磁共振检查对胃癌术前TNM分期的价值

Detection of TNM-staging in gastric cancer with MR

目的:分析磁共振(MR)检查对胃癌术前分期的价值,并与病理结果对照。方法:42例经胃镜诊断的胃癌患者,于术前1周内行MR(SIGNA1.5)检查,术后将病理与术前诊断相对照。MR扫描的序列包括FSET1W、FSET2W、FSET1W加脂肪抑制以及动态FSPGR加脂肪抑制增强扫描,所有数据均行统计检验,使用统计软件SAS完成。结果:MR对胃癌浸润深度(T)判断与手术病理比较的准确率分别为T188.8%(5/6)、T270%(7/10)、T386.8%(13/15)、T4100%(11/11)。MR动态增强加脂肪抑制以及延迟扫描对于早期病变的显示、区分T2与T3、T3与T4以及邻近组织的侵犯都有着优势。MR对胃癌术前N分期的判断准确率为61.9%(26/42),其中N063.6%(7/11)、N161.9%(13/21)、N260.0%(6/10)。MR检出M准确率达到83.3%(6/7)。结论:MR检测对胃癌术前分期具有一定的优势,特别是判断肿瘤浸润深度有相当的准确性的,但对于淋巴结的判定仍存在缺陷。

Objective To evaluate the diagnostic accuracy of MR (magnetic resonance) images for preoperative TNM-staging in patients with gastric cancer. Methods MR examination was performed in 42 cases of gastric cancer diagnosed by biopsy prior to operation. After an oral intake of 1 000ml of water and an injection of hypotonic agent, MR scan was applied. MR sequences included FSET1W, FSET2W, FSE T1W with fat suppression and dynamic enhanced FSPGR with fat suppression. All these findings were prospectively analyzed in two doctors separately and compared with the post-operative pathological findings. Statistic works were performed with SAS. Results According to histopathologic staging, the accuracy for T-staging detected with MR were 88.8% in T1, 70% in T2, 86.8% in T3 and 100% in T4 respectively. Dynamic enhanced and delayed MR with fat suppression was superior for revealing the involvement of organs nearby, early stage of invasiveness and providing more evidences in differentiating T2 from T3 or T3 from T4 staging. The accuracy of MRI in N staging was 61.9% (N0 63.6%, N1 61.9%, N2 60.0%, respectively) . The accuracy for M staging was 83.3%. Conclusions MR is superior in T-staging of gastric cancer and can be used to optimize the therapeutic strategy, thus avoiding unnecessary operation. However, MR has limitation in the evaluation of N staging.