Applied Value of Magnetic Resonance Imaging in the Clinical Stage of Cervical Cancer

doi:10.3877/cma.j.issn.1673-5250.2012.05.008

Objective

To evaluate applied value of magnetic resonance imaging (MRI) in the clinical stage of cervical cancer.

Methods

From September 2009 to September 2011, a total of 92 cases (29- to 82-year-old) of cervical cancer with completely clinical data were included into this study. The results of MRI before surgery were analyzed. Among those 92 cases, 73 of them received selective radical hysterectomy + pelvic lymph node dissection. The pathological and MRI results were compared. Informed consent was obtained from all participates.

Results

MRI could show the cervical cancer in all cases with the exception of only 2 cases of Ⅰ_A stage. Positive rate was 97.8%(90/92). The tumor was represented by isointensity and hypo intensity on T1-weighted MR images and hyper intensity on T2-weighted MR images. After bolus intravenous GD-DTPA injection, varied enhancement presented in 81 cases, the tumor was hyper intensity on DWI. The cervical stoma of 49 cases showed incompletely, 43 cases completely. A total of 21 cases of enlarged pelvic node were well shown. MRI had an accuracy of 85.9% in clinical stage diagnosis. The negative predictive value of parametrical invasion, vaginal invasion, metastasis of lymph nodes and cervical cannel invasion for MRI were 95.3%, 98.2%, 93.1%, 78.3%, respectively. The specificity were 93.8%, 83.6%, 84.4%, 90.4%, respectively. The sensitivity were 62.5%, 83.3%, 55.6%, 38.1%, respectively.

Conclusions

MRI can show the location, size, signal characteristics, extension of the primary tumor and parametrical tissue. MRI plays a very useful role in identifying the stages of cervical cancer, especially for invasive carcinoma. MRI can be used as the first choice method for clinical stage of cervical cancer.

Key words: cervical carcinoma, clinical stage, neoplasm invasiveness, magnetic resonance imaging

表1 宫颈癌的MRI分期及表现

Table 1 The MRI clinical stage and features of cervical cancer

分期		MRI分期及表现
Ⅰ期		?
?	Ⅰ_A	呈阴性
?	Ⅰ_B	轴位见宫颈部中等信号的肿瘤突破正常宫颈低信号的结合带，但肿瘤边缘清晰，完整，没有向环状轮廓外突出
Ⅱ期		?
?	Ⅱ_A	宫颈低信号间质环中断，肿瘤向下侵犯低信号的阴道上1/3
?	Ⅱ_B	低信号间质环中断，肿瘤突向一侧或周围高信号的宫旁组织但未达盆壁
Ⅲ期		?
?	Ⅲ_A	类似Ⅱ_A，但向下累及阴道下1/3
?	Ⅲ_B	类似Ⅱ_B，但向周围突破达主韧带附着处或盆底肌肉受累或输尿管积水
Ⅳ期		?
?	Ⅳ_A	局部侵犯低信号的膀胱壁和/或使高信号的直肠壁增厚
?	Ⅳ_B	远处器官受累证据

表1 宫颈癌的MRI分期及表现

Table 1 The MRI clinical stage and features of cervical cancer

分期		MRI分期及表现
Ⅰ期		?
?	Ⅰ_A	呈阴性
?	Ⅰ_B	轴位见宫颈部中等信号的肿瘤突破正常宫颈低信号的结合带，但肿瘤边缘清晰，完整，没有向环状轮廓外突出
Ⅱ期		?
?	Ⅱ_A	宫颈低信号间质环中断，肿瘤向下侵犯低信号的阴道上1/3
?	Ⅱ_B	低信号间质环中断，肿瘤突向一侧或周围高信号的宫旁组织但未达盆壁
Ⅲ期		?
?	Ⅲ_A	类似Ⅱ_A，但向下累及阴道下1/3
?	Ⅲ_B	类似Ⅱ_B，但向周围突破达主韧带附着处或盆底肌肉受累或输尿管积水
Ⅳ期		?
?	Ⅳ_A	局部侵犯低信号的膀胱壁和/或使高信号的直肠壁增厚
?	Ⅳ_B	远处器官受累证据

表2 宫颈癌患者MRI分期与临床分期比较(n)

Table 2 Comparison of MRI stage and clinical stage of cervical cancer patients(n)

临床分期	MRI分期		合计
临床分期	Ⅰ期	≥Ⅱ期	合计
Ⅰ期	46	8	54
≥Ⅱ期	4	34	38
合计	50	42	92

表2 宫颈癌患者MRI分期与临床分期比较(n)

Table 2 Comparison of MRI stage and clinical stage of cervical cancer patients(n)

临床分期	MRI分期		合计
临床分期	Ⅰ期	≥Ⅱ期	合计
Ⅰ期	46	8	54
≥Ⅱ期	4	34	38
合计	50	42	92

表3 73例行广泛子宫切除术后病理学检查结果与术前MRI比较(n)

Table 3 Comparison of MRI results before treatment and postoperative pathological results among 73 cases with hysterectomy (n)

术前MRI	病理学检查
术前MRI	淋巴结转移		宫旁浸润		累及阴道		累及颈管
?	＋	－	＋	－	＋	－	＋	－
＋	5	10	5	4	5	11	8	5
－	4	54	3	61	1	56	13	47
合计	9	64	8	65	6	67	21	52

表3 73例行广泛子宫切除术后病理学检查结果与术前MRI比较(n)

Table 3 Comparison of MRI results before treatment and postoperative pathological results among 73 cases with hysterectomy (n)

术前MRI	病理学检查
术前MRI	淋巴结转移		宫旁浸润		累及阴道		累及颈管
?	＋	－	＋	－	＋	－	＋	－
＋	5	10	5	4	5	11	8	5
－	4	54	3	61	1	56	13	47
合计	9	64	8	65	6	67	21	52

表4 MRI对宫颈癌的阴性预测值、特异度及灵敏度(%)

Table 4 Negative predictive value, specificity and sensitivity of cervical cancer viewed by MRI (%)

侵犯部位	阴性预测值	特异度	灵敏度
累及颈管	78.3	90.4	38.1
累及阴道	98.2	83.6	83.3
宫旁浸润	95.3	93.8	62.5
淋巴结转移	93.1	84.4	55.6

表4 MRI对宫颈癌的阴性预测值、特异度及灵敏度(%)

Table 4 Negative predictive value, specificity and sensitivity of cervical cancer viewed by MRI (%)

侵犯部位	阴性预测值	特异度	灵敏度
累及颈管	78.3	90.4	38.1
累及阴道	98.2	83.6	83.3
宫旁浸润	95.3	93.8	62.5
淋巴结转移	93.1	84.4	55.6

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