3.0T MRI对新辅助化疗后食管癌术前T分期的准确性及组织病理学相关性

Accuracy of 3.0T MRI for preoperative T staging of esophageal cancer after neoadjuvant chemotherapy and its relation with histopathology

目的:探讨3.0T磁共振成像对新辅助化疗食管癌术前T分期及组织病理学分期一致性的价值。方法:前瞻性纳入2017年1月至2018年12月期间79例食管癌患者。患者均接收2周期新辅助化疗后再接收3.0T MRI检查及根治性手术。2位不同的阅片人员分别对T2加权TSE BLADE、增强StarVIBE、高分辨率StarVIBE延迟扫描上病灶T分期进行判断。结果:新辅助化疗结束至MRI检查间隔时间为(23±2)d。在T2加权TSE BLADE扫描中,2位阅片人的判断准确性最高(κ=0.810,P<0.0001)。T2加权TSE BLADE、增强StarVIBE、高分辨率StarVIBE延迟扫描对术后组织病理学T分期的诊断准确率分别为86.1%~96.2%,86.1%~94.9%,86.1%~96.2%。高分辨率StarVIBE延迟扫描在对T0,T1,T2,T4的判断价值最高,而T2加权TSE BLADE对T3病变的判断价值最高。结论:除T3期病变外,T2加权TSE BLADE序列在明确新辅助化疗后食管癌病变T分期方面具有更高的精准度。T2加权TSE BLADE、增强StarVIBE和高分辨率StarVIBE延迟扫描三者联合不能进一步提高诊断准确性。

Objective:To explore the value of 3.0T MRI for evaluating the preoperative T staging of esophageal cancer(EC)treated with neoadjuvant chemotherapy(NAC),with histopathologic confirmation.Methods:A total of 79 patients with EC from January 2017 to December 2018 were prospectively included.All patients received 2 cycles of NAC.After NAC,all patients received 3.0 T MRI examination and radical surgery.Two different reviewers judged the T staging of lesions on T2-weighted TSE BLADE,enhanced StarVIBE and high resolution StarVIBE delayed scanning respectively.Results:The average interval between the end of NAC and the examination of MRI was(23±2)d.Interbreeder agreements of T category assignment were highest for T2-weighted TSE BLADE(κ=0.810,P<0.0001).The diagnostic accuracy of T2-weighted TSE BLADE,enhanced StarVIBE and high-resolution StarVIBE delayed scanning for T-staging was 86.1%–96.2%,86.1%–94.9%,86.1%–96.2%,respectively.High-resolution StarVIBE delayed scan has the highest value in judging T0,T1,T2 and T4,while T2-weighted TSE BLADE has the highest value in judging T3 lesions.Conclusion:High-resolution delayed phase StarVIBE had the highest diagnostic accuracy in staging EC after NAC for all T categories except T3,for which T2-weighted TSE BLADE had the highest accuracy.Combining all three sequences did not improve diagnostic accuracy.