| Obj ective:Pelvic normal morphology,diffusion-weighted imaging and dynamic contrast-enhanced scan by using 3.0T MRI were performed in the middle-late stage cervix cancer,and combining the ADC values,the value of micro-vascular parameters,such as Ktrans,Kep,Ve,to study the the value of prediction and evaluation about diffusion-weighted imaging for locally advanced cervical cancer after radiotherapy,and summarizes the cervical cancer focal microvascular features and changes after radiotherapy,and quantitative values of each cancer group before and after radiotherapy for statistical analysis.In turn,to provide more clinical diagnosis,at the same time increases the recurrence of early cervical cancer and the detection rate and positive rate of metastases.Methods:35 cases of middle-late stage cervix cancer,underwent pelvic normal morphology,diffusion-weighted imaging and dynamic contrast-enhanced scan of Siemens Magnetom Verio 3.0T superconducting type MRI in radiology department of Guangxi medical university affiliated hospital after pathological examinations and clinical confimed during Jun.2012 to Dec.2014,with the age range of 29?68 years,and the median age is 42 years.There are 33 cases of squamous cancer,and adeno cancer.All the subjects in case group underwent conventional radiotherapy 1?2 months in our hospital after MRI examination.All the subjects in case group after radiotherapy are selected to the control group(its control principle).All the research objects in the case group and control group are selected by referencing 09 the international union of department of gynaecology FIGO staging diagnosis standard.According to the lesions have or without residue after radiotherapy,the control group can be devided into residual group and no residual group.All the cases in the residual group are selected to the second radiotherapy again,the radiotherapy plan is same to the previous one,and the duration was continued for a months.All the cases in the residual group,respectively underwent pelvic normal morphology,diffusion-weighted imaging and dynamic contrast-enhanced scan of Siemens Magnetom Verio 3.0T superconducting type MRI after conventional radiotherapy 1?2 months,we measured the volume of tumor lesion size,DWI signal strength,ADC values,dynamic enhanced perfusion quantitative parameter values such as Ktrans,Kep,Ve at the same time before radiotherapy,radiotherapy after 1 months and radiotherapy after 2 months,and analysis of the quantitative indicators of differences between carcinoma groups have statistical significance.Results:?35 cases of cervical cancer after radiotherapy in patients with tumor volume is significantly reduced before radiotherapy(t=4.838),reduce signal on DWI sequence can relatively before radiotherapy,the ADC values is significantly increased before radiotherapy(t=15.698),the difference has statistical significance(P<0.01).Residual group before and after radiotherapy ADC values were 1.09+0.02,1.47±0.09,ADC values change rate is 19.85±4.10.No residue groups before and after radiotherapy ADC values were 0.899±0.06,2.28±0.05,ADC values change rate is 43.23±10.65.Before radiotherapy,the residual group ADC values are higher than no residual group,ADC values are less than no residue group after radiotherapy group,ADC values change rate are less than no residue group,the difference is statistically significant(P<0.01).? There are 30 cases of residual group before radiotherapy,which Ktrans,Kep,Ve values are 0.95±0.56,1.54±0.78,0.68±0.17,The residual group after radiotherapy one month which Ktrans,Kep,Ve values are O.66±0.44,0.41±0.13,0.26±0.11.The microvascular quantitative indicators of numerical difference between the two groups which residual group before and after radiotherapy is statistically significant(P<0.05).? There are 30 cases of residual group and 5 cases of no residual group after cervical cancer radiotherapy one month,in which residual group Ktrans,Kep,Ve values are0.86±0.37,1.30±0.49,0.65±0.23,no residue group Ktrans,Kep,Ve values are 0.59±0.23,0.85±0.47,0.48±0.10.The microvascular quantitative index numbers of the residual group is higher than that of the no residual group,the difference is statistically significant(P<0.05).? There are 26 cases of residual group and 4 cases of no residual group after cervical cancer radiotherapy two months,in which residual group Ktrans,Kep,Ve values are 0.86±0.37,1.30±0.49,0.65±0.23,the residue group after cervical cancer radiotherapy one month which Ktrans,Kep,Ve values are 0.74±0.29,1.20±0.38,0.57±0.04.The microvascular quantitative index numbers of the residual group is higher than that of the no residual group,the difference is statistically significant(P<0.05).?In cervical cancer group before radiotherapy,3 3 cases are squamous carcinoma,2 cases are adenocarcinoma,in squamous carcinoma group Ktrans,Kep,Ve values were 0.55±0.16,1.44±0.68,0.48±0.17,in adenocarcinoma group,Ktrans,Kep,Ve values are 0.86±0.34,1.61±0.10,0.29±0.19.Ktans,Kep between squamous carcinoma and adenocarcinoma are statistically significant,Ve is not obvious difference,no statistical significant(P>0.05).?In cervical cancer group after radiotherapy one month,3 3 cases are squamous carcinoma,2 cases are adenocarcinoma,in squamous carcinoma group Ktrans,Kep,Ve values are 0.37±0.21,1.07±0.36,0.80±0.15,in adenocarcinoma group,Ktrans,Kep,Ve values are 0.65±0.40,1.10±0.83,0.55±0.71.Ktrans,Kep between squamous carcinoma and adenocarcinoma are statistically significant,Ve is not obvious difference,no statistical significant(P>0.05).?24 cases of squamous cancer of the cervix in grade ?,8 cases in grade ?,1 case in grade IV before radiotherapy.In grade? squamous carcinoma of the cervix group,Ktrans,Kep,Ve values were 0.56 ± 0.21?0.95±0.31.0.83±0.15,in grade III squamous carcinoma of the cervix group,Ktrans,Kep,Ve values were 0.67±0.33,1.14±0.43,0.53±0.11.Ktrans,Kep between cervical squmaous carcinoma II and III were statistically significant,Ve was not obvious difference,no statistical significant(P>0.05).Grade IV due to cervical cancer cases was too little,so it comparaed to the rest of the quantitative indicators between the two groups have no statistical significance.?8 cases of squamous cancer of the cervix in grade II,5 cases in grade ?,1 case in grade IV after radiotherapy one month.In grade II squamous carcinoma of the cervix group,Ktrans,Kep,Ve values were 0.477±0.32,0.84±0.29,0.75±0.11,in grade ? squamous carcinoma of the cervix group,Ktraps,Kep,Ve values were 0.58±0.23,0.98±0.56,0.46±0.11.Ktrans,Kep between cervical squmaous carcinoma II and III were statistically significant,Ve was not obvious difference,no statistical significant(P>0.05).Grade IV due to cervical cancer cases was too little,so it comparaed to the rest of the quantitative indicators between the two groups have no statistical significance.? 14 cases of squamous cancer of the cervix in grade II,3 cases in grade ?,1 case in grade IV after radiotherapy two months.In grade II squamous carcinoma of the cervix group,Krans,Kep,Ve values were 0.40±0.29,0.79±0.21,0.70±0.11,in grade III squamous carcinoma of the cervix group,Ktrans,Kep,Ve values were 0.55±0.22,0.93±0.51,0.39±0.15.Ktrans,Kep between cervical squmaous carcinoma II and III were statistically significant,Vewas not obvious difference,no statistical significant(P>0.05).Grade IV due to cervical cancer cases was too little,so it comparaed to the rest of the quantitative indicators between the two groups have no statistical significance.Conclusion:Regular morphology scan of cervical cancer is of important value for tumor detection and staging,but not sensitive to early lesions after radiotherapy changes.Residual cervical lesions after radiotherapy of ADC values than before radiotherapy,it is sensitive and stable to predict radiotherapy curative-effection and has diagnostic accuracy,applying diffusion weighted imaging and conventional morphological examination is more valuable.Dynamic enhanced scan of SI-T curve type,perfusion quantitative Ktrans values,Kep values in evaluation of tumor neovascular qualitative change after radiotherapy has important significance.A variety of fMRI methods evaluate cervical cancer radiotherapy combined use of better curative effect,and is very important to determine early tumor recurrence and metastasis. |
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