小视野ZOOMit DWI和常规DWI在胃癌术前T分期评估中的应用价值比较  

Application Value of ZOOMit DWI in Preoperative T Staging Evaluation of Gastric Cancer,A Comparison with Conventional DWI

作　　者：许玮月 李琼 后雅珺 桑梓桐 李博文 刘希胜 XU Weiyue;LI Qiong;HOU Yajun(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu Province 210029,P.R.China)

机构地区：[1]南京医科大学第一附属医院江苏省人民医院放射科,210029 [2]南京医科大学第一附属医院江苏省人民医院普外科,210029

出　　处：《临床放射学杂志》2024年第8期1365-1370,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金资助项目(编号:82071919);国家自然科学基金青年项目(编号:82002558)。

摘　　要：目的比较小视野扩散加权成像(ZOOMit DWI)和常规视野扩散加权成像(fFOV⁃DWI)二者的图像质量以及其在胃癌术前T分期评估中的诊断价值。方法前瞻性纳入2021年11月至2022年8月经内镜及病理活检证实为胃癌且在南京医科大学附属第一医院行3.0 T MR全胃扫描的患者。MR扫描序列包括fFOV⁃DWI和ZOOMit DWI两种扩散成像序列。由2名具有5年及以上MRI诊断经验的放射科医师对这两种扩散加权图像上可测量的病变进行感兴趣区(ROI)勾画,计算信噪比(SNR)和对比噪声比(CNR),采用组内相关系数(ICC)和配对样本t检验进行一致性评估及差异性分析。2名诊断医师采用双盲5分法对fFOV⁃DWI和ZOOMit DWI的图像进行主观评分,采用Kendall协调系数和配对样本非参数检验进行一致性评估及差异性分析。此外,2名医师对照第八版AJCC胃癌分期指南、基于两个序列分别进行胃癌T分期评估,采用Kappa检验和配对卡方检验进行一致性评估及差异性分析。结果2名医师对177例患者的ZOOMit DWI图像的主观评分均分高于fFOV⁃DWI(4.01±1.00 vs.3.60±1.01,4.25±0.95 vs.3.86±0.87),二者图像质量主观评分的差异具有统计学意义(P<0.01)。其中,共144例患者的病变大小可测量,对该部分图像进行定量分析的结果表明,ZOOMit DWI的信噪比(SNR)、对比噪声比(CNR)优于fFOV⁃DWI,并且2位医师的测量结果具有较好的一致性(ICC=0.730~0.840,P<0.01)。此外,以术后病理T分期为金标准,2名诊断医师基于ZOOMit DWI进行T分期评估的整体准确率均高于fFOV⁃DWI(0.644 vs.0.441,0.718 vs.0.435,P<0.05)。ZOOMit DWI在区分早期胃癌(≤T2)和进展期胃癌(≥T3)以及鉴别进展期胃癌浆膜突破(≥T4a)方面,优于fFOV⁃DWI。结论与fFOV⁃DWI相比,ZOOMit DWI在具有更好的图像质量的前提下,能提高胃癌术前T分期准确率,对胃癌患者的诊断及治疗具有重要意义。Objective To compare the image quality and diagnostic value of ZOOMit diffusion⁃weighted imaging(ZOOMit DWI)and the conventional full field of view DWI(fFOV⁃DWI)in gastric cancer(GC).Methods Consecutive patients who were confirmed to have gastric cancer by endoscopy and pathological biopsy and underwent 3.0 T gastric MR scanning at the First Affiliated Hospital of Nanjing Medical University from November 2021 to August 2022 were prospectively included.Axial fFOV⁃DWI and ZOOMit DWI were performed.Two radiologists with more than 5 years of MRI diagnostic experience quantitatively analyzed the measurable lesions on images of two sequences independently,including signal⁃to⁃noise ratio(SNR)and contrast⁃to⁃noise ratio(CNR),using interclass correlation coefficient(ICC)and paired sample t⁃test for consistency evaluation and difference analysis.The two diagnostic radiologists subjectively scored the images of fFOV⁃DWI and ZOOMit DWI using a 5⁃scale Likert scales,and Kendall's concordance coefficient and paired sample non-parametric test were used for statistical analysis.In addition,T staging was evaluated by the same two radiologists based on the results of both sequences according to the 8th edition of the American Joint Committee on Cancer(AJCC)TNM staging standard for gastric cancer,and kappa test and paired chi⁃square test were used for statistical analysis.Results Among the 177 patients,144 had measurable lesion sizes,and quantitative analysis of these images showed that ZOOMit DWI had higher SNR and CNR than fFOV⁃DWI(P<0.05),with good consistency(ICC=0.730~0.840,P<0.01).Furthermore,the subjective scores of the ZOOMit DWI images by the two diagnostic radiologists were better than those of the fFOV⁃DWI images(4.01±1.00 vs.3.60±1.01,4.25±0.95 vs.3.86±0.87),and the difference in image quality subjective scores between the two was statistically significant(P<0.01).With the postoperative pathological T staging as the golden standard,the overall accuracy of T staging evaluation using ZOOMit D

关 键 词：胃癌 磁共振成像 扩散加权成像 T 分期 小视野扩散加权成像 

分 类 号：R735.2[医药卫生—肿瘤]