胃癌术前淋巴结分期的MDCT研究  

Preoperative MDCT Evaluation of Gastric Cancer for N-staging

作　　者：贾海鹏[1] 张欢[1] 潘自来[1] 付天鹏[1] 宋琦[1] 丁蓓[1] 凌华威[1] 陈克敏[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,瑞金二路197号上海200025

出　　处：《中国医学计算机成像杂志》2009年第4期338-344,共7页Chinese Computed Medical Imaging

基　　金：上海市卫生局资助项目(编号:2007072)~~

摘　　要：目的:本研究利用多层螺旋CT(MDCT),以不同的淋巴结分期标准对胃癌区域淋巴结前瞻性的术前N分期,术后与病理对照,探讨其在胃癌术前淋巴结N分期中的价值。方法:经胃镜确诊的118例胃癌患者,采用16层螺旋CT,行水充盈法三期增强扫描。分别以Ⅰ组(胃周淋巴结短径>6mm,胃周外淋巴结短径>8mm)、Ⅱ组(胃周淋巴结短径>5mm,胃周外淋巴结短径>6mm)诊断标准,并分别采用横断面图像与横断面结合多层面重组(MPR)图像N分期,进行组间对照。结果:单独采用横断面图像,以Ⅰ组、Ⅱ组标准判断时,两组N分期结果基本一致(Kappa=0.7105),但各期(N0～N3)的诊断水平有差异(P<0.05)。Ⅰ组对胃癌N分期的准确率、敏感性、特异性分别为62.7%、67.8%、77.8%,Ⅱ组分别为67.8%、79.7%、71.2%,其中Ⅱ组的敏感性高于Ⅰ组(s=7,P=0.0082<0.05),Ⅱ组N2期的准确率优于Ⅰ组(s=6,P=0.0143<0.05);Ⅰ组过低分期率较Ⅱ组高(26.2%vs16.9%,P=0.0253<0.05)。横断面结合MPR图像与单独采用横断面图像N分期准确率分别为71.2%、67.8%,两者间无统计学差异(P>0.05,Kappa=0.84)。结论:应用美国癌症联合委员会(AJCC)N分期法,采用胃周淋巴结短径>5mm,胃周外淋巴结短径>6mm,更能较为准确地进行术前N分期。横断面结合MPR图像比单独采用横断面图像有助于改善胃癌术前准确N分期,但无统计学差异。Purpose： To prospectively evaluate the accuracy of dynamic multidetector CT images for preoperative N（lymph node） staging of gastric cancer with different MDCT diagnostic criterias. Methods： One hundred and eighteen patients with gastric cancer confirmed by endoscopy underwent preoperative triphasic 16 - MDCT scanning with water - filling method. According to Group Ⅰ （the short - axis diameter was 〉 6mm for the perigastric lymph nodes and 〉 8mm for the extraperigastric lymph nodes） and the Group Ⅱ （the short - axis diameter was 〉 5mm for the perigastric lymph nodes and 〉 6mm for the extraperigastric lymph nodes）as the reference diagnostic criteria, the images of all cases were evaluated on the axial CT images alone and in combination with multiplanar reformation（MPR） images respectively. The American Joint Committee on Cancer （AJCC 6th edition） TNM classification system was used. Results： Although all the diagnosis results （118 cases） of the lymph node metastases of gastric cancer of Group Ⅰ were accordance with the results of group Ⅱ （Kappa = 0. 7105）, the difference of diagnostic levels for each N stage（N0- N3） was statistically significant（P 〈 0.05） . Overall accuracy（liB cases） in assessment of N staging was 62.7% （N0 78.0% ,N1 59.0% ,N2 29.5% ,N3 0%, respectively）with Group Ⅰ and 65.2% （ N0 66.1% ,N1 69.2% ,N2 64.7% ,N3 0%, respectively） with Group Ⅱ . The result of group Ⅱ was better than group Ⅰ at N2 staging accuracy（P = 0. 0143 〈 0.05）. Furthermore, overstaging rate of the N staging in group Ⅰ （26.2%） was higher than that in group Ⅱ （16.9%） （ P 〈 0.05） . Regarding N staging, the accuracy of the axial and the combination of axial and MPR was as follows： 67.8% versus 71.2%. This difference was not statistically significant（P = 0. 1797〉 0.05） .Conclusions： In order to achieve more accurate preoperative N staging with AJCC TNM classification , we shoud pay more attention to the small regional lym

关 键 词：体层摄影术 X线计算机 胃癌 淋巴结 TNM 

分 类 号：R735.2[医药卫生—肿瘤]