Nicolet V, Carignan L, Bourdon F, Prosmanne O
Department of Radiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke Est, Montréal, Québec, Canada.
Radiographics. 2000 Nov-Dec;20(6):1539-49. doi: 10.1148/radiographics.20.6.g00nv111539.
Cervical carcinoma is the third most common gynecologic malignancy and is typically seen in younger women, often with serious consequences. The International Federation of Gynecology and Obstetrics (FIGO) staging system provides worldwide epidemiologic and treatment response statistics. However, there are significant inaccuracies in the FIGO staging system, and magnetic resonance (MR) imaging, although not included in that system, is now widely accepted as optimal for evaluation of important prognostic factors such as lesion volume and metastatic lymph node involvement that will help determine the treatment strategy. MR imaging examination obviates the use of invasive procedures such as cystoscopy and proctoscopy, especially when there is no evidence of local extension. Brachytherapy and external beam therapy are optimized with MR imaging evaluation of the shape and direction of lesion growth. In general, T2-weighted MR imaging more clearly delineates cervical carcinoma and is preferred for evaluation of the lymph nodes. Dynamic gadolinium-enhanced T1-weighted imaging may help identify smaller tumors, detect or confirm invasion of adjacent organs, and identify fistulous tracts. MR imaging staging, when available, is invaluable for identifying important prognostic factors and optimizing treatment strategies.
宫颈癌是第三大常见妇科恶性肿瘤，多见于年轻女性，往往会造成严重后果。国际妇产科联盟（FIGO）分期系统提供了全球范围内的流行病学和治疗反应统计数据。然而，FIGO分期系统存在显著的不准确之处，磁共振（MR）成像虽未纳入该系统，但目前已被广泛认为是评估重要预后因素（如病变体积和转移性淋巴结受累情况）的最佳方法，这些因素有助于确定治疗策略。MR成像检查避免了使用诸如膀胱镜检查和直肠镜检查等侵入性操作，尤其是在没有局部扩散证据的情况下。通过对病变生长的形状和方向进行MR成像评估，可以优化近距离放射治疗和外照射治疗。一般来说，T2加权MR成像能更清晰地勾勒出宫颈癌，是评估淋巴结的首选方法。动态钆增强T1加权成像可能有助于识别较小的肿瘤，检测或确认邻近器官的侵犯，并识别瘘管。如果可以进行MR成像分期，对于识别重要预后因素和优化治疗策略将非常有价值。
