CT及DWI评价食管癌术前淋巴结转移及N分期对比研究  

Pre-operative detection of lymph node metastasis and N staging in esophageal carcinoma with CT and DWI： a comparative study

作　　者：张倩倩[1,2] 徐亮[1] 申洪明[1] 李文武[1] 黄勇[1] 

机构地区：[1]山东省医学科学院山东省肿瘤防治研究院CT室,山东济南250117 [2]济南大学山东省医学科学院医学与生命科学学院

出　　处：《实用放射学杂志》2013年第7期1075-1078,共4页Journal of Practical Radiology

摘　　要：目的研究CT及磁共振扩散加权成像（DwI）术前评价食管癌淋巴结转移及N分期的价值。方法连续随机选择经食管镜证实、拟行手术的95例食管癌患者，术前1周内行CT及MRI检查．以术后病理为“金标准”,比较CT及DWI诊断食管癌淋巴结转移及N分期的敏感性、特异性、准确性、阳性预测值及阴性预测值。结果63例存在淋巴结转移，共切除并分离淋巴结782枚（422组）．其中131枚（93组）发现转移。CT诊断淋巴结转移的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为54．2％、92．8％、86．3％、60．2％、90．1％；DW1分别为89．3％、93．9％、93．1％、74．5％、97．8％。DWI诊断淋巴结转移的敏感性、准确性及阴性预测值均显著高于CT，差异有统计学意义（P〈0．05）．特异性及阳性预测值差异无统计学意义（P〉0．05）。cT及DWI确定N分期的准确率分别为74．7％和91．6％，差异有统计学意义（P〈0．05）。转移淋巴结的ADC值（1．71±0．12）×10^-3mm2／s高于非转移淋巴结（2．61±0．15）×10^-3mm2／s．差异有统计学意义（P〈0．05）。结论通过比较CT及DWI评价食管癌淋巴结转移及N分期的价值．显示DWI能更准确地预测食管癌淋巴结转移的情况。Objective To compare the diagnostic values of CT and DWI in detection of lymph node metastasis and N staging for pre-operative esophageal carcinoma. Methods 95 patients with esophageal carcinoma proved by esophagoscope were enrolled in this study. The CT and DWI examination were performed before surgery. The diagnostic values of CT and DWI in detection of lymph node metastasis and N staging were compared. The pathological results served as gold standard. Results The pathological results confirmed the metastases in 63 patients with 131 metastatic lymph nodes in a total of 782 excised lymph nodes. The sensitivity, spe- cificity, accuracy, positive predictive value and negative predictive value of CT was 54.2%, 92.8%, 86.3%, 60.2% and 90. 1%, respectively, meanwhile those of DWI were 89. 3% , 93.9%, 93. 1%, 74.5% and 97.8%. The accuracy of CT and DWI in defining N staging was 74.7% and 91.6 %, respectively. DWI was better in diagnostic sensitivity, accuracy, negative predictive value and de- fining N staging than CT （P〈0.05）. However, the differences in specificity and positive predictive value between DWI and CT were not shown. The AIN2 value of lymph node with or without metastasis was （ 1.71 ± 0. 12） × 10-3 mm2/s or （2. 61 ± 0. 15） × 10 -3 mm2/s respec- tively, exhibiting a significant difference （P〈0.05）. Conclusion The diagnostic values of DWI in detection of metastatic lymph node and N staging for esophageal carcinoma outweighs that of CT.

关 键 词：食管肿瘤 扩散加权成像 计算机体层成像 淋巴结转移 

分 类 号：R735.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]