deSouza N M, Scoones D, Krausz T, Gilderdale D J, Soutter W P
Robert Steiner Magnetic Resonance Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
AJR Am J Roentgenol. 1996 Mar;166(3):553-9. doi: 10.2214/ajr.166.3.8623627.
The purposes of this study were to assess the appearance of stage 1 neoplasia of the cervix by high-resolution MR imaging with an enveloping transvaginal receiver coil and to correlate the imaging findings with the pathologic findings.
Fifteen patients (25-73 years old; mean, 40 years old) with clinical stage I disease were examined with a 37-mm-diameter ring-design solenoid receiver coil placed around the cervix. Axial 2.5-mm contiguous slices were obtained with a field of view of 10-15 cm on a 1.0-T HPQ Vista scanner with T1-weighted (660/20 msec [TR/TE]) and T2- weighted (2500/80 msec) spin-echo sequences and dynamic gradient-echo sequences during injection of gadopentetate dimeglumine (0.1 mmol/kg). Ten patients subsequently underwent Wertheim's hysterectomy, two underwent radiotherapy, two underwent extended cone biopsy for microinvasive disease, and one underwent a punch biopsy. For seven of 10 patients who had a hysterectomy, the widths of the tumor and the residual stroma were measured at eight radial points on the transverse images and at corresponding points on the histologic specimens at 5, 10, 15, 20, and 25 mm from the ectocervix. We then compared the widths of the tumor and the stroma on images and histologic specimens at each of these 40 points. Tumor volumes were calculated from the MR imaging and pathologic data and compared. For the other three patients, detailed MR imaging-pathology correlation was not possible because of multifocal tumor distribution (two patients) and insufficient detailed pathologic data (one patient).
Three carcinoma types were recognized. Squamous carcinoma (nine cases) was seen as a centrally expanding intermediate-signal-intensity mass, whereas oat (small)-cell carcinoma (one case) and clear-cell carcinoma (one case) showed a multifocal distribution. For patients who had a radical hysterectomy, we noted good agreement between the widths of the tumor and the stroma determined by MR imaging and histology. Tumor volumes were determined to be 0-28.2 cm3 by MR imaging and 0-18.4 cm3 by pathology. We observed tumor extension into the immediate parametrium in four patients by MR imaging; one of these cases was not confirmed at surgery. Parametrial extension was not underestimated by MR imaging in any case.
High-resolution imaging of the cervix with a transvaginal coil provides accurate assessment of the intra- and extracervical extents of tumors in clinical stage 1 cervical neoplasia.
本研究的目的是通过使用包绕式经阴道接收线圈的高分辨率磁共振成像来评估宫颈1期肿瘤的表现，并将影像学表现与病理结果相关联。
15例临床I期疾病患者（年龄25 - 73岁；平均40岁）使用直径37毫米的环形设计螺线管接收线圈环绕宫颈进行检查。在1.0-T HPQ Vista扫描仪上，采用T1加权（660/20毫秒[TR/TE]）和T2加权（2500/80毫秒）自旋回波序列以及注射钆喷酸葡胺（0.1 mmol/kg）期间的动态梯度回波序列，获得轴向2.5毫米连续切片，视野为10 - 15厘米。10例患者随后接受了Wertheim子宫切除术，2例接受了放射治疗，2例因微浸润性疾病接受了扩大锥形活检，1例接受了穿刺活检。对于10例接受子宫切除术的患者中的7例，在距宫颈外口5、10、15、20和25毫米处的横向图像上以及组织学标本的相应点处，在八个径向点测量肿瘤和残余基质的宽度。然后我们比较了这40个点处图像和组织学标本上肿瘤和基质的宽度。根据磁共振成像和病理数据计算肿瘤体积并进行比较。对于另外3例患者，由于肿瘤多灶性分布（2例患者）和病理数据不足（1例患者），无法进行详细的磁共振成像 - 病理相关性分析。
识别出三种癌类型。鳞状细胞癌（9例）表现为中心性扩展的中等信号强度肿块，而燕麦（小）细胞癌（1例）和透明细胞癌（1例）表现为多灶性分布。对于接受根治性子宫切除术的患者，我们注意到磁共振成像和组织学确定的肿瘤和基质宽度之间具有良好的一致性。磁共振成像确定的肿瘤体积为0 - 28.2立方厘米，病理确定的肿瘤体积为0 - 18.4立方厘米。通过磁共振成像我们观察到4例患者肿瘤延伸至紧邻的子宫旁组织；其中1例在手术中未得到证实。在任何情况下，磁共振成像均未低估子宫旁组织的延伸。
经阴道线圈对宫颈进行高分辨率成像可准确评估临床1期宫颈肿瘤在宫颈内和宫颈外的范围。
