MR-DWI在结直肠癌术前N分期中的价值及与螺旋CT增强扫描的比较研究  

Evaluation of MR-DWI in Preoperative N-staging of Colorectal Carcinoma and Its Comparison with Contrast Helical CT

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,石家庄市050011

出　　处：《中国肿瘤临床》2011年第5期280-283,共4页Chinese Journal of Clinical Oncology

基　　金：国家科技支撑计划项目(编号:2007BAIO5B05);河北省2009年医学科学研究重点计划基因资助(编号:20090511)~~

摘　　要：目的：结合术后病理结果比较螺旋CT与MRI对结直肠癌术前N分期的诊断价值.方法：选取河北医科大学第四医院2008年12月至2009年12月经手术病理证实的结直肠癌患者共53例.采用GE Light Speed Pro 32螺旋CT行平扫及增强扫描.使用Simens Avanto 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.本实验数据采用SPSS 11.5软件进行统计分析.CT和MRI对结直肠癌术前N分期与术后病理对照采用χ2检验,并计算每种诊断方法的敏感度、特异度、阳性预测值、阴性预测值、符合率等数据.结果：CT、MRI扫描和磁共振弥散加权成像（MR-DWI）扫描3种方法检查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%.MR-DWI扫描的敏感度及阴性预测值最高,分别为92.3%和88.2%,CT为75.0%和66.7%,MRI扫描为42.6%和57.1%.MR-DWI扫描的特异度为55.6%,介于常规MRI（74.1%）扫描和CT（41.3%）之间.MR-DWI扫描的阳性预测值为66.7%,略高于CT（51.4%）和MRI（61.1%）扫描.经χ2分析,MR-DWI扫描诊断结果与组织病理结果具有中等相关性,Kappa值为13.927（P=0.001）;CT和常规MRI扫描的诊断结果与组织病理结果无显著相关性,Kappa值分别为1.128（P=0.288）和1.585（P=0.208）.结论：通过对比CT、常规MRI和MR-DWI在结直肠癌淋巴结分期的诊断表现,显示出MR-DWI诊断结果与病理学结果具有较好的相关性,提示MR-DWI能够更准确地预测结直肠癌区域淋巴结转移情况.Objective： To compare the value of CT and MRI in preoperative N-staging of colorectal carcinoma （ CRC ） and to compare the imaging findings with the pathological findings. Methods： The study involved 53 histopathologically confirmed CRC patients. Plain and contrast scanning were performed by a GE Light Speed Pro 32 spiral CT scanner. All MRI examinations were performed by a 1.5 Tesla Siemens Avanto Superconduction MRI unit. Different techniques were proposed for phased-array surface coil MR/in both plain and contrast examinations. All analyses were conducted with SPSS 11.5. Chi-square （ χ^2 ） trend test was used to test the relationship between the results of MRI and CT. Results： The coincidence rates of CT and MRI and MR-DWI findings with the results of N staging and histopathology were 56.6 %, 58.5 % and 73.6%, respectively. The sensitivity and negative predictive value ranked the highest in the MR-DWI scan： 92.3 % and 88.2%. The values were 75 % and 66.7 % in CT, and 42.6 % and 57.1% in MRI, respectively. Z2 test showed that there was a moderate correlation between the results of MR-DWI scanning and histopathology results. The kappa value was 13.927 （ P = 0.001 ）. No statistical correlation was found between the diagnostic results of CT and conventional MR/scan （without DWI） and pathologic examination. The Kappa values were 1.128 （P = 0.288 ） and 1.585 （ P = 0.208 ）, respectively. Conclusion： MR-DWI is more accurate than CT and conventional MRI in diagnosis of CRC. MR-DWI can accurately predict the presence of nodal metastasis in CRC patients.

关 键 词：结直肠癌 肿瘤N分期 核磁共振 计算机体层摄影术 

分 类 号：R735.3[医药卫生—肿瘤]