Van Vierzen P B, Massuger L F, Ruys S H, Barentsz J O
Department of Radiology, University Hospital Nijmegen, The Netherlands.
Clin Radiol. 1998 Mar;53(3):183-92. doi: 10.1016/s0009-9260(98)80098-6.
The first pass phase of contrast material is most important to study vascularization and perfusion of tissue and can be studied using dynamic magnetic resonance (MR) imaging. The purpose of this prospective study was to evaluate the usefulness of pre-contrast vs. post-contrast and fast dynamic MR imaging in the pre-operative staging of cervical carcinomas. To assess the normal onset of enhancement of the uterus and cervix 15 volunteers underwent dynamic MR imaging. Forty-two consecutive patients with invasive cervical cancer underwent pre-operative evaluation using MR imaging. The results of the MR examinations were correlated with clinical (FIGO) staging under anaesthesia (n = 42) and with histopathological findings after operation (n = 26). The staging results of pre-contrast T1-weighted and T2-weighted turbo spin-echo (TSE) MR images, pre-contrast MR images plus post-contrast enhanced (two dimensional fast low angle shot (FLASH 2-D) post contrast), pre-contrast MR images plus post-contrast enhanced plus fast dynamic enhanced (single slice turbo fast low angle shot (turbo FLASH)) MR images compared to histopathology (n = 26) were 77%, 81% and 85% respectively. The improvement was statistically not significant. The result of MR staging compared to clinical staging (n = 42) with pre-contrast MR images was correct in 79% of the cases. Pre-contrast MR images combined with post-contrast MR images did not significantly improve staging accuracy (83%). Pre-contrast plus post-contrast plus fast dynamic MR imaging improved staging to 91%. However, the improvement was only statistically significant for one reader (P = 0.01), whereas the improvement of the second reader was not significant (P = 0.07). The single slice turbo FLASH images showed enhancement of all squamous cell carcinomas (n = 32) with an average onset of 5s (range 4-8s) during the first 45s of bolus injection of gadolinium. The normal cervix showed enhancement with an average of 10s (range 6-14 s). FLASH 2-D post-contrast images showed less intense enhancement of the cervical tumours with respect to the parametria and other surrounding structures. Fast dynamic MR imaging and to a lesser degree post-contrast MR imaging showed a higher level of confidence than pre-contrast MR. Fast dynamic MRI compared with clinical staging (n = 42) was correct in 91% (38/42) and to histopathology in 85% (22/26). Comparison of clinical staging with histopathology was 85% (22/26). In conclusion, fast dynamic MR imaging is superior to post-contrast and pre-contrast MR imaging and is at least as good as clinical staging in the evaluation of cervical carcinoma.
对比剂的首次通过期对于研究组织的血管形成和灌注最为重要，可通过动态磁共振（MR）成像进行研究。这项前瞻性研究的目的是评估对比剂注射前与注射后以及快速动态MR成像在宫颈癌术前分期中的作用。为评估子宫和宫颈强化的正常起始情况，15名志愿者接受了动态MR成像检查。42例连续性浸润性宫颈癌患者接受了术前MR成像评估。MR检查结果与麻醉下的临床（国际妇产科联盟（FIGO））分期（n = 42）以及术后组织病理学结果（n = 26）进行了相关性分析。对比剂注射前T1加权和T2加权快速自旋回波（TSE）MR图像、对比剂注射前MR图像加对比剂注射后强化（二维快速低角度激发（FLASH 2-D）对比剂注射后）、对比剂注射前MR图像加对比剂注射后强化加快速动态强化（单层面快速低角度激发（turbo FLASH））MR图像与组织病理学（n = 26）相比的分期结果分别为77%、81%和85%。改善情况在统计学上无显著意义。对比剂注射前MR图像与临床分期（n = 42）相比，MR分期结果在79%的病例中是正确的。对比剂注射前MR图像与对比剂注射后MR图像相结合并未显著提高分期准确性（83%）。对比剂注射前加对比剂注射后加快速动态MR成像将分期准确性提高到91%。然而，仅一位读者的改善情况具有统计学意义（P = 0.01），而另一位读者的改善情况不显著（P = 0.07）。单层面turbo FLASH图像显示所有鳞状细胞癌（n = 32）在注射钆对比剂团注的前45秒内均有强化，平均起始时间为5秒（范围4 - 8秒）。正常宫颈的强化平均时间为10秒（范围6 - 14秒）。FLASH 2-D对比剂注射后图像显示宫颈肿瘤相对于宫旁组织和其他周围结构的强化程度较低。快速动态MR成像以及程度稍低的对比剂注射后MR成像显示出比对比剂注射前MR更高的可信度。快速动态MRI与临床分期（n = 42）相比，91%（38/42）正确，与组织病理学相比85%（22/26）正确。临床分期与组织病理学相比为85%（22/26）。总之，在宫颈癌评估中，快速动态MR成像优于对比剂注射后和对比剂注射前MR成像，且至少与临床分期效果相当。
