Fischetti S G, Coppolino F, Priolo G D, Chiarenza R, Garufi A, Privitera G, Materazzo S, Loreto C
Università degli Studi, Catania.
Radiol Med. 1991 Oct;82(4):470-9.
Cervical carcinoma is one of the most frequent gynecologic malignancies. Its prognosis depends on both tumor volume at diagnosis and its stage. Staging accuracy is important not only for prognosis but also for optimal treatment planning. According to FIGO criteria, carcinomas without parametrial involvement (stage I and limited stage IIA disease) can be surgically treated. For more advanced stages, treatment, in most cases, consists of radiation therapy or chemotherapy alone. The authors evaluated MR accuracy in the diagnosis of parametrial involvement; to this purpose, 32 patients with histologically proven lesions were referred for MR imaging, which was performed with a 0.5 T superconductive magnet. Transverse and sagittal SE images were obtained with T2 weighting (TR 1800 ms, TE 30-100 ms); transverse and sometimes sagittal images were obtained with T1 weighting (TR 450/300 ms, TE 20/30). T1-weighted images distinguished neoplasm from cervical stroma or dense parametrial connective tissue in 40% of cases only. T2-weighted images, instead, demonstrated the difference in all cases, showing tumor as a hyperintense area in 90% of patients. Neoplastic involvement of pericervical connective tissue was diagnosed, with those sequences, on the basis of focal disruptions of the outer hypointense fibrous cervical stroma; findings were correlated with those from a previous clinical staging and in 26/32 patients with pathologic findings. MR accuracy in demonstrating parametrial involvement was 88%, sensitivity was 77% and specificity was 94%. Clinical staging accuracy in the evaluation of this parameter was 66%. In 6 cases with no surgical findings, MR confirmed extensive parametrial and vesical or rectal neoplastic involvement, as diagnosed at clinics. MR imaging, thanks to its multiplanar and multiparametric imaging capabilities is a very reliable technique in the preoperative staging of cervical carcinoma. Moreover, since clinical staging can sometimes underestimate pericervical connective spread, the higher accuracy of MR imaging can help avoid useless interventional procedures.
宫颈癌是最常见的妇科恶性肿瘤之一。其预后取决于诊断时的肿瘤体积及其分期。分期准确性不仅对预后很重要，对最佳治疗方案的制定也很重要。根据国际妇产科联盟（FIGO）标准，未累及宫旁组织的癌（I期和局限的IIA期疾病）可通过手术治疗。对于更晚期的病例，大多数情况下，治疗仅包括放射治疗或化疗。作者评估了磁共振成像（MR）在诊断宫旁组织受累方面的准确性；为此，32例经组织学证实有病变的患者接受了MR成像检查，使用的是0.5T超导磁体。采用T2加权（TR 1800ms，TE 30 - 100ms）获得横轴位和矢状位SE图像；采用T1加权（TR 450/300ms，TE 20/30）获得横轴位图像，有时也包括矢状位图像。T1加权图像仅在40%的病例中能将肿瘤与宫颈基质或致密的宫旁结缔组织区分开来。相反，T2加权图像在所有病例中都能显示出差异，90%的患者中肿瘤表现为高信号区。基于宫颈外低信号纤维基质的局灶性中断，利用这些序列诊断宫颈周围结缔组织的肿瘤累及情况；检查结果与先前的临床分期结果以及32例中有病理检查结果的26例患者的结果进行了对比。MR显示宫旁组织受累的准确性为88%，敏感性为77%，特异性为94%。评估该参数时临床分期的准确性为66%。在6例手术未发现病变的病例中，MR证实了临床诊断的广泛宫旁及膀胱或直肠肿瘤累及。由于MR成像具有多平面和多参数成像能力，它在宫颈癌术前分期中是一种非常可靠的技术。此外，由于临床分期有时会低估宫颈周围结缔组织的扩散情况，MR成像更高的准确性有助于避免不必要的干预性操作。
