螺旋CT与磁共振对直肠癌术前分期的比较研究  

Comparative study between preoperative staging by MR and computed tomography in rectal carcinoma

作　　者：王亚宁[1] 时高峰[1] 杜煜[1] 

机构地区：[1]河北医科大学第四医院CT室,河北石家庄050011

出　　处：《临床荟萃》2010年第21期1859-1863,共5页Clinical Focus

基　　金：国家科技支撑计划课题(2007BAI05B05);河北省二○○九年医学科学研究重点课题计划(20090511)

摘　　要：目的结合术后病理结果比较螺旋CT与磁共振(MR)对直肠癌术前分期的诊断价值。方法经手术病理证实的结直肠癌患者共106例。采用GE Light Speed Pro 32排螺旋CT行平扫及增强扫描。采用Si mensAvanto 1.5 T超导型磁共振仪,均采用相控阵线圈行平扫及增强扫描。CT和MR对结直肠癌术前分期与术后病理对照进行比较。结果螺旋CT判断浸润深度(T)分期总的准确率为75.5%,T1-2的准确率为50.0%,T3的准确率为88.2%,T4的准确率为81.1%。MR判断T分期总的准确率为92.5%,T1-2:的准确率为92.6%,T3的准确率为94.1%,T4期的准确率为90.9%。MR对T1-2分期的准确率明显高于螺旋CT(P<0.05);MR对T3、T4分期的准确率与螺旋CT相比差异无统计学意义(χ2=0.366、0.772,P>0.05)。CT、MR扫描和磁共振弥散加权(DWI-MRI)扫描3种方法淋巴结分期结果与组织病理学结果的符合率分别为56.6%、58.5%、73.6%。DWI-MR扫描的敏感度及阴性预测值最高,分别为92.3%和88.2%,CT为75%和66.7%,MRI扫描为42.6%和57.1%。DWI-MR扫描的特异度为55.6%,介于常规MR扫描(74.1%)和CT(41.3%)之间。DWI-MR扫描的阳性预测值为66.7%,略高于CT(51.4%)和MR扫描(61.1%)。经χ2检验分析,DWI-MR扫描诊断结果与组织病理结果具有中等一致性Kappa=13.927(P<0.01);CT和常规MR扫描的诊断结果与组织病理结果无明显一致性(Kappa=1.128、1.585,P>0.05)。结论本研究通过与手术后病理分期比较显示,螺旋CT和MR对于直肠癌术前分期具有非常重要的意义,在判断直肠癌T分期方面,MR优于螺旋CT,可以作为直肠癌术前分期的首选方法。本研究通过对比CT、常规MR和DWI-MR在直肠癌淋巴结分期的诊断表现,显示出DWI-MR诊断结果与病理学结果具有较好的相关性,提示DWI-MR能够更为准确的预测直肠癌区域淋巴结转移情况。DWI因其功能成像的特点,提升了MR检出转移淋巴结的能力。Objective To evaluate the accuracy of CT imaging as compared with MR in preoperative staging in recal carcinoma by comparison with the pathologic findings.Methods The study included 106 histopathologically proven rectal carcinoma patients.Plain and contrast scanning were perfomed with a row CT scanner（GE Light Speed Pro 32）.All MR examinations were performed on a 1.5 Tesla Simens Avanto unit.Different techniques had been proposed for phased-array surface coil MR imaging in both plain and contrast examinations.The relationship between MR and CT imaging results were tested.Results The accuracy of CT for overall T,T1-2,T3 and T4 stage was 75.5%,50.0%,88.2%,81.1% respectively;the accuracy of MR for overall T,T1-2,T3 and T4 stage was 92.5%,92.6%,94.1%,90.9%.The accuracy of MR for T1-2 was superior to CT（P0.05,Fisher exact test）.The difference was not statisticly significant for T3,T4 stage（χ2=0.366,0.772,P0.05）.The overall accuracy of CT,MR without DWI and MR with DWI were respectively 56.6%,58.5% and 73.6%.Analyzed by statistics of χ2,MR with DWI had medium relationship with pathologic results and kappa value was 13.927（P0.01）.No statistic relationship between the definition of the involved lymph node using CT and MR without DWI and pathologic results was found.The Kappa values were respectively 1.128 and 1.585（P0.05）.Conclusion MR and CT were accurate in predicting the stage of bowel wall penetration in rectal carcinoma.Preoperative staging of tumor penetration was performed better with MR as compared with CT.MR could be as the first choice for preoperative T staging in rectal carcinoma.MR with DWI is more accurate than CT and MR for definition of the involved lymph node in patients with rectal cancer.

关 键 词：直肠肿瘤 肿瘤分期 磁共振成像 体层摄影术 X线计算机 

分 类 号：R735.37[医药卫生—肿瘤]