| ObjectiveTo evaluate the role of diffusion weighted inmaging?DWI?and dynamic contrast enhanced magnetic resonance imaging?DCE-MRI?in the diagnosis,preoperative-staging,histological typing and grading of cervical cancer and to investigate the correlation between apparent diffusion coefficient?ADC?value and DCE-MRI parameters?maximum relative enhancement,MRE;wash-in rate,WIR;time to peak,TTP?.Materials and Methods1.Philips Achieva 3.0T MRI scanner,equipped with 8-channel phased-array torso surface coils was used in the experiment.Sixty cervical cancer patients?Fifty cases of squamous cell carcinoma and ten cases of adenocarcinoma confirmed by tissue biopsy?,between December 2014 and December 2015 in the First Affiliated Hospital of Bengbu Medical College were enrolled into this study.All patients underwent the conventional MRI and DWI scans,and DCE-MRI was performed in thirty-five of sixty casesof squamous cell carcinoma to get the sagittal images of cervical cancer.2.Spin echo-echo planar imaging?SE-EPI?DWI images were produced with b value of0 and 1000s/mm2.The ADC values of cervical cancer were measured using a separate dedicated Philips post-processing workstation.Then the correlation the mean ADC value and histological type and grade,gross classification and the age of onset of cancers.3.The conventional imaging and DWI sequences were performed in sixty cases of cervical cancer for preoperative staging.The result of postoperative pathology was regarded as a gold standard to compare the accuracy of these two staging methods,as well as the consistency between them and postoperative pathology.4.The e-THRIVEdynBH SENSE techniques in DCE-MRI were used to scan the35 cases of squamous cell carcinoma to obtain the sagittal images andtime-signal intensity curve?TIC?from the Philips post-processing workstation.After identifying the characters and regularity of the TIC,the DCE-MRI parameters including MRE,WIR and TTP generated by each region of interest?ROI?were automatically calculated with the Perfusion software.And the correlation between these values and the mean ADC values of tumor was analyzed.5.Statistical analysis:the data was analyzed by using SPSS19.0 software package.The measurement data were shown in the form of??x±s?,and compared with independent-samples T test and one-way analysis of variance;the data correlation was analyzed by using Spearman or Pearson algorithm,and the data consistency were analyzed by using the Chi-square test and Kappa.In this thesis,?level was set at 0.05,and P less than 0.05 denoted to significance.Results1.In this study,the mean ADC values of the 50 cases of squamous cell carcinoma and 10 cases of adenocarcinoma were?0.831±0.072?×10-3mm2/s and?0.946±0.085?×10-3mm2/s,respectively,and the difference was statistical significance.The mean ADC values of well,moderately and poorly differentiated cervical cancer were?0.889±0.073?×10-3mm2/s,?0.829±0.048?×10-3mm2/s,and?0.778±0.086?×10-3mm2/s,respectively,and the difference between any two was statistically significance?P=0.000?.While the correlation between the gross types and the ADC values was not statistically significance?F=2.023,P=0.121>0.05?.There was no significant correlation between the mean ADC values and the age of onset?r=0.196,P=0.134?.2.According to the International Federation of Gynecology and Obstetrics?FIGO?staging system for cervical cancer,the overall accuracy of the conventional MRI and MRI+DWI sequence for preoperative tumor staging was 75.44%and 85.96%,respectively,chi-square test showed that the difference between these two staging methods was statistical significant.When compared with the pathological findings,the Kappa value was 0.617 and 0.782.Among the 35 cases ofsquamous cell carcinoma,5cases were with type?curve,21 cases with type?curve,and 9 cases with type?curve.MRE and WIR were negatively correlated?r=-0.603,-0.544?with ADC value,while TTP positively with ADC value?r=0.703?.Conclusions1.The quantitative indicator ADC values play specific in distinguishing different pathological type of squamous cell carcinoma and adenocarcinoma and have some significance to discern squamous cell carcinoma with different level of differentiation.There was no significant correlation between the ADC values of tumor and gross type of tumor as well as the age of onset.2.The MRI+DWI sequence,with a higher accuracy as compared with the conventional MRI can well guide the clinical staging before the treatment.The DCE-MRI can reveal the morphological features of the blood supply in tumor tissues.The correlation between quantitative parameters and the ADC values canindicate the relevance between the proliferation of tumor tissue and internal microcirculation perfusion,which will provide important information for further research on the microstructure of tumor tissues. |
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