| Objective: To study the3.0T dynamic contrast-enhanced and Diffusion-weighted MR Imaging features of the normal uterine cervix and the cervicalcancer respectively; thus to evaluate the application of DWI combined withDCE-MRI in diagnosis and indication of pathological type grading andmonitoring the response of cervical carcinoma after chemo-radiotherapy.Methods: Cervical carcinoma group: twenty-eight female patients admitted ingynecology department and oncology department of our hospital with cervicalcarcinoma were collected from June2013to January2014. Normal controlgroup: ten female patients without cervical disease were collected from June2013to January2014. All cervical carcinoma cases were confirmed through asurgery pathology or at least a cervical biopsy.3cases were pre-invasive carcinoma and25cases progressive carcinoma (21cases were squamous carcinoma,3cases were adenocarcinoma and one case was small cell carcinoma). Inaddition to conventional MRI, cervical carcinoma group need to perform DWIand DCE-MRI scanning. According to the clinic treatment schedule, cervicalcarcinoma group was divided into operation group and chemo-radiation group.Analyzing the conventional MRI, DWI and the dynamic contrast-enhancementMRI of all the patients. Philips Extended Workspace was used to acquire the ADC (apparent diffusion coefficient) value and time-signal intensity curve. TheADC values were compared among the normal uterine cervix three-tier structures.The ADC values of the normal uterine cervix and cervical carcinoma, theadenocarcinoma and squamous carcinoma, different pathological levels ofsquamous carcinoma were also pairwise-compared respectively. Additionally,TIC types of the surrounding normal myometrium and cervical carcinoma werecompaired. The normal cases in control group were all undergo conventionalMR and DWI.25patients with cervical carcinoma were divided into operationgroup(10) and chemo-radiation group(15) with respect to therapeutic strategy.Another MR examination was done in13patients to further analyze the changesin carcinoma size,the mean ADC value and TIC types after chemo-radiotherapy.Meanwhile compare the mean ADC value and TIC types between completeresponse and partial response subgroups. Results:(1): The cervical endometrium, junctional zone and myometrium in normal uterine cervix weredisplayed clearly on diffusion weighted imaging. The mean ADC value ofcervical endometrium was (1.65±0.17)×10-3mm2/s, junctional zone’s meanADC value was (1.36±0.12)×10-3mm2/s, and the mean ADC value ofmyometrium was (1.85±0.15)×10-3mm2/s. The ADC value of junctional zonewas lower than the other two layers structures, the normal uterine cervix’s meanADC was (1.62±0.25)×10-3mm2/s. While, the differences between junctionalzone and myometrium, cervical endometrium and myometrium, cervicalendometrium and junctional zone were statistically significant (F=26.800, P＜ 0.05).(2): The cervical carcinoma’s mean ADC value was（0.83±0.12）×10-3mm2/s, which was relatively lower than the normal uterine cervix. Thisdifference in ADC values was statistically significant (t=14.536, P＜0.05).(3):The mean ADC value of squamous carcinoma was (0.79±0.08)×10-3mm2/s, themean ADC value of adenocarcinoma was (1.09±0.10)×10-3mm2/s. the meanADC value was statistically different between squamous carcinoma andadenocarcinoma of cervical carcinoma (t=-6.023, P＜0.05).(4): The meanADC value of the poorly differentiated squamous carcinoma, moderatelydifferentiated squamous carcinoma and well-differentiated squamous carcinomawas (0.68±0.07)×10-3mm2/s,(0.79±0.04)×10-3mm2/s,(0.90±0.19)×10-3mm2/s respectively. The difference among them was statistically significant(F=37.682, P＜0.05).(5): In cervical carcinoma group, there showed typeⅠcurve(2), type Ⅱcurve(14), type Ⅲ curve(9). But22cases showed typeⅠcurve,3showed typeⅡcurve in the surrounding normal myometrium,. Thedifference between curve types was statistically significant (χ2=32.784, P＜0.05).(6): According to pathologic staging, the accuracy of routine MRIstaging and routine MRI combined with DWI and DCE-MRI staging was60%and90%respectively. The coincidence rate of fifteen patients in chemo-radiationgroup between clinic staging and routine MRI combined with DWI andDCE-MRI was78.6%.(7): After chemo-radiation therapy,13patients showedan increase in ADC values. The difference of mean ADC value betweenpre-chemoradiation (0.80±0.13)×10-3mm2/s and the post-chemoradiation (1.43 ±0.29)×10-3mm2/s was statistically significant(P＜0.05). The TIC typesbetween pre-chemo-radiation and post-chemo-radiation also has been changedstatistically （P＜0.05）.(8): The mean ADC value of CR group and partialresponse (PR) group were(1.57±0.12)×10-3mm2/s and(0.96±0.04)×10-3mm2/s.The CR group had a higher mean ADC value than PR group (P＜0.05). Thedifference in TIC types of CR and PR group showed no statistical significance (P＜0.05).Conclusion: DWI and DCE-MRI might be likely to differentiate betweencancerous and normal tissue in the uterine cervix and can display therelationship between lesions and surrounding tissue. They may be helpful toimprove diagnosis.1.The mean ADC value of squamous carcinoma andadenocarcinoma of cervix were statistically significant (P＜0.05). The ADCvalue may indicate the pathological type of cervical carcinoma. The ADCvalue of squamous carcinoma in different grades were statistically significant(P＜0.05). The ADC value may evaluate the pathological grading of cervicalsquamous carcinoma.2.DWI and DCE-MRI can improve the accuracy of thestaging in cervical carcinoma, this is to play a key role for the formulation ofthe follow-up treatment.accuracy of the staging in cervical carcinoma, this is toplay a key role for the formulation of the follow-up treatment.3.DWI andDCE-MRI have the ability to monitor the response of cervical carcinoma afterchemo-radiotherapy, this provide a new method for diagnosis and evaluate thepathological grading and monitoring of uterine cervical carcinoma after chemo-radiotherapy. |
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