功能磁共振成像与CT在食管癌T分期中的应用价值比较

Comparison of the value of applying functional magnetic resonance imaging and CT imaging to T staging of esophageal cancer

目的探讨功能磁共振成像（MRI）及CT成像在食管癌T分期中的应用价值。方法选取拟行手术的食管癌患者54例为研究对象，均接受胸部MRI及CT检查。对照术后病理学结果，比较弥散加权成像（DWI）联合高分辨率T2加权成像（HR—T2WI）、单独HR—T2WI及CT对于食管癌T分期的诊断价值。结果54例患者（1例为双原发病灶）中，包括鳞癌49例，腺癌1例，低分化神经内分泌癌1例，原位癌或高度不典型增生4例。T1～T4期中，DWI联合HR—T2WI、单独HR—T2WI、CT判断T分期的准确率分别为89．1％（49／55）、83．6％（46／55）、67．3％（37／55），DWI联合HR—T2WI与CT、单独HR-T2WI与CT比较，差异均有统计学意义（P=0．005，P=0．038）；其中T1～T2期（包括Tis期）中，3种检查方法的准确率分别为70．6％（12／17）、64．7％（11／17）、29．4％（5／17），DWI联合HR—T2WI与CT、单独HR—T2WI与CT比较，差异均具有统计学意义（P=0．019，P=0．042）；T3～T4期中，3种方法的准确率分别为97．4％（37／38）、92．1％（35／38）、84．2％（32／38），DWI联合HR—T2WI与CT、单独HR—T2WI与CT比较，差异均无统计学意义。结论DWI联合HR—T2WI在诊断食管癌T分期准确性方面优于CT，尤其在T1～T2期（包括Tis期）食管癌患者中优势更明显。

Objective To explore the value of applying functional magnetic resonance imaging （MRI） and CT imaging to T staging of esophageal cancer. Methods Fifty-four patients with esophageal cancer who planned to undergo surgery were selected as subjects and received chest CT and MRI examination. The diagnostic value of diffusion weighted imaging （DWI） combined with high resolution T2-weighted imaging （ HR-T2WI）, HR- T2WI alone, and CT for T staging of esophageal cancer was compared according to postoperative pathological results. Results Of 54 patients, 1 had double primary lesions, 49 had squamous cell carcinoma, 1 had adenocarcinoma, 1 had poorly differentiated neuroendocrine carcinoma, and 4 had carcinoma in situ or high atypical hyperplasia. For T1 -W4 stage of esophageal cancer, the accuracies of DWI combined with HR-T2WI, HR-T2WI alone, and CT for determining the stage were 89.1% （49/55）, 83.60/0 （46/55）, and 67.30/0 （37/55）, respectively. The differences between DWI combined with HR-T2WI and CT, and HR-T2WI alone and GT were statistically significant （P =0. 005, P =0. 038）. For T1 -T2 staging （including Tis stage） of esophageal cancer, the accuracies of the three methods were 70. 60/0 （12/17）, 64. 70/0 （11/17）, and 29.40/0 （5/17）, respectively. The differences between DWI combined with HR-T2WI and CT, and HR-T2WI alone and CT were statistically significant （P=0. 019, P=0. 042）. For T3 -T4 staging of esophageal cancer, the accuracies of the three methods were 97.4% （37/38）, 92.1%（35/38）, and 84.2% （32/38）, respectively. The differencesbetween DWI combined with HR-T2WI and CT, and HR-T2WI alone and CT were not statistically significant. Conclusion The accuracy of DWI combined with HR-T2WI for diagnosing the T staging of esophageal cancer is better than that of GT, especially for patients with T1 -Tz stage （including Tis stage） of esophageal cancer.