含弥散加权成像磁共振与增强CT对胃癌术前T分期诊断准确率的比较  

Preoperative T staging of gastric cancer： comparison between MR including diffusion weighted imaging and contrast enhanced CT scan

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

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

出　　处：《中华胃肠外科杂志》2014年第3期245-249,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省自然科学基金（BK2012531）

摘　　要：目的比较增强cT与含弥散加权成像（DWI）的磁共振（MR）成像对胃癌术前T分期诊断的准确率。方法前瞻性纳入2011年11月至2012年8月间经胃镜活检病理证实的41例胃癌患者，术前分别予增强CT和MR检查（包含DWI、T2WI和动态增强扫描）。由两位放射科医师分别对癌灶进行检测和T分期．并以手术病理结果为金标准，比较CT与MR的T分期准确率以及观察者间一致性。结果含DWI的MR对胃癌患者总体T分期的诊断准确率为87．8％（36／41），明显高于增强cT65．9％（27／41）的诊断准确率（P=0．004）。MR诊断的观察者问一致性（Kappa=O．813）优于增强cT诊断（Kappa=0．603）。结论含DWI的MR成像对胃癌术前T分期的诊断准确率较增强CT显著提高，有望于临床广泛应用。Objective To compare the accuracy of CT and MR including diffusion-weighted imaging （DWI） in preoperative diagnosis and T staging of gastric cancer. Methods Forty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging （including DWI, T2 weighted and dynamic enhanced imaging） preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated. Results Overall T staging accuracy in MR including DWI was significantly higher than that in CT imaging （87.8% vs. 65.9%, P=0.004）. MR had a better inter- observer agreement than CT（Kappa=0.813, 0.603, respectively）. Conchlsion MR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.

关 键 词：胃肿瘤 T分期 磁共振成像 弥散加权成像 体层摄影术 X线计算机 

分 类 号：R735.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44