磁共振二维成像与三维重建技术对胃癌术前分期的评估  

Preoperative Evaluation of Gastric Cancer Using MR 2D Imaging with 3D Reconstruction Techniques

作　　者：钟喨[1] 李磊[1] 孙建华[2] 许建荣[1] 

机构地区：[1]上海第二医科大学仁济医院放射科,上海200001 [2]上海第二医科大学仁济医院外科,上海200001

出　　处：《上海第二医科大学学报》2005年第10期1009-1013,共5页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的探讨磁共振二维成像与三维重建技术的综合应用对胃癌术前诊断与分期的临床价值。方法对15例临床拟诊胃癌患者作水充盈法磁共振检查,二维成像的MR扫描序列包括TSE-T1W I、TSE-T2W I及脂肪抑制(SPIR)。MR水成像扫描(重度T2加权TSE序列)的源图像在工作站上以最大强度重建法(M IP)、表面遮盖法(SSV)、容积透视法(VR)和仿真内镜法(VE)作三维图像后处理,并与钡餐造影和胃镜图像相对照。所有15例患者的16个胃癌病灶均经手术病理证实。结果15例患者均成功获得二维成像和三维重建图像,其M IP、SSV和VR图像类似钡餐造影,VE图像类似胃镜所见。MR检查准确检出了16个胃癌病灶中的14个(87.5%)进展期胃癌,且肿瘤位置、大小和形态分型均被正确评估。MR检查的术前TNM分期准确性为64.3%(9/14),与术后病理分期间有显著相关性(P<0.01)。T、N、M各因素的分期判断准确性分别为71.4%(10/14)、57.1%(8/14)和85.7%(12/14)。结论水充盈法MR二维成像与三维重建技术是胃癌术前诊断和分期的有效方法,但其对早期胃癌和良性病变的检测及N分期的评判,仍需作进一步的深入研究。Objective To evaluate the clinical value of magnetic resonance（MR） 2D imaging with 3D reconstruction techniques for preoperative diagnosis and TNM-staging of gastric cancers. Methods MR imaging with waterfilling method was performed in 15 patients with suspected gastric cancers. MR 2D imaging sequences included TSE- T1WI, TSE-T2WI and fat suppression （SPIR）. The source images of MR hydrography （heavy TSE-T2WI sequence） were reconstructed on workstation. Four 3D post-processing algorithms, including maximum intensity projection （MIP）, surface shaded viewing （SSV）, volume rendering （VR） and virtual endoscopy （VE）, were performed and compared with barium study and endoscopy. All 15 patients with 16 gastric cancers were confirmed by the post-opera- tive pathological findings. Results MR 2D imaging and 3D reconstruction images were successfully obtained in all 15 patients. MIP, SSV and VR images corresponded to upper gastrointestinal series findings, and VE images corresponded to gastroscopic views. In 16 gastric lesions, MR imaging advanced gastric cancers were diagnosed correctly 14 （87.5%） and the tumor location, size and classification were also accurately identified. The accuracy of MR imaging for determining preoperative TNM-staging was 64.3% （9/14） , and had a significant correlation with that of histopathologic staging （P 〈 0.01 ） Based on T, N and M factors, the staging accuracy of MR imaging was 71.4% （ 10/ 14） , 57.1% （8/14） and 85.7% （12/14） , respectively. Conclusion MR 2D imaging with 3D reconstruction techniques is an effective modality in preoperative diagnosis and TNM-staging of gastric cancers. However, detection of early cancer or benign lesion and N-staging should be further studied.

关 键 词：胃肿瘤 磁共振 三维重建 术前诊断 TNM分期 

分 类 号：R735.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学]