MRI与CT评估局部晚期食管鳞癌可切除性的比较研究  

Comparison of the accuracy of MRI and CT in evaluating resectability of locally advanced esophageal squamous cell carcinoma

作　　者：赵可可 张霄 张宏凯 鲁亚南 王昭琦 曲金荣 ZHAO Ke-ke;ZHANG Xiao;ZHANG Hong-kai(Department of Radiology,the Affiliated Cancer Hospital of Zhengzhou University&Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院,河南省肿瘤医院放射科,450008

出　　处：《放射学实践》2022年第2期243-248,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(科技攻关)(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:比较3.0T MRI与CT评估局部晚期食管鳞癌是否侵犯胸主动脉、气管或支气管的准确性,以判断肿瘤的可切除性。方法:前瞻性收集本院2018年11月-2020年11月间经内镜活检证实为食管鳞癌的患者,MRI与CT检查均在气管镜检查或术前一周内进行。扫描序列包括膈肌导航的应用刀锋采集技术的快速自旋回波的T_(2)加权成像(T_(2)WI-TSE-BLADE)、DWI及增强后自由呼吸放射状K空间填充方式的容积内插体部检查(增强后Star-VIBE)。2位阅片者采用双盲法分别对MRI和CT图像进行独立评估,判定胸主动脉、气管或支气管是否受侵。采用Kappa一致性检验评价2位阅片者评价结果的一致性。综合术中所见及术后病理或气管镜结果为金标准,计算并比较MRI及CT诊断食管鳞癌侵及胸主动脉、气管或支气管的敏感度、特异度及准确度。结果:37例患者纳入本研究。2位阅片者评价结果的一致性均非常好(Kappa≥0.85,P<0.05)。MRI评估局部晚期食管鳞癌侵及胸主动脉、气管或支气管的准确度分别为90.0%、83.3%,CT评价的准确度分别为40.0%、23.3%。MRI与CT评估食管鳞癌侵犯胸主动脉、气管或支气管的准确度差异均具有统计学意义(P<0.05)。结论:3.0T MRI多序列成像评估食管鳞癌侵犯胸主动脉、气管或支气管的准确度明显高于CT,MRI可以更好地指导局部晚期食管鳞癌患者治疗方案的选择。Objective:To compare the accuracy of 3.0T MRI and CT in evaluating the invasion of thoracic aorta,trachea or bronchus by locally advanced esophageal squamous cell carcinoma(ESCC),and determine the resectability of tumor.Methods:Patients with ESCC confirmed by endoscopic biopsy from November 2018 to November 2020 were prospectively collected.Both MRI and CT were performed within one week before tracheoscopy or surgery.The MRI scanning sequences included T_(2)WI-TSE-BLADE,DWI and post-contrast enhanced Star-VIBE.Two readers independently evaluated whether the thoracic aorta,trachea or bronchus were invaded on MRI and CT images using the double-blind method.The Kappa test was uesed to evaluate the inter-reader agreement between two readers.Utilization of intraoperative observation and postoperative pathology or fiberobronchoscopy as a reference standard,the sensitivity,specificity and accuracy of MRI and CT in evaluating the invasion of thoracic aorta,trachea or bronchus from ESCC were calculated and compared,respectively.Results:A total of 37 patients were included in this study.The inter-reader agreement between two readers was excellent(Kappa≥0.85,P<0.05).The accuracy of MRI in the assessment of local advanced ESCC invading thoracic aorta,trachea or bronchus were 90.0%and 83.3%,and that of CT were 40.0%and 23.3%,respectively.The differences in the accuracy of MRI and CT in evaluating the invasion of thoracic aorta,trachea or bronchus by ESCC were statistically significant(P<0.05).Conclusion:The accuracy of 3.0T MRI in evaluating the invasion of thoracic aorta,trachea or bronchus by ESCC is significantly higher than that of CT,and MRI can better guide the selection of treatment options for locally advanced ESCC.

关 键 词：食管鳞癌 食管肿瘤 肿瘤分期 磁共振成像 体层摄影术 X线计算机 

分 类 号：R735.1[医药卫生—肿瘤] R445.2[医药卫生—临床医学]