[MRI在早期宫颈癌伴阴道超声凝胶填充分期中的价值]
[The Value of MRI in Early Cervical Cancer Staging with Vaginal Filling of Ultrasound Gel].
作者信息
Mou Can, Lü Fa-Jin, Yu Bin, Xiao Zhi-Bo
机构信息
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
出版信息
Sichuan Da Xue Xue Bao Yi Xue Ban. 2021 May;52(3):523-527. doi: 10.12182/20210560307.
OBJECTIVE
To investigate the value of MRI after ultrasonic gel vagina filling in the staging of early-stage cervical cancer.
METHODS
A total of 158 patients with cervical cancer who underwent MRI examination after their cervical cancer diagnosis was confirmed by cervical biopsy were prospectively enrolled. Routine MRI examination was performed first, followed by another MRI examination after vaginal filling with ultrasound gel. Two physicians used a double-blind method to determine the staging of cervical cancer based on the MRI images before and after vaginal filling of ultrasound gel. Results of the postoperative pathology analysis were used as the golden standard. The positive predictive value and negative predictive value for stage Ⅱa cases of the two examinations of the same patient were compared, and the sensitivity, specificity and accuracy in identifying stage Ⅱa cervical cancer were compared.
RESULTS
Two physicians used the double blind method to determine the staging of cervical cancer based on conventional MRI images, achieving moderate consistency ( =0.680). However, for the staging of cervical cancer with MRI images after vaginal filling of ultrasound gel, the two physicians achieved highly consistent results ( =0.932). Regarding identifying stage Ⅱa cervical cancer, the positive predictive value of conventional MRI was 66.67%, the negative predictive value was 76.74%, and the sensitivity, specificity and accuracy were 70.59%, 73.33% and 72.15%, respectively. The positive predictive value of MRI after vaginal filling of ultrasound gel was 90.91%, the negative predictive value was 91.3%, and the sensitivity, specificity and accuracy were 88.24%, 93.33% and 91.14%, respectively. The sensitivity, specificity and accuracy of the two methods were compared and the difference was statistical significant ( <0.05).
CONCLUSION
MRI examination after ultrasound gel vaginal filling has better diagnostic value for identifying stage Ⅱa cervical cancer. The method is simple and easy to do, and can be used in routine MRI examination of cervical cancer.
目的
探讨超声凝胶阴道填充后MRI在早期宫颈癌分期中的价值。
方法
前瞻性纳入158例经宫颈活检确诊为宫颈癌后接受MRI检查的患者。先进行常规MRI检查，然后在阴道填充超声凝胶后再进行一次MRI检查。两名医师采用双盲法根据超声凝胶阴道填充前后的MRI图像确定宫颈癌分期。术后病理分析结果作为金标准。比较同一患者两次检查对Ⅱa期病例的阳性预测值和阴性预测值，并比较两种方法在识别Ⅱa期宫颈癌中的敏感性、特异性和准确性。
结果
两名医师采用双盲法根据常规MRI图像确定宫颈癌分期，一致性一般（κ=0.680）。然而，对于超声凝胶阴道填充后的MRI图像进行宫颈癌分期，两名医师的结果高度一致（κ=0.932）。在识别Ⅱa期宫颈癌方面，常规MRI的阳性预测值为66.67%，阴性预测值为76.74%，敏感性、特异性和准确性分别为70.59%、73.33%和72.15%。超声凝胶阴道填充后MRI的阳性预测值为90.91%，阴性预测值为91.3%，敏感性、特异性和准确性分别为88.24%、93.33%和91.14%。比较两种方法的敏感性、特异性和准确性，差异有统计学意义（P<0.05）。
结论
超声凝胶阴道填充后MRI检查对识别Ⅱa期宫颈癌具有较好的诊断价值。该方法简单易行，可用于宫颈癌的常规MRI检查。
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