螺旋CT及磁共振成像诊断检测对食管癌分期的诊断价值

Spiral CT and magnetic resonance imaging for staging of esophageal cancer

目的:探讨螺旋计算机断层扫描(computertomography,CT)及磁共振成像(magnetic resonance imaging,MRI)对食管癌TNM的评价价值.方法:100例食管癌患者均接受螺旋CT及MRI检查.观察食管癌螺旋CT及MRI平扫、强化特征.以病理学结果为准,分析螺旋CT及MRI对食管癌TNM分期的诊断情况.结果:(1)病理学类型包括鳞癌81例,腺癌16例,小细胞未分化癌3例,病变长度20-11 mm,平均6.4 mm±2.1 mm.共68例患者存在区域淋巴结转移.TNM分期包括T1期9例,T2期23例,T3期40例,T4期28例,N0期32例,N1期68例;(2)螺旋CT诊断食管癌TNM分期包括T1期6例,T2期13例,T3期47例,T4期34例,N0期52例,N1期48例;(3)MRI诊断食管癌TNM分期包括T1期8例,T2期26例,T3期41例,T4期25例,N0期35例,N1期65例;(4)MRI对T1、T2期食管癌诊断灵敏度和正确率均显著高于螺旋CT,差异具有统计学意义(P<0.05).M R I对N0期食管癌特异度高于螺旋C T,但灵敏度低于螺旋CT,差异具有统计学意义(P<0.05).在N1期食管癌的诊断中,MRI诊断灵敏度显著高于螺旋CT,差异具有统计学意义(P<0.05).两者联合应用,在T分期还是N分期的诊断中,均显著优于单独应用,差异具有统计学意义(P<0.05).结论:MRI对T1、T2期食管癌诊断价值较高.CT与MRI联合应用,在T分期还是N分期的诊断中,均显著优于单独应用.

AIM： To assess the value of spiral computed tomography （CT） and magnetic resonance imag- ing （MRI） in esophageal carcinoma tumor-node- metastasis （TNM） staging.METHODS： One hundred esophageal cancer patients underwent spiral CT and MRI ex- aminations. The imaging features of plain and contrast-enhanced CT and MRI of esophageal carcinoma were observed. Using the pathologi- cal result as the standard, the value of spiral CT and MRI in TNM staging of esophageal cancer was analyzed.RESULTS： Pathological examinations revealed 81 cases of squamous cell carcinoma, 16 cases of adenocarcinoma, and 3 cases of small cell undif- ferentiated carcinoma. Lesion length ranged from 20 mm to 11 mm, with an average value of 6.4mm ± 2.1 mm. Sixty-eight patients had regional lymph node metastasis. Pathological TNM clas- sification included 9 cases of T1 stage, 23 cases of T2 stage, 40 cases of T3 stage, 28 cases of T4 stage, 32 cases of NO stage, and 68 cases of N1 stage. Spiral CT TNM classification included 6 cases of T1 stage, 13 cases of T2 stage, 47 cases of T3 stage, 34 cases of T4 stage, 52 cases of NO stage, and 48 cases of N1 stage. MRI TNM classification in- cluded 8 cases of T1 stage, 26 cases of T2 stage, 41 cases of T3 stage, 25 cases of T4 stage, 35 cases of NO stage, and 65 cases of N1 stage. The diagnostic sensitivity and accuracy of MRI for stages T1 and T2 esophageal cancer were significantly higher than those of spiral CT （P 〈 0.05）. The specific- ity of MRI for diagnosis of stage NO esophageal cancer was significantly higher than that of spiral CT, but the sensitivity was significantly lower than that of spiral CT （P 〈 0.05）. In the diagnosis of stage N1 esophageal cancer, the diagnostic sen- sitivity of MRI was significantly higher than that of spiral CT （P 〈 0.05）. The diagnostic accuracy of combined MRI and spiral CT for T stage and N stage was significantly better than that of either of the two modalities （P 〈 0.05）.CONCLUSION： MRI have high value in the di- agnosis of stages T1 and T2 esophageal cancer, and combined application of CT and MRI in T staging and N staging is significantly better their single application.