MRI在胃癌术后复发诊断中的应用价值

Application of high field magnetic resonance image in diagnosing recurrent gastric carcinoma

目的:探讨MRI在胃癌术后复发诊断中的价值及临床意义。方法:选择2组胃癌术后患者,胃癌术后复发组33例,未复发对照组10例,均经胃镜活检、病理检查证实。2组病例均应用1.5 T MRI行TSE DRIVE/T_2WI、T_1-FFE T_1WI等序列及动态增强扫描检查,测量残胃壁及吻合口胃壁厚度,观察吻合口胃壁MRI常规序列及动态增强信号变化。结果:未复发对照组残胃壁厚度(4.5±0.3)mm,吻合口胃壁厚度(6.3±1.4)mm;术后复发组残胃吻合口胃壁增厚>8mm30例,吻合口邻近胃壁厚度>5mm19例,吻合口软组织肿块并邻近胃壁增厚11例,肝脾胰腺等周围脏器转移5例,肝胃之间、腹腔、腹膜后淋巴结转移9例。病灶在动脉期不均匀强化9例,静脉期及平衡期病灶呈渐进性、延迟强化30例。结论:MRI能够较好地显示残胃壁及吻合口胃壁的厚度,准确判断肿瘤浸润深度及与周围组织毗邻关系、是否有淋巴结和腹腔内脏器转移等,可指导临床选择手术方案或综合治疗,对提高胃癌术后生存率具有重要的临床意义。

objective： To evaluate the clinical application of high-field-strength magnetic resonance image in diagnosing recurrent gastric cancer. Methods： Forty-three postoperative patients after gastric cancer surgery were divided into two groups. The group with recurrent gastric carcinoma was clinically confirmed by barium meal of alimentary canal or pathological results. Patients underwent magnetic resonance image including T1 WI, T2 WI, DWI, B-FFE, MR cholangiopancreatography and dynamic contrast enhancement sequences when gastrointestinal tract was in hypotonic, patients drank or were primed with water or Gd-DTPA as contrast. Results： Thirty patients were diagnosed as recurrent gastric cancer with MRI, 28 of them were confirmed by clinical results. Three patients were missed by MRI and two patients were misdiagnosed. Wall thickness of gastric remnant was （4.5±0.3） mm and that of stomas was （6.3±1.4） mm in control group. Types of lesions were found on MRI： thickening of remnant stomach stomas more than 8 mm （ n = 30）, thickening of neighbor remnant stomach stomas more than 5ram （n =19）, mass of stomas （ n =11）, metastasis of neighbor viscus （ n =5）, and metastasis of lymph nodes （ n =9）. On enhancement scan, 9 patients showed inhomogeneous enhancement in arterial phase and 30 patients showed gradual delayed enhancement in venous phase and equilibrium phase. Conclusion： MRI is an effective imaging method in illustrating wall thickness of gastric remnant and stomas, invasion depth by carcinoma, relationship with neighbor tissue structures and metastasis of lymph nodes and abdominal viscus. It plays an important role in directing clinical therapy .