高场MRI检查不同扫描序列对胃癌术前T分期的诊断效能对比

Comparison of Diagnostic Efficacy of Different Scanning Sequences of High-field MRI on Preoperative T Staging of Gastric Cancer

目的研究高场MRI检查T2WI、弥散加权成像(DWI)和动态增强扫描成像(DCE-MRI)扫描序列对胃癌术前T分期的诊断效能。方法选取2017年12月至2019年12月我院胃癌患者137例为样本,术前2周内均完成T2WI、DWI和DCE-MRI扫描并处理图像,根据结果对胃癌进行T分期,以术后病理结果为"金标准",分析各序列单独及联合应用时分期准确率。结果137例患者MRI检查结果显示T2WI表现为7例等信号影,38例稍高信号影以及92例明显高信号影;DWI均为高信号病灶,ADC值较周围正常组织明显降低;DCE-MRI扫描显示强化类型包括不规则强化89例,其中TIC类型为Ⅰ型19例、Ⅱ型47例和Ⅲ型23例;分层强化48例,其中TIC类型为Ⅰ型21例,Ⅱ型18例以及Ⅲ型9例。T2WI对胃癌T分期准确率为T1期83.33%(10/12)、T2期72.41%(21/29)、T3期70.49%(43/61)和T4期68.57%(24/35),合计72.99%(100/137),一致性Kappa值为0.589。DWI对胃癌T分期准确率为T1期91.67%(11/12)、T2期82.76%(24/29)、T3期78.69%(48/61)和T4期82.86%(29/35),合计81.02%(111/137),一致性Kappa值为0.736。DCE-MRI对胃癌T分期准确率为T1期91.67%(11/12)、T2期86.21%(25/29)、T3期88.52%(54/61)和T4期85.71%(30/35),合计87.59%(120/137),一致性Kappa值为0.818,M R I各序列联合诊断对胃癌T分期准确率为T 1期100.00%(12/12)、T2期92.10%(25/29)、T3期91.80%(56/61)和T4期91.43%(32/35),合计92.70%(127/137),一致性Kappa值为0.893。结论采用T2WI、DWI和DCE-MRI等高场MRI序列进行检查对胃癌术前T分期均具有良好参考价值,可为合理选择治疗方案提供指导依据。

Objective To study the diagnostic efficacy of T2 WI,diffusion-weighted imaging(DWI),and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)scanning sequences of high-field MRI on preoperative T staging of gastric cancer.Methods 137 patients with gastric cancer in our hospital from December 2017 to December 2019 were selected as samples.T2 WI,DWI,and DCE-MRI scans were completed within 2 weeks before surgery and the images were processed.According to the results,the T staging was performed on gastric cancer.The pathological results were taken as the gold standard to analyze the accuracy rates of sequence alone and in combination with staging.Results MRI examination results of 137 patients showed that T2 WI showed 7 cases of iso-signal shadows,38 cases of slightly high signal shadows,and 92 cases of obviously high signal shadows.DWI showed highsignal lesions,and the ADC value was significantly lower than that of the surrounding normal tissues.DCE-MRI scan showed that the types of enhancement included 89 cases of irregular enhancement(19 cases of typeⅠ,47 cases of typeⅡ,23 cases of typeⅢ)and 48 cases of stratified enhancement(21 cases of typeⅠ,18 cases of typeⅡ,and 9 cases of typeⅢ).The accu racy rate of T2 WI for T staging of gast ric ca ncer was 83.33%(10/12)for T1 stage,72.41%(21/29)for T2 stage,70.49%(43/61)for T3 stage and 68.57%(24/35)for T4 stage,totaling 72.99%(100/137),and the consistency Kappa value was 0.589.The accu ra cy rate of DWI for T staging of gastric cancer was 91.67%(11/12)for T1 stage,82.76%(24/29)for T2 stage,78.69%(48/61)for T3 stage and 82.86%(29/35)for T4 stage,totaling 81.02%(111/137),and the consistency Kappa value was 0.736.The accuracy rate of DCE-MRI for T staging of gastric cancer was 91.67%(11/12)for T1 stage,86.21%(25/29)for T2 stage,88.52%(54/61)for T3 stage and85.71%(30/35)for T4 stage,totaling 87.59%(120/137),and the consistency Kappa value was 0.818.The accu ra cy rate of com bined detection of MRI sequences for T staging of gastric ca ncer was 100.00%(12/12)for the T1 stage,92.10%for the T2 stage(25/29),91.80%(56/61)for the T3 stage,and 91.43%(32/35)for T4 stage,totaling 92.70%(127/137),and the consistency Kappa value was 0.893.Conclusion High-field MRI sequences such as T2 WI,DWI,and DCE-MRI have an exceuent reference value in checking the preoperative T staging of gastric cancer and can guid the rational selection of treatment regimens.