磁共振成像对胃癌术前TNM分期的临床应用价值

The value of magnetic resonance imaging in the preoperative TNM-staging assessment of gastric carcinoma

目的探讨磁共振成像(MRI)在胃癌术前TNM分期评估中的临床应用价值。方法对48例经手术病理确诊的胃癌患者的MRI增强扫描图像与手术后病理结果相对照。结果对胃癌T分期的总体诊断准确率为83.3%,其中T_1、T_2、T_3和T_4期分别为54.5%、75.0%、84.2%和100.0%;对N分期的总体诊断准确率为77.0%,其中N_0期63.6%、N_1期70.5%、N_2期83.3%和N_3期87.5%;对M分期的总体诊断准确率为81.3%,其中M_0期85.3%、M_1期86.7%;TNM分期诊断总的准确率为77.1%,其中Ⅰa期50.0%、Ⅰb期57.1%、Ⅱ期75.5%、Ⅲa期67.7%、Ⅲb期80.0%和Ⅳ期80.0%。MRI对胃癌术前TNM分期与术后病理结果有着较高一致性(Kappa值=0.671～0.763,P<0.05)。结论 MRI可较准确地显示胃癌侵犯胃壁的深度,同时可反映淋巴结转移情况及远处脏器的转移情况,对胃癌术前临床分期的评估有独特的优越性。

Objective To explore the value of MRI in the preoperative TNM - staging assessment of gastric carcinoma. Methods MRI was performed in 48 patients with gastric carcinoma diagnosed by pathology after operation. The results of MRI were prospectively analyzed by one professor and compared with those of surgical pathological findings. Results In comparison with pathological results,the accuracy of MRI for T stages was 83.3% ：54.5% for T1, 75.0% for T2 , 84.2% for T3 and 100.0% for T4 ; respectively. The accuracy of MRI for N stages was 77.0% ：63.6% for No, 70.5% for N1, 83.5% for N2 and 87.5% for N3 , respectively. The accuracy of MRI for M stages was 81.3% ：85.38% for M0 and 86.7% for M1, respectively. The accuracy of MRI for TNM stages was 77.1% ：50.0% for Ia,57.1% for I b, 75.57% for Ⅱ, 67.7% for Ⅲa, 80.0% for Ⅲb 和80.0% for Ⅳ. It showed concordance tendency between the preoperative TNM - staging and surgical patholagieal findings. Conclusion MR1 plays a very important role in the assessment of invasion depth of gastric carcinoma as far as lymph nodes and distant organ metastases are concerned. It shows unique priority in the preoperative assessment.