滑动多层磁共振成像对卵巢癌分期的应用研究
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摘要
目的：分析滑动多层磁共振成像(SMS-MRI)的技术特点，并探讨SMS-MRI在原发性卵巢癌分期中的价值。
方法：对15例卵巢癌患者术前行多层螺旋CT(MSCT)和SMS-MRI扫描，扫描范围包括胸腹盆腔(从胸廓入口至盆底)。MSCT采用64排螺旋CT行平扫及增强扫描；SMS-MRI扫描的主要序列有常规T_2WI TSE序列、SMS-TIRM序列和SMS FLASH 2D压脂增强序列。MSCT和SMS-MRI图像由两位放射科医师随机单盲阅片后进行分期诊断，并将其结果与手术病理结果对照。影像资料的观察内容包括：(1)肿瘤定位(单侧或双侧)；(2)局部浸润：子宫输卵管或其他盆腔组织受侵；(3)腹膜转移；(4)淋巴结转移；(5)远处转移。
结果：术后病理证实15例卵巢癌病例中浆液性囊腺癌9例，粘液性囊腺癌2例，子宫内膜样癌2例，透明细胞癌和颗粒细胞癌各1例。手术病理分期为Ⅰ期0例，Ⅱ期2例，Ⅲ期10例，Ⅳ期3例。以手术病理结果为金标准，SMS-MRI对于原发性卵巢癌总的分期准确率为100％(15／15)；MSCT将1例Ⅲ期病例低估为Ⅱ期，总的分期准确率为87％(13／15)。SMS-MRI和MSCT在卵巢癌的定位诊断、子宫输卵管局部浸润和远处转移等方面的准确率均为100％。SMS-MRI在显示其他盆腔组织受侵、腹膜转移和淋巴结转移等的准确率均高于MSCT。
结论：采用SMS技术行MR成像能在保证图像质量的情况下，在较短的时间内一次性完成体部胸腹盆腔扫描。SMS-MRI在卵巢癌原发灶和转移的侦测和分期准确性等方面均不逊于MSCT，是采用影像学方法对卵巢癌进行分期诊断的一项新选择。
Objective: To analyze the technical characteristics of sliding multislice magneticresonance imaging (SMS-MRI), and to evaluate the value of ovarian carcinomastaging by SMS-MRI.
Methods: Fifteen patients with ovarian carcinoma were performed both multislice CT(MSCT) and SMS-MRI scan before operation. Scanning range included thoraciccavity, abdominal cavity and pelvic cavity (from superior aperture of thorax to bottomof pelvic). Routine scan and enhanced scan were performed with 64 rows spiral CT.Main sequences of SMS-MRI were T_2WI TSE, SMS TIRM and SMS FLASH 2Denhanced T_1WI. The imagines of MSCT and SMS-MRI were analyzed by tworadiologists using a randomized, single-blind method, and staged according to FIGO'sclassification. The diagnosis results were compared with operative and pathologicalfindings. Main outcome measures: (1)location of tumor; (2) local infiltration(involvement of uterus and fallopian tube or other pelvic tissues); (3)peritoneummetastasis; (4)lymph node metastasis; (5)distal metastasis.
Results. In all patients, 9 cases of serous cystadenocarcinoma, 2 cases of mucouscystoadenocarcinoma, 2 cases of endometrioid carcinoma, 1 case of clear-cellcarcinoma and 1 case of granular cell carcinoma were proved by pathology. There were 0 case of stageⅠ, 2 cases of stageⅡ, 10 cases of stageⅢand 3 cases of stageⅣ. Compared with the pathological findings, the accuracy of total staging ofSMS-MRI was 100% (15/15), and that of MSCT was 87% (13/15). The signs oftumor location, involvement of uterus and fallopian and distal metastasis wereaccurately showed by both MSCT and SMS-MRI. Accuracy of SMS-MRI was higherthan MSCT for diagnosis of involvement of other pelvic tissues, peritoneummetastasis and lymph nodes metastasis.
Conclusion: SMS-MRI can finish one-off body scan in shorter time and provide goodquality imagines. SMS-MRI is a alterative method of imaging diagnosis for ovariancarcinoma staging.
方法：对15例卵巢癌患者术前行多层螺旋CT(MSCT)和SMS-MRI扫描，扫描范围包括胸腹盆腔(从胸廓入口至盆底)。MSCT采用64排螺旋CT行平扫及增强扫描；SMS-MRI扫描的主要序列有常规T_2WI TSE序列、SMS-TIRM序列和SMS FLASH 2D压脂增强序列。MSCT和SMS-MRI图像由两位放射科医师随机单盲阅片后进行分期诊断，并将其结果与手术病理结果对照。影像资料的观察内容包括：(1)肿瘤定位(单侧或双侧)；(2)局部浸润：子宫输卵管或其他盆腔组织受侵；(3)腹膜转移；(4)淋巴结转移；(5)远处转移。
结果：术后病理证实15例卵巢癌病例中浆液性囊腺癌9例，粘液性囊腺癌2例，子宫内膜样癌2例，透明细胞癌和颗粒细胞癌各1例。手术病理分期为Ⅰ期0例，Ⅱ期2例，Ⅲ期10例，Ⅳ期3例。以手术病理结果为金标准，SMS-MRI对于原发性卵巢癌总的分期准确率为100％(15／15)；MSCT将1例Ⅲ期病例低估为Ⅱ期，总的分期准确率为87％(13／15)。SMS-MRI和MSCT在卵巢癌的定位诊断、子宫输卵管局部浸润和远处转移等方面的准确率均为100％。SMS-MRI在显示其他盆腔组织受侵、腹膜转移和淋巴结转移等的准确率均高于MSCT。
结论：采用SMS技术行MR成像能在保证图像质量的情况下，在较短的时间内一次性完成体部胸腹盆腔扫描。SMS-MRI在卵巢癌原发灶和转移的侦测和分期准确性等方面均不逊于MSCT，是采用影像学方法对卵巢癌进行分期诊断的一项新选择。
Objective: To analyze the technical characteristics of sliding multislice magneticresonance imaging (SMS-MRI), and to evaluate the value of ovarian carcinomastaging by SMS-MRI.
Methods: Fifteen patients with ovarian carcinoma were performed both multislice CT(MSCT) and SMS-MRI scan before operation. Scanning range included thoraciccavity, abdominal cavity and pelvic cavity (from superior aperture of thorax to bottomof pelvic). Routine scan and enhanced scan were performed with 64 rows spiral CT.Main sequences of SMS-MRI were T_2WI TSE, SMS TIRM and SMS FLASH 2Denhanced T_1WI. The imagines of MSCT and SMS-MRI were analyzed by tworadiologists using a randomized, single-blind method, and staged according to FIGO'sclassification. The diagnosis results were compared with operative and pathologicalfindings. Main outcome measures: (1)location of tumor; (2) local infiltration(involvement of uterus and fallopian tube or other pelvic tissues); (3)peritoneummetastasis; (4)lymph node metastasis; (5)distal metastasis.
Results. In all patients, 9 cases of serous cystadenocarcinoma, 2 cases of mucouscystoadenocarcinoma, 2 cases of endometrioid carcinoma, 1 case of clear-cellcarcinoma and 1 case of granular cell carcinoma were proved by pathology. There were 0 case of stageⅠ, 2 cases of stageⅡ, 10 cases of stageⅢand 3 cases of stageⅣ. Compared with the pathological findings, the accuracy of total staging ofSMS-MRI was 100% (15/15), and that of MSCT was 87% (13/15). The signs oftumor location, involvement of uterus and fallopian and distal metastasis wereaccurately showed by both MSCT and SMS-MRI. Accuracy of SMS-MRI was higherthan MSCT for diagnosis of involvement of other pelvic tissues, peritoneummetastasis and lymph nodes metastasis.
Conclusion: SMS-MRI can finish one-off body scan in shorter time and provide goodquality imagines. SMS-MRI is a alterative method of imaging diagnosis for ovariancarcinoma staging.
引文
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1．汤钊献．现代肿瘤学．上海：上海医科大学出版社，1994：949-950．
2．曹泽毅．中华妇产科学．北京：人民卫生出版社，1999：1881．
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17. NIH consensus conference. Ovarian cancer: Screening, treatment, and follow-up. JAMA, 1995,273(6):491-497.
18. 乐杰.妇产科学(第6版).北京:人民卫生出版社,2005:306-311.
19. De Vita VT Jr, Hellman S, Rosenberg SA. Cancer. Principles and practice of oncology (6th ed). Philadelphia: Lippincott Williams & Wilkins, 1597-1632.
20. Vaisbuch E, Dgani R, Ben-Arie A, et al. The role of laparoscopy in ovarian tumors of low malignant potential and early-stage ovarian cancer. Obstet Gynecol Surv. 2005, 60:326-330.
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34. Megibow AJ, Bosniak MA, Ho AG, et al. Accuracy of CT in detection of persistent or recurrent ovarian carcinoma: correlation with second-look laparotomy. Radiology, 1988, 166: 341-345.
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