Application Values Of High-resolution MRI With Dynamic Contrast-enhancement?DWI In Diagnosis And Staging Of Cervical Carcinoma

Objective To investigate the application values of high-resolution 3.0T MRI with dynamic contrast-enhancement?DWI in diagnosis and staging of cervical carcinoma.Materials and MethodsSubjectsPatient group:88 cases of patients(age27?71,average age 50.2 � 9.3)diagnosed cervical cancer durning August 2013 to January 2015 at the First Affiliated Hospital of Guangxi Medical University,took pelvic MRI examination.Among them,30 cases were takend hysterectomy surgical pathology in a week;84 cases were squamous cell carcinoma,4 cases were adenocarcinoma;among the squamous cell carcinoma,16 cases were pathological grade ?,46 cases were grade ?,22 cases were grade ?.Normal control group:10 healthy wonmen(age28?64,average age47.6� 12.8)who were in non-menstrual period or menopause took pelvic MRI.MRI examination and image post-processing Siemens Magnetom Verio 3.0T superconducting magnetic resonance scanner,Magnetic resonance image processing software:Siemens 3.0T MRI workstation of Mean Cure software.uterus high-resolution scan sequence:transverse,sagittal T1WI,T2WI and fat suppression sequences,DWI sequence(Diffusion weighted imaging)(b = 1000 s/mm2),dynamic contrast-enhanced.Vascular remodeling,drawing time-signal intensity curve and ADC values.Research project1.Taking the pathological staging diagnosis as the gold standard,evaluate the diagnostic value of high-resolution 3.0T MR imaging combined with dynamic contrast-enhancement?DWI in diagnosing and staging cervical cancer and compute the sensitivity and specificity of IB,II A,IIB,respectively;2.Analysis MRI hemodynamic characteristics of Cervical Cancer(time-signal intensity curve,early intensive rate,strengthening the peak,the peak time);3.Compare the differences between cervical cancer and normal cervix,cervical squamous cell carcinoma and adenocarcinoma in ADC value.Using ROC curve to analyse the diagnostic efficacy of ADC values in discriminating cervical cancer with normal cervix,cervical squamous cell carcinoma with adenocarcinoma,and determine the best diagnostic threshold;4.Compare the difference of ADC values in different pathological level of cervical cancer;5.Analyse the correlation ship of cervical squamous cell carcinoma with ADC values and pathological level.Statistical analysis Using SPSS 17.0 statistical software.(1)Pathological diagnosis as the gold standard to calculate the sensitivity and specificity indices in MRI scan combined with dynamic contrast-enhancement?DWI of cervical cancer;(2)Calculate the early intensive rate,strengthening the peak and the peak time of TIC(mean � standard deviation);(3)After confirmed all the data were normally distributed,Using two independent samples t test to compare the differences of ADC values between cervical cancer with normal cervix,cervical squamous cancer with adenocarcinoma;Valuate criteria of them by the area under the ROC;(4)After confirmed the data were normal distribution and homogeneity of variance,ANOVA analysis were used to compare the ADC values of different pathological grade cervical cancer;Bivariate correlation analysis were used to calculate Spearman rank correlation coefficient,to analyze the correlation ship between histological grade and ADC values of cervical cancer.Test significance level p<0.05 was considered statistically significant.ResultsMorphological manifestationsIn 30 cases of cervical cancer,1 case in staging I A,19 cases in I B,6 cases in II A,4 cases in ?B,pathology showed 1 case was invased the basement membrane less than 5mm,19 cases invased the superficial muscle,10 cases invased the deep muscle but without parametrial invasion.All these cases were without vagina invasion.MRI can't detecte I A.Cervical cancer shows equal signal on T1WI,slightly higher or high signal on T2WI and T2WI fat-press sequence,and shows high signal with shap boundaries on DWI map(b value = 1000s/mm2),with low signal on ADC map.Cervical cancer 's(staging I b,II a,II b)sensitivity and specificity in high-resolution MR imaging combined with dynamic contrast-enhancement,DWI were I b 94.7%,100%;II a of 66.7%,95.8%;II b of 100%,92.3%,respectively.Hemodynamic performanceCervical cancer:TIC type I was 60.0%(18/30),type II was 20.0%(6/30),type III was 6.7%(2/30),type VI was 13.3%(4/30),early intensive rate was 154.76 � 38.22%,peak enhancement was307.62 � 65.32,Time to peak was(2.07� 0.12)min.After injection,non-invasive myometrium performance:TIC type I was 10%(1/10),type II was 10%(1/10),type ? was 40%(4/10),type IV was 40%(4/10).early intensive rate was 198.50 � 29.84%,peak enhancement was 308.31� 44.55,Time to peak was(2.11 � 0.17)min.Took two-sample T-test between cervical cancer and non-invasive myometrium with early intensive rate,peak enhancement,Time to peak,t ?-3.291,-0.031,-0.778,P = 0.002,0.976,0.441,respectively.Function characteristicsThe mean ADC value of cervical cancer was(0.843 � 0.151)� 10-3mm2/s,the mean ADC value of normal cervix was(1.445 � 0.069)�10-31mm2/s,ADC value of cervical cancer was lower than ADC value of normal cervix,and two differences were statistically significant(t ?-12.418,p = 0.000).Applicate the ROC to analyze the distinguish of ADC values between cervical,cancer and normal cervix,AUC value was 0.995,indicating that the ADC value in differentiating cervical cancer with normal cervix had a highly diagnostic efficacy,95%confidence interval is(0.000?1.000)� 10-3/mm2/s.Select the best ADC threshold 1.283 �10-3mm2/s,the resulting maximum Youden index,and the sensitivity and specificity were 100%and 98.9%,respectively.The mean ADC value of cervical squamous cell carcinoma was {(0.835 ?0.149)�10-3mm2/s },lower than the mean ADC value of adenocarcinoma{(0.999 � 0.083)�l0-3mm2/s },the difference was statistically significant(t =-2.165,p = 0.033).Applicate the ROC to analyze the distinguish of ADC values between cervical squamous cell carcinoma and adenocarcinoma,AUC value was 0.908,indicating that the ADC value in differentiating cervical squamous cell carcinoma and adenocarcinoma of the cervix has a high diagnostic efficacy,95%confidence interval(0.842?0.973)�10-3 mm2/s.Select the best ADC threshold 0.943 �10-3mm2/s,the resulting maximum Youden index,the sensitivity and specificity were 100%and 86.9%.With pathological grade cervical squamous cell carcinoma(? ? ? grade level)rises,its degree of malignancy increased,ADC values decreased.The mean ADC values of grade I,II,III were(1.059 � 0.155)�10-3mm2/s,(0.847� 0.043)�10-3mm2/s,(0.680 � 0.084)�10-3mm2/s.ANOVA F = 91.932,P =0.000;Turkey test grade I,II grade,III grade were significant differences with each other.using Bivariate correlation analysis to calculate Spearman correlation coefficient(two-tailed test),resulting in a negative correlation between ADC values and histological grade(r =-0.832,P = 0.000).Conclusion1.Dynamic contrast-enhanced MRI of cervical cancer showed early tumor enhancement,and display a good signal contrast between normal tissue with tumor tissue,all there improved the detection rate of small lesions;,with the contrast agent quit in delayed enhancement,the small lesions would be more obviously noticed;2.DWI in Cervical cancer examination will help to highlight cervical cancer and to improve the accuracy of clinical staging;3.There were significant differences between ADC values of cervical cancer and normal cervix,the same as cervical squamous cell carcinoma and adenocarcinoma.All tthese suggest that DWI examination can help diagnose cancer and indicate the pathological type;4.ADC value of cervical cancer and its pathological grade was negatively correlated(r =-0.832),grade I(well-differentiated),grade II(moderately differentiated)and grade ?(poorly)tumor ADC values were(1.059 � 0.155)X 10-3mm2/s,(0.847 � 0.043)X 10-3mm2/s,(0.680 � 0.084)X 10-3mm2/s,respectively.The ADC values between Grade ? and ?,?? and?,? and ? were significantly different,suggest that the ADC value of cervical cancer can be used to assess the pathological level.