张思维,鲁凤珠等.中国恶性肿瘤死亡谱及分类构成特征研究[J].中华肿瘤杂志.1997.19(5)：323-328.
[2]Kaur H, Silverman PM, Iyer RB, et al. Diagnosis, staging, and surveillance of cervical carcinoma. AJR Am J Roentgenol.2003; 180(6):1621-31.
[3]Scheidler J,Hricad H,Yu KK,et al.Radiological evaluation of lymph node metastases in patients with cervical cancer:a meta-analysis.JAMA,1997,278 (13):1096-1101.
[4]Gonzalez-Martin A, Gonzalez-Cortijio L,Carballo N, et al.The current role of neoadjuvant chemotherapy in the management of cervical carcinoma. Gynecol Oncol.2008 Sep;110(3 Suppl 2):S36-40.
[5]Eddy GL, Bundy BN, Creasman WT, et al.Treatment of ("bulky") stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy:a phase III trial of the gynecologic oncology group.Gynecol Oncol.2007;106(2):362-9.
[6]Romano A, Bozzao A, Bonamini M,et al. Diffusion-weighted MR Imaging:clin-ical applications in neuroradiology.Radiol Med (Torino).2003;106(5-6):521-548
[7]Koh DM, Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR Am J Roentgenol.2007;188(6):1622-35.
[8]杨正汉.磁共振成像技术指南—检查规范临床策略及新技术应用[M].人民军医出版社.2007,263-264..
[9]Sorensen AG, Wu O, Copen WA, et al.Human acute cerebral ischemia:detection of changes in water diffusion anisotropy by using MR imaging.Radiology.1999 Sep;212(3):785-92.
[10]Murakami R, Sugahara T, Nakamura H, et al.Malignant supratentorial astroc-ytoma treated with postoperative radiation therapy:prognostic value of pretreat-ment quantitative diffusion-weighted MR imaging.Radiology.2007;243(2):
493-9.
[11]Colagrande S, Carbone SF, Carusi LM.et al.Magnetic resonance diffusion-weighted imaging:extraneurological applications.Radiol Med.2006 Apr;lll(3): 392-419.
[12]Bulakbasi N, Guvenc I, Onguru O, et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differen-tiation and grading of malignant brain tumors.J Comput Assist Tomogr.2004; 28(6):735-46.
[13]Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus:comparison with the normal uterine cervix. Eur Radiol, 2005,15(1):71-8.
[14]张赞,梁碧玲,高立等.正常子宫颈和宫颈癌的弥散加权成像特[J].癌症.2007,26(5)：508-512
[15]刘颖,白人驹等.DWI在宫颈癌诊断中的应用价值及其与病理相关性[J].临床放射学杂志.2009,28(2)：225-9.
[16]Okamoto Y, Tanaka YO, Nishida M,et al MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics.2003;23(2):425-445
[17]McCarthy S, Scott G, Majumdar S,et al. Uterine junctional zone:MR study of water content and relaxation properties. Radiology.1989;171(1):241-3.
[18]Kim SH,Choi BI.Lee HP et al. Uterine cervical carcinoma:comparison of CT and MRI findings. Radiology.1990;175(1):45-51.
[19]Lyng H, Haraldseth O, Rofstad EK.Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic reson-ance imaging.Magn Reson Med.2000;43(6):828-36.
[20]Sugahara T, Korogi Y, Kochi M et al.Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas.J Magn Reson Imaging.1999,9(1):53-60.
[21]李彩英,封海龙,殷小平等,3.0T MR DWI在肝脏良、恶性局灶性病变诊断中的初步研究[J],临床放射学杂志2009,28(8)：1091-4.
[22]Cova M, Squillaci E, Stacul F, et al.Diffusion-weighted MRI in the evaluation of renal lesions:preliminary results.Br J Radiol.2004;77(922):851-7.
[23]秦海燕,白人驹,孙浩然等,肾上腺肿瘤MR扩散加权成像表现与细胞密度相关性的初步研究[J].临床放射学杂志.2007,26(6)：575-580
[24]史浩,丁红宇等,弥散加权成像在前列腺癌诊断与鉴别诊断中的应用价值[J].中华男科学杂志.2007,13(7)：605-609
[25]罗建东,刘园园,张雪林等,磁共振扩散加权成像在乳腺病变鉴别诊断中的应用价值[J],癌症.2007,26(2)：168-171
[26]Roth Y, Tichler T, Kostenich G, et al.High-b-value diffusion-weighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice.Radiology.2004 Sep;232(3):685-92.
[27]赵继红,丁军,蒋世旭,等.细胞密度与表观弥散系数的相关性探讨[J].中国实验诊断学.2006,10(4)：379-82.
[28]Kim CK, Park BK, Han JJ, Kang TW, Lee HM.Diffusion-weighted imaging of the prostate at 3 T for differentiation of malignant and benign tissue in transition and peripheral zones:preliminary results.J Comput Assist Tomogr.2007;31(3): 449-54.
[29]Matoba M, Tonami H, Kondou T,et al.Lung carcinoma:diffusion-weighted mr imaging-preliminary evaluation with apparent diffusion coefficient.Radiology. 2007 May;243(2):570-7.
[30]Lin G, Ho KC, Wang JJ,et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T.2008 Jul;28(1):128-35.
[31]Kim JK, Kim KA, Park BW, et al.Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experi-ence.J Magn Reson Imaging.2008;28(3):714-9.
[32]Xue HD, Li S, Sun F, et al. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer.Chin Med Sci J,2008,23(3):133-137
[33]Li S, Xue HD, Wang XH, et al.MR diffusion weighted imaging for evaluation of radiotherapeutic effects on rabbit VX2 tumor model.Chin Med Sci J.2008;23(3): 172-7.
[34]Harry VN, Semple SI, Gilbert FJ, Parkin DE.Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer.Gynecol Oncol.2008;111(2):213-20.
[35]马婉玲,宦怡,魏丽春等,3.0T MR及DWI在宫颈癌放射治疗中的应用研究[J].临床放射学杂志.2009,28(12)：1561-1564.
[36]刘桐宇,谢榕,林玉珍等.DWI应用于宫颈癌放化疗疗效观察19例分析[J].福建医药杂志.200931(2)：113-114
[37]易祥华,张容轩,罗本芳,等.非小细胞肺癌新辅助化疗后的光镜和电镜观察[J].电子显微学报,2000,19(6)：804-10.
[38]韦长元,陈建思,刘剑仑等.应用顺铂后肝癌细胞超微结构的研究[J].中华肝脏病杂志,2000,8(2)：89-90.
[39]季穗生,刘唐彬,潘翠玲,等.肾母细胞瘤和神经母细胞瘤术前化疗及超微结构改变[J].浙江肿瘤,1998,4(2)：81-82.
[40]Shimofusa R,Fujimoto H,Akamata H,et al. Diffusion-weighted imaging of prostate cancer. J Comput Assist Tomogr.2005,29(2):149-153
[41]Abdel Razek AA, Soliman N Y, Elkhamary S, et all. Role of diffusion-weighted MR imaging in cervical lymphadenopathy.Eur Radiol,2006,16 (7):1468-71
[42]Lin G, Ho KC, Wang J, et all. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magneticresonance imaging at 3T. J Magn Reson Imaging.2008,28(1):128-35
[43]Taouli B, Vilgrain V, Dumont E,et al.Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences:prospective study in 66 patients.Radiology.2003;226(1): 71-8.
[44]Kim T, Murakami T, Takahashi S, et al.Diffusion-weighted single-shot echopl-anar MR imaging for liver disease.AJR Am J Roentgenol.1999;173(2):393-8.
[1]李连弟,张思维,鲁凤珠等.中国恶性肿瘤死亡谱及分类构成特征研究[J].中华肿瘤杂志.1997.19(5)：323-328..
[2]Kaur H, Silverman PM, Iyer RB, et al. Diagnosis, staging, and surveillance of cervical carcinoma. AJR Am J Roentgenol.2003; 180(6):1621-31.
[3]Scheidler J,Hricad H,Yu KK,et al.Radiological evaluation of lymph node metastases in patients with cervical cancer:a meta-analysis. JAMA,1997, 278(13):1096-1101.
[4]Romano A, Bozzao A, Bonamini M,et al. Diffusion-weighted MR Imaging: clinical applications in neuroradiology.Radiol Med (Torino).2003;106 (5-6): 521-528
[5]Bammer R,Keellng SL,Augustin M,et al. Improved diffusion-weighted single-shot echo-planar imaging (EPI) in stroke using sensitivity encoding (SENSE). Magn Reson Med.2001,46 (3):548-554.
[6]Bammer R. Basic Principles of Diffusion-weighted Imaging. Eur J Radiol 2003,45 (3):169-184.
[7]Hanyu, H,Shindou H,Suqiki S,et al.MR diffusion-weighted imaging of cerebral infarction.No To Shinkei.1996;48(4):345-349
[8]Naganawa S, Sato K, Katagiri T,Mimura T, Ishigaki T et al. Regional ADC values of the normal brain:differences due to age, gender, and laterality.Eur Radiol 2003,13(1):6-11
[9]Kantarci K, Jack CR Jr, Xu YC, et al. Mild cognitive impairment and Alzheimer disease:regional diffusivity of water. Radiology 2001,219(1):101-107
[10]徐胜生,肖家和,周翔平等,正常人脑内不同结构MR弥散加权成像研究[J].华西医学.2008,23(2)：258-260。
[11]Castillo M, Smith JK, Kwock L,Wilber K et al. Apparent diffusion coefficients in the evaluation of high grade cerebral gliomas. Am J Neuroradiol 2001,22(1):60-64
[12]Kono K, Inoue Y, Nakayama K, et al. The role of diffusion-weightedimaging in patients with brain tumors. AJNR Am J Neuroradiol,2001,22:1081-1088
[13]陈业媛,周战梅,何斌等,DWI在单发性脑转移瘤、脑胶质瘤和脑脓肿鉴别诊断中的价值[J].实用临床医学,2008,9(4)：87-89
[14]Fumiyuki Yamasaki Kaoru Kurisu et al. Apparent Diffusion Coefficient of Human Brain Tumors at MR Imaging Radiology 2005; 235:985-991
[15]Koh DM, Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR Am J Roentgenol.2007;188(6):1622-35.
[16]李彩英,封海龙,殷小平等,3.0T MR DWI在肝脏良、恶性局灶性病变诊断中的初步研究[J].临床放射学杂志2009,28(8)：1091-1094.
[17]杨洋,宋彬,吴苾等,磁共振弥散加权成像技术评价慢性病毒性肝炎的纤维化程度及活动度[J].中国医学科学院学报.2009,31(2)：155-159
[18]Woodhams R, Matsunaga K, Iwabuchi K, et al. Diffusion-weighted imaging of malignant breast tumors:the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr.2005;29(5):644-9.
[19]郭勇,蔡祖龙,蔡幼铨等.弥散加权成像鉴别乳腺良恶性病变的价值初探[J].中华放射学杂志.2001(35)：132-135
[20]罗建东,刘园园,张雪林等.磁共振扩散加权成像在乳腺病变鉴别诊断中的应用价值[J].癌症,2007,26(2)：168-171
[21]Namimoto T, Yamashita Y,Mitsuzaki K, et al. Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echop lanar MR imaging. J Magn Reson Imaging,1999,9 (6):832-837.
[22]Xu Y,Wang X, J iang X. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate:preliminary experience. J Magn Reson Imaging,2007,26 (3):678-681.
[23]Kim CK, Park BK, Han JJ,et al.Diffusion-weighted imaging of the prostate at 3T for differentiation of malignant and benign tissue in transition and peripheral zones:preliminary results.J Comput Assist Tomogr.2007;31(3):449-54.
[24]王丽娟,袁曙光,闫东等.前列腺癌的磁共振DWI诊断价值[J].放射学实践.2009,24(6)：661-663.
[25]Lauenstein TC, Goehde SC, Herborn CU, et, al. Whole-body MR imaging: evaluation of patients for metastases. Radiology.2004; 233(1):139-148
[26]Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus:comparison with the normal uterine cervix. Eur Radiol, 2005,15(1):71-78.
[27]张赞,梁碧玲,高立等.正常子宫颈和宫颈癌的弥散加权成像特[J].癌症.2007,26(5)：508-512.
[28]郭勇,王辅林,蔡幼铨,等.乳腺肿瘤表观扩散系数与组织细胞密度相关性研究[J].中国医学影像学杂志,2002,10(4)：241-244.
[29]Bulakbasi N, Guvenc I, Onguru O,et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors.J Comput Assist Tomogr.2004;28(6):735-46.
[30]刘颖,白人驹等.DWI在宫颈癌诊断中的应用价值及其与病理相关性[J].临床放射学杂志,2009,28(2)：225-229
[31]Lin G, Ho KC, Wang JJ,et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T.2008 Jul;28(1):128-35.
[32]Kim JK, Kim KA, Park BW, et al.Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience.J Magn Reson Imaging.2008;28(3):714-9.
[33]Xue HD, Li S, Sun F, et al. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer.Chin Med Sci J,2008,23(3):133-137
[34]马婉玲,宦怡,魏丽春等,3.0T MR及DWI在宫颈癌放射治疗中的应用研究[J].临床放射学杂志,2009,28,(12)：1561-1564.
[35]Harry VN, Semple SI, Gilbert FJ, Parkin DE.Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer.Gynecol Oncol.2008;111(2):213-20.
[36]Shimofusa R,Fujimoto H,Akamata H,et al. Diffusion-weighted imaging of prostate cancer. J Comput Assist Tomogr.2005,29(2):149-153
[37]Colagrande S, Carbone SF, Carusi LM, et al.Magnetic resonance diffusion-weighted imaging:extraneurological applications.Radiol Med.2006;111(3):392-419.
[38]Abdel Razek AA, Soliman N Y, Elkhamary S, et all. Role of diffusion-weighted MR imaging in cervical lymphadenopathy.Eur Radiol,2006,16 (7):1468-71
[39]Lin G, Ho KC, Wang JJ, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magneticresonance imaging at 3T. J Magn Reson Imaging.2008,28(1):128-135
[2]Kaur H, Silverman PM, Iyer RB, et al. Diagnosis, staging, and surveillance of cervical carcinoma. AJR Am J Roentgenol.2003; 180(6):1621-31.
[3]Scheidler J,Hricad H,Yu KK,et al.Radiological evaluation of lymph node metastases in patients with cervical cancer:a meta-analysis.JAMA,1997,278 (13):1096-1101.
[4]Gonzalez-Martin A, Gonzalez-Cortijio L,Carballo N, et al.The current role of neoadjuvant chemotherapy in the management of cervical carcinoma. Gynecol Oncol.2008 Sep;110(3 Suppl 2):S36-40.
[5]Eddy GL, Bundy BN, Creasman WT, et al.Treatment of ("bulky") stage IB cervical cancer with or without neoadjuvant vincristine and cisplatin prior to radical hysterectomy and pelvic/para-aortic lymphadenectomy:a phase III trial of the gynecologic oncology group.Gynecol Oncol.2007;106(2):362-9.
[6]Romano A, Bozzao A, Bonamini M,et al. Diffusion-weighted MR Imaging:clin-ical applications in neuroradiology.Radiol Med (Torino).2003;106(5-6):521-548
[7]Koh DM, Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR Am J Roentgenol.2007;188(6):1622-35.
[8]杨正汉.磁共振成像技术指南—检查规范临床策略及新技术应用[M].人民军医出版社.2007,263-264..
[9]Sorensen AG, Wu O, Copen WA, et al.Human acute cerebral ischemia:detection of changes in water diffusion anisotropy by using MR imaging.Radiology.1999 Sep;212(3):785-92.
[10]Murakami R, Sugahara T, Nakamura H, et al.Malignant supratentorial astroc-ytoma treated with postoperative radiation therapy:prognostic value of pretreat-ment quantitative diffusion-weighted MR imaging.Radiology.2007;243(2):
493-9.
[11]Colagrande S, Carbone SF, Carusi LM.et al.Magnetic resonance diffusion-weighted imaging:extraneurological applications.Radiol Med.2006 Apr;lll(3): 392-419.
[12]Bulakbasi N, Guvenc I, Onguru O, et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differen-tiation and grading of malignant brain tumors.J Comput Assist Tomogr.2004; 28(6):735-46.
[13]Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus:comparison with the normal uterine cervix. Eur Radiol, 2005,15(1):71-8.
[14]张赞,梁碧玲,高立等.正常子宫颈和宫颈癌的弥散加权成像特[J].癌症.2007,26(5)：508-512
[15]刘颖,白人驹等.DWI在宫颈癌诊断中的应用价值及其与病理相关性[J].临床放射学杂志.2009,28(2)：225-9.
[16]Okamoto Y, Tanaka YO, Nishida M,et al MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics.2003;23(2):425-445
[17]McCarthy S, Scott G, Majumdar S,et al. Uterine junctional zone:MR study of water content and relaxation properties. Radiology.1989;171(1):241-3.
[18]Kim SH,Choi BI.Lee HP et al. Uterine cervical carcinoma:comparison of CT and MRI findings. Radiology.1990;175(1):45-51.
[19]Lyng H, Haraldseth O, Rofstad EK.Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic reson-ance imaging.Magn Reson Med.2000;43(6):828-36.
[20]Sugahara T, Korogi Y, Kochi M et al.Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas.J Magn Reson Imaging.1999,9(1):53-60.
[21]李彩英,封海龙,殷小平等,3.0T MR DWI在肝脏良、恶性局灶性病变诊断中的初步研究[J],临床放射学杂志2009,28(8)：1091-4.
[22]Cova M, Squillaci E, Stacul F, et al.Diffusion-weighted MRI in the evaluation of renal lesions:preliminary results.Br J Radiol.2004;77(922):851-7.
[23]秦海燕,白人驹,孙浩然等,肾上腺肿瘤MR扩散加权成像表现与细胞密度相关性的初步研究[J].临床放射学杂志.2007,26(6)：575-580
[24]史浩,丁红宇等,弥散加权成像在前列腺癌诊断与鉴别诊断中的应用价值[J].中华男科学杂志.2007,13(7)：605-609
[25]罗建东,刘园园,张雪林等,磁共振扩散加权成像在乳腺病变鉴别诊断中的应用价值[J],癌症.2007,26(2)：168-171
[26]Roth Y, Tichler T, Kostenich G, et al.High-b-value diffusion-weighted MR imaging for pretreatment prediction and early monitoring of tumor response to therapy in mice.Radiology.2004 Sep;232(3):685-92.
[27]赵继红,丁军,蒋世旭,等.细胞密度与表观弥散系数的相关性探讨[J].中国实验诊断学.2006,10(4)：379-82.
[28]Kim CK, Park BK, Han JJ, Kang TW, Lee HM.Diffusion-weighted imaging of the prostate at 3 T for differentiation of malignant and benign tissue in transition and peripheral zones:preliminary results.J Comput Assist Tomogr.2007;31(3): 449-54.
[29]Matoba M, Tonami H, Kondou T,et al.Lung carcinoma:diffusion-weighted mr imaging-preliminary evaluation with apparent diffusion coefficient.Radiology. 2007 May;243(2):570-7.
[30]Lin G, Ho KC, Wang JJ,et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T.2008 Jul;28(1):128-35.
[31]Kim JK, Kim KA, Park BW, et al.Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experi-ence.J Magn Reson Imaging.2008;28(3):714-9.
[32]Xue HD, Li S, Sun F, et al. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer.Chin Med Sci J,2008,23(3):133-137
[33]Li S, Xue HD, Wang XH, et al.MR diffusion weighted imaging for evaluation of radiotherapeutic effects on rabbit VX2 tumor model.Chin Med Sci J.2008;23(3): 172-7.
[34]Harry VN, Semple SI, Gilbert FJ, Parkin DE.Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer.Gynecol Oncol.2008;111(2):213-20.
[35]马婉玲,宦怡,魏丽春等,3.0T MR及DWI在宫颈癌放射治疗中的应用研究[J].临床放射学杂志.2009,28(12)：1561-1564.
[36]刘桐宇,谢榕,林玉珍等.DWI应用于宫颈癌放化疗疗效观察19例分析[J].福建医药杂志.200931(2)：113-114
[37]易祥华,张容轩,罗本芳,等.非小细胞肺癌新辅助化疗后的光镜和电镜观察[J].电子显微学报,2000,19(6)：804-10.
[38]韦长元,陈建思,刘剑仑等.应用顺铂后肝癌细胞超微结构的研究[J].中华肝脏病杂志,2000,8(2)：89-90.
[39]季穗生,刘唐彬,潘翠玲,等.肾母细胞瘤和神经母细胞瘤术前化疗及超微结构改变[J].浙江肿瘤,1998,4(2)：81-82.
[40]Shimofusa R,Fujimoto H,Akamata H,et al. Diffusion-weighted imaging of prostate cancer. J Comput Assist Tomogr.2005,29(2):149-153
[41]Abdel Razek AA, Soliman N Y, Elkhamary S, et all. Role of diffusion-weighted MR imaging in cervical lymphadenopathy.Eur Radiol,2006,16 (7):1468-71
[42]Lin G, Ho KC, Wang J, et all. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magneticresonance imaging at 3T. J Magn Reson Imaging.2008,28(1):128-35
[43]Taouli B, Vilgrain V, Dumont E,et al.Evaluation of liver diffusion isotropy and characterization of focal hepatic lesions with two single-shot echo-planar MR imaging sequences:prospective study in 66 patients.Radiology.2003;226(1): 71-8.
[44]Kim T, Murakami T, Takahashi S, et al.Diffusion-weighted single-shot echopl-anar MR imaging for liver disease.AJR Am J Roentgenol.1999;173(2):393-8.
[1]李连弟,张思维,鲁凤珠等.中国恶性肿瘤死亡谱及分类构成特征研究[J].中华肿瘤杂志.1997.19(5)：323-328..
[2]Kaur H, Silverman PM, Iyer RB, et al. Diagnosis, staging, and surveillance of cervical carcinoma. AJR Am J Roentgenol.2003; 180(6):1621-31.
[3]Scheidler J,Hricad H,Yu KK,et al.Radiological evaluation of lymph node metastases in patients with cervical cancer:a meta-analysis. JAMA,1997, 278(13):1096-1101.
[4]Romano A, Bozzao A, Bonamini M,et al. Diffusion-weighted MR Imaging: clinical applications in neuroradiology.Radiol Med (Torino).2003;106 (5-6): 521-528
[5]Bammer R,Keellng SL,Augustin M,et al. Improved diffusion-weighted single-shot echo-planar imaging (EPI) in stroke using sensitivity encoding (SENSE). Magn Reson Med.2001,46 (3):548-554.
[6]Bammer R. Basic Principles of Diffusion-weighted Imaging. Eur J Radiol 2003,45 (3):169-184.
[7]Hanyu, H,Shindou H,Suqiki S,et al.MR diffusion-weighted imaging of cerebral infarction.No To Shinkei.1996;48(4):345-349
[8]Naganawa S, Sato K, Katagiri T,Mimura T, Ishigaki T et al. Regional ADC values of the normal brain:differences due to age, gender, and laterality.Eur Radiol 2003,13(1):6-11
[9]Kantarci K, Jack CR Jr, Xu YC, et al. Mild cognitive impairment and Alzheimer disease:regional diffusivity of water. Radiology 2001,219(1):101-107
[10]徐胜生,肖家和,周翔平等,正常人脑内不同结构MR弥散加权成像研究[J].华西医学.2008,23(2)：258-260。
[11]Castillo M, Smith JK, Kwock L,Wilber K et al. Apparent diffusion coefficients in the evaluation of high grade cerebral gliomas. Am J Neuroradiol 2001,22(1):60-64
[12]Kono K, Inoue Y, Nakayama K, et al. The role of diffusion-weightedimaging in patients with brain tumors. AJNR Am J Neuroradiol,2001,22:1081-1088
[13]陈业媛,周战梅,何斌等,DWI在单发性脑转移瘤、脑胶质瘤和脑脓肿鉴别诊断中的价值[J].实用临床医学,2008,9(4)：87-89
[14]Fumiyuki Yamasaki Kaoru Kurisu et al. Apparent Diffusion Coefficient of Human Brain Tumors at MR Imaging Radiology 2005; 235:985-991
[15]Koh DM, Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR Am J Roentgenol.2007;188(6):1622-35.
[16]李彩英,封海龙,殷小平等,3.0T MR DWI在肝脏良、恶性局灶性病变诊断中的初步研究[J].临床放射学杂志2009,28(8)：1091-1094.
[17]杨洋,宋彬,吴苾等,磁共振弥散加权成像技术评价慢性病毒性肝炎的纤维化程度及活动度[J].中国医学科学院学报.2009,31(2)：155-159
[18]Woodhams R, Matsunaga K, Iwabuchi K, et al. Diffusion-weighted imaging of malignant breast tumors:the usefulness of apparent diffusion coefficient (ADC) value and ADC map for the detection of malignant breast tumors and evaluation of cancer extension. J Comput Assist Tomogr.2005;29(5):644-9.
[19]郭勇,蔡祖龙,蔡幼铨等.弥散加权成像鉴别乳腺良恶性病变的价值初探[J].中华放射学杂志.2001(35)：132-135
[20]罗建东,刘园园,张雪林等.磁共振扩散加权成像在乳腺病变鉴别诊断中的应用价值[J].癌症,2007,26(2)：168-171
[21]Namimoto T, Yamashita Y,Mitsuzaki K, et al. Measurement of the apparent diffusion coefficient in diffuse renal disease by diffusion-weighted echop lanar MR imaging. J Magn Reson Imaging,1999,9 (6):832-837.
[22]Xu Y,Wang X, J iang X. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate:preliminary experience. J Magn Reson Imaging,2007,26 (3):678-681.
[23]Kim CK, Park BK, Han JJ,et al.Diffusion-weighted imaging of the prostate at 3T for differentiation of malignant and benign tissue in transition and peripheral zones:preliminary results.J Comput Assist Tomogr.2007;31(3):449-54.
[24]王丽娟,袁曙光,闫东等.前列腺癌的磁共振DWI诊断价值[J].放射学实践.2009,24(6)：661-663.
[25]Lauenstein TC, Goehde SC, Herborn CU, et, al. Whole-body MR imaging: evaluation of patients for metastases. Radiology.2004; 233(1):139-148
[26]Naganawa S, Sato C, Kumada H, et al. Apparent diffusion coefficient in cervical cancer of the uterus:comparison with the normal uterine cervix. Eur Radiol, 2005,15(1):71-78.
[27]张赞,梁碧玲,高立等.正常子宫颈和宫颈癌的弥散加权成像特[J].癌症.2007,26(5)：508-512.
[28]郭勇,王辅林,蔡幼铨,等.乳腺肿瘤表观扩散系数与组织细胞密度相关性研究[J].中国医学影像学杂志,2002,10(4)：241-244.
[29]Bulakbasi N, Guvenc I, Onguru O,et al.The added value of the apparent diffusion coefficient calculation to magnetic resonance imaging in the differentiation and grading of malignant brain tumors.J Comput Assist Tomogr.2004;28(6):735-46.
[30]刘颖,白人驹等.DWI在宫颈癌诊断中的应用价值及其与病理相关性[J].临床放射学杂志,2009,28(2)：225-229
[31]Lin G, Ho KC, Wang JJ,et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T.2008 Jul;28(1):128-35.
[32]Kim JK, Kim KA, Park BW, et al.Feasibility of diffusion-weighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience.J Magn Reson Imaging.2008;28(3):714-9.
[33]Xue HD, Li S, Sun F, et al. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer.Chin Med Sci J,2008,23(3):133-137
[34]马婉玲,宦怡,魏丽春等,3.0T MR及DWI在宫颈癌放射治疗中的应用研究[J].临床放射学杂志,2009,28,(12)：1561-1564.
[35]Harry VN, Semple SI, Gilbert FJ, Parkin DE.Diffusion-weighted magnetic resonance imaging in the early detection of response to chemoradiation in cervical cancer.Gynecol Oncol.2008;111(2):213-20.
[36]Shimofusa R,Fujimoto H,Akamata H,et al. Diffusion-weighted imaging of prostate cancer. J Comput Assist Tomogr.2005,29(2):149-153
[37]Colagrande S, Carbone SF, Carusi LM, et al.Magnetic resonance diffusion-weighted imaging:extraneurological applications.Radiol Med.2006;111(3):392-419.
[38]Abdel Razek AA, Soliman N Y, Elkhamary S, et all. Role of diffusion-weighted MR imaging in cervical lymphadenopathy.Eur Radiol,2006,16 (7):1468-71
[39]Lin G, Ho KC, Wang JJ, et al. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magneticresonance imaging at 3T. J Magn Reson Imaging.2008,28(1):128-135