高场MRI斜矢状位与斜冠状位扫描在贲门癌术前检查中的应用价值  

Value of oblique sagittal and oblique coronal scanning of high field MRI in cardiac cancer bofore surgery

作　　者：张宏凯[1] 路双 张建伟[1] 张首宁[1] 李彦乐[1] 曲金荣[1] ZHANG Hong-kai;LU Shuang;ZHANG Jian-wei(Department of Radiology,Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]河南省肿瘤医院放射科,郑州450008 [2]河南省肿瘤医院PET-CT,郑州450008

出　　处：《放射学实践》2022年第1期104-109,共6页Radiologic Practice

基　　金：国家自然科学基金面上项目(No.81972802);河南省卫生健康科技创新领军人才培养项目(YXKC2020011);河南省重点研发与推广专项(212102310133);2020年河南省医学科技攻关计划省部共建重点项目(SBGJ202002021)。

摘　　要：目的:探讨改进高场MRI斜矢状位与斜冠状位扫描在贲门癌术前检查中的应用价值。方法:回顾性分析69例贲门癌患者的MRI图像资料,MRI检查均采取平行于食管下段长轴的斜矢状位、斜冠状位和标准正矢状位、正冠状位的扫描方法。两位MRI诊断医师采用双盲法根据食管MRI图像评判两种不同扫描方法下距离肿块边缘的食管胸下段及腹段是否受累,标记受侵范围,同时与术后病理侵犯范围进行对比。结果:69例贲门癌患者中,斜矢状位、斜冠状位MRI扫描低年资组和高年资组医师分别预测贲门癌存在胸下段食管受累26例和24例,分别预测腹段食管受累43例和45例,术后病理切缘阴性符合率分别为91%和94%;标准正矢状位、正冠状位MRI扫描中低年资组和高年资组医师分别预测贲门癌存在胸下段食管受累11例和14例,分别预测腹段食管受累58例和55例,术后病理切缘阴性符合率分别为67%和71%。斜矢状位及斜冠状位MRI改进扫描较标准正矢状位及正冠状位传统MRI扫描可以更好地预测贲门癌患者食管的侵犯情况及切缘的阴性情况,低年资组和高年资组医师采用改进扫描方法预测贲门癌食管受侵情况的曲线下面积(AUC)分别0.939为0.959,传统扫描预测的AUC值分别为0.612和0.643。结论:在贲门癌术前检查采用平行于食管下段长轴的斜矢状位、斜冠状位MRI扫描,较标准正矢状位、正冠状位扫描能更好地显示患者连续的食管胸下段及腹段的黏膜下浸润范围,且有效地提高了低年资医师的预测准确率及信心,可为贲门癌患者临床手术方式的选择及手术范围的确定提供有力参考依据。Objective:To investigate the value of modified oblique sagittal and oblique coronal scan in preoperative high-field MRI examination of cardiac cancer.Method:The MRI images of 69 patients with cardiac cancer were retrospectively analyzed.MRI scan was performed in oblique sagittal and oblique coronal planes paralleled to the long axis of the lower esophagus and in standard sagittal and coronal planes.The involvement of the lower thoracic and abdominal segments of the esophagus from the edge of the mass under two different scanning methods was evaluated by two groups of MRI radiologists of juniority and seniority double-blindly based on the esophageal MRI images.The scope of invasion was marked and compared with the postoperative pathological results.Results:Among the 69 patients with cardiac cancer, the lower thoracic esophagus was invaded in 26/24 patients predicted by junior/senior radiologists, and the abdominal esophagus was invaded in 43/45 patients predicted by junior/senior radiologists on the oblique sagittal and oblique coronal MRI images.The coincidence rate of negative postoperative pathological resection margin was 91% and 94%,respectively.The lower thoracic esophagus was invaded in 11/14 patients predicted by junior/senior radiologists, and the abdominal esophagus was invaded in 58/55 patients predicted by junior/senior radiologists on the standard sagittal and coronal MRI images. The coincidence rate of negative postoperative pathological resection margin was 67% and 71%,respectively.Improved oblique sagittal and oblique coronal MRI scans could better predict esophageal invasion and negative margins in patients with cardiac cancer than that of traditional standard sagittal and coronal MRI scans.The AUC predicted by the improved scanning protocols was 0.939 and 0.959 under the assessment of junior and senior radiologists, respectively, while the AUC predicted by traditional scanning protocols was 0.612 and 0.643,respectively.Conclusion:In preoperative examination of cardiac cancer, MRI scan in oblique

关 键 词：贲门肿瘤 磁共振成像 贲门 食管 斜矢状位 斜冠状位 

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