CT多平面重组技术(MPR)对于食管癌淋巴结术前评估的意义

The value of MPR reconstruction in the preoperative evaluation of esophageal cancer lymph nodes

目的探讨CT多平面重组技术(MPR)对于食管癌淋巴结术前评估的意义。方法收集分析37例经病理证实的食管癌患者术前MSCT增强扫描图像,由两组同年资医师分别应用多平面重组技术(multi-plane reformation,MPR)及常规轴位图像,对37例食管癌No.105组、No.106组(No.106rec、No.106tb、No.106pre)、No.107组、No.108组、No.110组、No.111组、No.2组、No.7组淋巴结进行评估。转移淋巴结标准为:淋巴结短径大于7mm或淋巴结有不均质强化或淋巴结之间相互融合。依据术后病理结果对比分析MPR重建图像与常规轴位图像,对于食管癌术前淋巴结评估的敏感性、特异性、阳性预测值、阴性预测值及Younden指数。淋巴结分组参考日本食管癌协会第十版指南。结果 37例患者术中共清理肿大淋巴结366枚,其中转移淋巴结72枚。MPR重建图像标记转移淋巴结80枚,正确诊断60枚;常规轴位图像标记转移淋巴结76枚,正确诊断42枚。MPR重建图像评估食管癌转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为:83.3%、93.1%、75%、95.8%,约登指数为0.765;常规轴位图像评估食管癌转移淋巴结的敏感性、特异性、阳性预测值、阴性预测值分别为:58.3%、88.4%、55.2%、89.6%;约登指数为0.467。结论 CT多平面重组技术的运用对检出食管癌转移淋巴结有更好的敏感性和特异性,对食管癌术前影像评估及术中淋巴结清扫有重要临床意义。

Objective To evaluate the application values of MPR （multi-plane reformation） reconstruction of preoperative contrast-enhanced MSCT in the diagnosis of esophageal cancer lymph node metastasis. Methods 37 patients who were diagnosed of esophageal cancer were examined with preoperative contrast-enhanced multi-slice CT （MSCT）. The rawdata was analyzed inde- pendently by the MPR reconstructed view group and routine axial view group to evaluate the No. 105 group, No. 106 group （No. 106 tee, No. 106 tb, No. 106 pre）, No. 107group, No. 108 group, No. 110 group, No. 111 group, No. 2 group, No. 7 group lymph nodes of the 37 patients. The standard of lymph node metastasis included the shorter line larger than 7 mm or iuhomoge- neous enhancement of the lymph node or fusion lymph node. The sensitivity, specificity and Younden index were used to evaluate the application values of MPR for diagnosis the esophageal cancer lymph node metastasis. All the dissected lesions were confined by the histopathology and classified by the 〈 Japanese Classification of Esophageal Cancer, tenth edition 〉. Results 366 lymph nodes were dissected during the operation including 72 malignant lymph nodes which confirmed by pathology. MPR reconstructed view group found 360 lymph nodes and detected 80 malignant lymph nodes, in which 60 lymph nodes were proved to be true posi- tive. Routine axial view group found 327 lymph nodes and detected 42 malignant lymph nodes which were proved by pathology. The sensitivity, specificity and Younden index of the MPR reconstructed view group were 83.3% , 93. 1% , 75% , 95.8% , 0. 765 ; and for the Routine axial view group were 58.3% , 88.4% , 55.2%, 89.6% , 0. 467. Conclusion The application of MPR in the preoperative contrast-enhanced MSCT has highly sensitivity, specificity, which plays a significant rule the diagnosis of esophageal cancer lymph node metastasis. This is also meaningful for the preoperative evaluation of esophageal cancer.