| In China,the incidence of cervical cancer has been at a high level,which is one of the most common malignant tumors in women.The incidence and mortality of cervical cancer rank first among female reproductive malignant tumors in China,and the age of cervical cancer is becoming younger and younger,which serious physical and mental damage to patients.Clinicians make diagnosis and treatment plans for cervical cancer according to the clinical stages of cervical cancer,the fertility requirements of patients and the health status of patients.Obstetricians and gynecologists both here and abroad have always taken clinical examination as the main basis for staging cervical cancer.The accuracy of staging cervical cancer is determined by the experience and subjective consciousness of clinicians.In the latest FIGO staging criteria for cervical cancer in2018,pelvic and abdominal aortic lymph node metastasis was included in cervical cancer staging for the first time,and imaging technology was used as a diagnostic method for lymph node metastasis.High-frequency ultrasound,magnetic resonance imaging,CT and PET-CT are commonly used in the diagnosis and staging of cervical cancer by clinicians.The advantages of MRI are non-radiation,high soft tissue resolution,non-invasive functional imaging and multi-directional and multi-sequence imaging,which are favored by clinicians.In the past,conventional MRI and other imaging techniques mostly used to stage cervical cancer from morphological aspects,and the accuracy of staging was not particularly ideal.In recent years,with the continuous development of magnetic resonance technology,new magnetic resonance technology has been maturing and perfecting.Diffusion weighted imaging?DWI?can detect the internal changes of tissues at the molecular level,and it is non-invasive,and quantify the internal changes by ADC value.DCE-MRI is based on T1WI transverse scanning,injecting contrast agent,which flows through the lesion.The clearance of contrast agent in blood vessels and tissues can reflect the angiogenesis and tissue cells in the lesion.Relevant studies have proved that conventional MRI combined with DWI and DCE-MRI can improve the accuracy of diagnosis and staging of cervical cancer.This article mainly discusses the application of DWI,ADC value,TIC curve of DCE-MRI and quantitative parameters K trans,Ve and Kepp in the diagnosis and staging of cervical cancer.ObjectiveTo clarify the application of diffusion weighted imaging?DWI?and its quantitative index ADC value,dynamic contrast-enhanced magnetic resonance imaging?DCE-MRI?and its TIC curve,quantitative parameters(K trans,Ve,Kep)in the diagnosis and staging of cervical cancer.Materials and MethodsThe imaging data of 45 patients with cervical cancer confirmed by histopathology in our hospital were retrospectively analyzed and recorded.All patients underwent Conventional MRI,DWI and DCE-MRI scanning before relevant treatment.In addition,45 patients with normal cervix and other pelvic examinations were retrospectively analyzed.Routine plain scan,DWI and DCE-MRI were also performed.The normal cervical and cervical cancer were observed and recorded on conventional MRI,DWI?b=800s/mm2 and corresponding ADC maps?and DCE-MRI.According to FIGO 2018standard,the imaging data of 45 patients with cervical cancer were staged and grouped.The accuracy of conventional MRI,DWI and DCE-MRI in the diagnosis of cervical cancer and the coincidence rate of staging were counted according to the staging of cervical cancer patients by clinicians.The ADC value of cervical cancer group was compared with that of normal group.The ADC values between different stages of cervical cancer were compared.According to the DCE-MRI images of cervical cancer group and normal cervix group,region of interest?ROI?was selected to draw TIC curve,and the difference of TIC curve between cervical cancer group and normal cervix group was statistically compared.Quantitative parameters Ktrans,Ve and Kepp of DCE-MRI in45 patients with cervical cancer were analyzed.Quantitative parameters of normal cervix and cervical cancer at different stages were compared.Result1.The criteria are clinical examination by clinicians or general stage after operation.Among the 45 cases,40 cases were squamous cell carcinoma,3 cases were adenocarcinoma and 2 cases were adenosquamous cell carcinoma.2.Cervical cancer focus showed low signal on T1WI,high signal on T2WI,high signal on DWI images with b=800 s/mm 2,and low signal on ADC images.Enhanced scanning lesions showed enhancement,and the degree of enhancement was lower than that of cervical muscular layer.3.In 2018 FIGO staging criteria of cervical cancer,cervical cancer included stage Ia in4 cases?8.9%?,stage Ib in 24 cases?53.3%?,stage IIa in 5 cases?11.1%?,stage IIb in 3cases?6.7%?,stage IIIa in 4 cases?8.9%?and stage IIIb in 5 cases?11.1%?.The diagnostic accuracy of conventional MRI scan was 77.8%,stage Ia in 3 cases?6.7%?,stage Ib in 24 cases?53.3%?,stage IIa in 4 cases?8.9%?,stage IIb in 2 case?4.4%?,stage IIIa in 4 case?8.9%?and stage IIIb 8 in cases?17.8%?,which underestimated 6cases and overestimated 4 cases.The diagnostic accuracy of conventional MRI and DCE-MRI was 88.9%,stage Ia in 3 cases?6.7%?,stage Ib in 24 cases?53.3%?,stage IIa6 in cases?13.3%?,stage IIb in 2 case?4.4%?,stage IIIa in 4 cases?8.9%?,stage IIIb in6 cases?13.3%?,3 cases were overestimated,1 case underestimated and 1 case was missed.The diagnostic accuracy of DWI+DCE-MRI was 93%,stage Ia in 3 cases?6.7%?,stage Ib in 24 cases?53.3%?,stage IIa in 4cases?8.9%?,stage IIb in 5 cases?11.1%?,stage IIIa in 5 cases?11.1%?and stage IIIb in 5 cases?11.1%?.Three cases were overestimated.4.The ADC value of normal cervix was?1.698+0.831?*10-33 mm2/s,and that of cervical cancer patients was?0.976+0.211?*10-33 mm2/s.The ADC values in the cervical cancer lesions of stage I,II and III ofwere?1.120+0.092?*10-33 mm2/s,?0.836+0.041?*10-3mm2/s,?0.650+0.066?*10-33 mm2/s respectively.The degree of staging of cervical cancer was negatively correlated with ADC values.5.The time-signal curve of normal cervix is persistently enhancing type?type I?.In this study,43 cases of TIC of cervical cancer were plateau type?type II?,and 2 cases were persistently enhancing type?type I?.Quantitative parameters K trans,Ve and Kepp of DCE-MRI increased with the increase of stage of cervical cancer.K transrans in stage I to stage?of cervical cancer was?0.178+0.032?min-1,?0.290+0.023?min-1,?0.406+0.097?min-11 respectively.Kepp in stage I to stage?of cervical cancer was?0.178+0.032?min-1,?0.290+0.023?min-1,?0.406+0.097?min-11 respectively.Ve in stage I to stage?of cervical cancer was?0.431±0.034?%,?0.566±0.029?%,?0.658±0.037?%respectively.ConclusionThe location and depth of invasion of early cervical cancer can be clearly displayed by T2WI sequence.The combination of DWI and DCE-MRI can significantly improve the accuracy of preoperative diagnosis of cervical cancer.DWI can observe the existence of abnormal signals of cervical cancer,DCE-MRI can further eliminate the interference of surrounding soft tissue edema on the boundary of the lesion,and increase the accuracy of staging cervical cancer.The ADC value of normal cervix is higher than that of cervical cancer.The ADC value is related to the stage of cervical cancer.The lower the ADC value,the higher the stage of cervical cancer.There is a negative correlation between them.DCE-MRI time-signal curve can continuously monitor the blood flow changes in cervical cancer lesions.TIC of cervical cancer lesions is different from TIC of normal cervix,which can be used to diagnose cervical cancer.DCE-MRI quantitative parameters K trans,Ve and Kepp increased with the increase of cervical cancer staging,which can be used to assist the clinical staging of cervical cancer. |
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