CT 及 MRI 成像在初诊食管癌分期中的应用价值

Value of CT and MRI imaging in the application of newly diagnosed esophageal cancer staging

目的：探讨 CT 及 MRI 成像在初诊食管癌分期中的应用价值。方法选取初诊管癌患者200例为研究对象，均自愿接受胸部 CT 及 MRI 检查，观察初诊食管癌病理学结果及其 CT、MRI 特征，比较螺旋 CT、MRI 对食管癌 T 分期及 N 分期的诊断情况。结果200例患者中，包括鳞癌160例，腺癌30例，其它类型10例。病变分期包括 T1期、T2期、T3期、T4期各19例、47例、81例、53例。N0期和 N1期各65例和135例。病变长径10～22（16．5±4．6）mm。CT 及 MRI 均显示食管壁不规则增厚，CT 呈等密度或略低密度， MR 中 T1 WI 呈等或低信号，T2 WI 呈略高信号。增强扫描，病变实质部分明显强化，坏死部分无强化。在 T1、T2期食管癌诊断中，MRI 的诊断敏感性和正确率更高，与 CT 比较，差异均有统计学意义（χ2＝4．32，3．89，均P ＜0．05），在 T3、T4期食管癌的诊断中，MRI 及 CT 的诊断敏感性、特异度及正确率比较差异无统计学意义（P ＞0．05）。两种方法联合应用，诊断敏感性和正确率均明显高于单独应用，差异均有统计学意义（χ2＝4.12，3．98，均 P ＜0．05）。在 N0及 N1期食管癌的诊断中，MRI 具有更高的敏感度，与 CT 比较差异均有统计学意义（χ2＝4．54，4．23，均 P ＜0．05）。两种检查方法对 N0及 N1期食管癌诊断特异性及正确率差异无统计学意义（P ＞0．05）。MR 及 CT 联合应用明显提高了诊断敏感度及正确率，与单独应用比较，差异均有统计学意义（χ2＝4．32，4．54，均 P ＜0．05）。结论MRI 对 T1、T2期及 N0及 N1期食管癌的诊断中具有更高的敏感性，MRI 及 CT 联合应用可以提高诊断敏感度及正确率。

Objective To explore CT and MRI imaging in the application of newly diagnosed esophageal cancer staging.Methods 200 patients with newly diagnosed esophageal cancer were selected as the research object, who voluntarily accepted the chest CT and MRI examination.Newly diagnosed esophageal cancer pathological results and CT,MRI features were observed.Spiral CT,MRI for T staging of esophageal cancer and N staging diagnosis were compared.Results In 200 patients,including 160 cases of squamous cell carcinoma,30 cases of adenocarcinoma, 10 cases of other types,T1 ,T2 ,T3 and T4 clinical staging period were respectively 19 cases,47 cases,81 cases and 53 cases,while N0 and N1 period were 65 cases and 135 cases respectively.The lesion diameter was 10 -22 （16.5 ± 4.6）mm.CT and MRI showed irregular thickening of the esophageal wall,CT showed equal or slightly lower density, T1 WI was MRI or low signal,T2 WI showed a slightly higher signal.Enhanced scanning,a substantial part of lesion enhancement,while the dead part had no enhancement.In T1 ,T2 of the diagnosis of esophageal carcinoma,MRI had higher diagnostic sensitivity and accuracy compared with CT,and the difference was statistically significant （χ2 =4.32,3.89,all P 〈0.05）.In T3 ,T4 of the diagnosis of esophageal carcinoma,there were no statistical significance of MRI and CT of the diagnostic sensitivity,specificity and accuracy rate difference （P 〉0.05）.By using the joint appli-cation of the two methods,the diagnostic sensitivity and accuracy were significantly higher than that used alone,the difference was statistically significant （χ2 =4.12,3.98,all P 〈0.05）.In the diagnosis of N0 and N1 in esophageal cancer,MRI had a higher sensitivity,there were statistically significant difference compared with CT （χ2 =4.54, 4.23,all P 〈0.05）.The two methods had no significant difference in N0 and N1 phase specific diagnosis of esophage-al cancer and the correct rate （P 〉0.05）.The combined application of MRI and CT significantly improved the diag-nostic sensitivity and accuracy.Compared with the single application,the difference was statistically significant （χ2 =4.32,4.54,all P 〈0.05）.Conclusion MRI is more sensitive to diagnosis T1 ,T2 stage and N0 ,N1 stage in esopha-geal carcinoma.Combined application of MRI and CT can improve the diagnostic sensitivity and accuracy.