磁共振弥散加权成像对胃癌淋巴结转移的诊断价值  

Diagnostic value of magnetic resonance diffusion weighted imaging for metastatic lymph nodes in patients with gastric cancer

作　　者：周竹萍[1] 何健[1] 刘松[1] 管文贤[2] 包善华[2] 俞海平[1] 周正扬[1] 

机构地区：[1]南京大学医学院附属鼓楼医院医学影像科,210008 [2]南京大学医学院附属鼓楼医院普通外科

出　　处：《中华胃肠外科杂志》2014年第3期225-229,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81371516）;国家卫生计生委科研课题（w201306）;江苏省自然科学基金（BK2012531）

摘　　要：目的探讨术前磁共振弥散加权成像（DWI）对胃癌淋巴结转移的诊断价值。方法对2011年12月至2012年12月间南京大学医学院附属鼓楼医院收治的52例胃癌患者进行磁共振DWI检查．对应术中标记的淋巴结，分别测量淋巴结的表观扩散系数（ADC）值及短径，并与术后病理结果相对照。采用受试者工作特征曲线（ROC）评价ADC值及短径对胃癌淋巴结转移的诊断价值。结果DWI检测到转移性淋巴结180枚，非转移性淋巴结57枚，均为高信号。DWI上转移性淋巴结ADC值明显低于非转移性淋巴结[（1．059±0．196）×10^-3mm2／s比（1．402±0．285）×10^-3mm2／s，P=0．000]；以1．189×10^-3mm2／s作为ADC值评估转移性淋巴结的最佳阈值，其敏感度、特异度和曲线下面积（AUC）分别为78．9％、72．8％和0．840，其对术前N分期诊断的总体准确率为75．0％（39／52）。DWI上转移性淋巴结短径明显长于非转移性淋巴结[（8．08±3．99）mm比（6．75±2．70）mm，P=0．005]；以5．05mm作为淋巴结短径评估转移性淋巴结的最佳阈值时，其敏感度、特异度和AUC分别为88．3％、29．8％和0．602，其对术前N分期诊断的总体准确率为67．3％（35／52）。结论磁共振DWI对胃癌淋巴结转移具有较高的诊断价值，以ADC值及淋巴结短径作为诊断标准可用于术前N分期的诊断。Objective To explore the preoperative diagnostic value of MR diffusion weighted imaging（DWI） for metastatic lymph nodes in patients with gastric cancer. Methods Between December 2011 and December 2012, 52 gastric cancer patients（34 men, 18 women） underwent preoperative MR DWI. The apparent diffusion coefficient （ADC） and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve （ROC） analysis. Results A total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [ （1.059±0.196）×10^-3mm2/s ] was significantly lower than that of non-metastatic nodes [ （ 1.402±0.285 ）×10^-3mm2/s, P〈0.001]. With ADC threshold of 1.189×10^-3 mm2/s, the sensitivity, specificity and area under the curve（AUC） were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%（39/52）. The short diameter of metastatic lymph nodes [ （8.08±3.99） mm] was significantly longer than that of non-metastatic lymph nodes [ （6.75±2.70） mm, P= 0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3% （35/52）. Conclusions MR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.

关 键 词：胃肿瘤 淋巴结转移 磁共振成像 弥散加权成像 诊断价值 

分 类 号：R445.2[医药卫生—影像医学与核医学]