无创性影像技术对于结直肠癌区域淋巴结侵犯术前评价的比较研究与病理对照

Evaluation of the invovled lymph node in patients with colorectal cancer using noninvasive imaging acquisition-compared with pathologic results

目的:评价多排螺旋计算机断层扫描(CT)、磁共振成像(MRI)、MRI结合扩散加权成像(DWI-MRI)在结直肠癌区域淋巴结侵犯中的作用。方法:35名原发结直肠癌患者,于术前进行MRI检查,其中25名患者同时进行CT检查。将CT、MRI、DWI-MRI对于肿瘤区域淋巴结侵犯的诊断结果与病理学结果进行对照,应用χ2分析检验不同影像方法诊断的准确性。结果:CT、MRI和DWI-MRI淋巴结分期结果与组织病理学结果的整体符合率分别为56%、57.1%和74.3%。经χ2分析,DWI-MRI诊断结果与病理学结果具有中等相关性,Kappa值为0.536(P<0.05);CT和MRI诊断结果与病理学结果无明显相关性,Kappa值分别为0.138(P>0.05)和0.150(P>0.05)。结论:DWI-MRI更为准确的预测结直肠癌区域淋巴结侵犯情况。

Objective：To evaluate the accuracy of computed tomography（CT）, magnetic resonance imaging（MRI）, and MRI with diffusion weight imaging（DWI-MRI） for demonstrating the invovled lymph node in patients with coloreetal cancer.Methods：35 patients with chnical diagnosis of colorectal cancer had undergone MR imaging acquisition, who had operation within one week. 25 of them had ulldergone CT scanning after MR acquistion on the same day. Three groups readers prospectively and independently analysed the CT imaging, MR imaging without DWI and MR imaging with DWI. Readem identified and characterized all lymph node by using a scale of 1 ～ 5 （ 1, definitely involvement; 5, definitely non-involvement）. Prospective imaging interpretations were compared directly with pathologic results. Results：On a node-by-node basis, the overall accuracy of CT imaging, MRI without DWI and MRI with DWI were respectively 56% ,57.1% and 74.3%. Analyzed by the statistics of χ^2, MRI with DWI had medium relationship with pathologic results and Kappa value is 0.536 （ P 〈 0.05）. No statistically relationship between the definition of the involved lymph node using CT and MRI without DWI and pathologic results was found. The Kappa values were respectively 0.138 and 0.150 （ P 〈 0.05）. Condusion：MRI with DWI is more accurately than the other two imaging protocol for definition of the involved lymph node in patients with coloreetal cancer.