MRI多序列在食管癌鉴别诊断中的价值

Evaluation of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer

目的探讨T1WI增强和DWI序列联合使用提高T2WI序列在食管癌局部复发、坏死或纤维化的鉴别诊断价值。方法对2012年9月至2017年3月的35例不愿手术或无法行手术治疗的食管癌患者行MRI检查。按照检查方法的组合分成4组:A组:行T2WI序列扫描;B组:T2WI序列+增强T1WI;C组:T2WI序列+DWI;D组:T2WI序列+增强T1WI+DWI。由高级组(副主任医师)、中级组(主治医师)和初级组(住院医师)3名影像科医师判断肿瘤复发情况。采用ROC计算各组阅片者在不同组合的MR序列上的诊断效能,采用Kappa值评价不同阅片者之间的一致性。结果经病理确诊13例复发。在T2WI序列上,高、中、低级在医师诊断的ROC下面积分别是0.701、0.407、0.584,与单纯T2WI序列相比,DWI及增强T1WI序列的加入对低级组ROC下面积有提高趋势(0.608~0.745)。采用不同的序列组合,不同级别医师间的差别很大(Kappa值为0.227~0.884),不同年资放射科医师间C组和D组诊断的差异性减小。结论T2WI序列与多序列联合使用对放射科医师鉴别诊断水平有明显提高,特别是经验不足的低年资医师。

Objective To evaluate the role of combination of multiple MRI sequences in the differential diagnosis of esophagus cancer and to assess the accordance among radiologists with different experience. Methods Thirty-fifty patients underwent conventional MRI including T2 weighted (T2) sequences, gadolinium fat-suppressed T1 weighted sequences (post-contrast T1), and DWI sequences. Three radiologists with different experience determined the possibility of local recurrence (LR) on T2, T2+post-contrast T1, T2+DWI, and T2+post-contrast T1+DWI. ROC and Kappa were used. Results In total, 13 patients had LR. On T2WI, the ROC curve (AUC) achieved by the senior,intermediate and junior groups were 0.701,0.407,and 0.584, respectively.Compared with simple T2WI sequences, DWI and T1 Gd significantly improved the AUC value for the intermediate radiologist. The great difference was observed between radiologists of different experience (Kappa coefficient was from 0.227 to 0.884). Combination of multiple sequences significantly reduced the diagnostic differences between radiologists with different experience for the senior radiologists particularly. Conclusions The addition of DWI and T1 post-contrast MRI increased diagnostic ability for LR of esophagus cancer and reduced the diagnostic differences between radiologists with different experience compared to T2WI.