增强磁共振成像在SiewertⅡ/Ⅲ型食管胃结合部腺癌术前评估中的价值

Value of enhanced magnetic resonance imaging in preoperative evaluation of Siewert typeⅡ/Ⅲadenocarcinoma of the esophagogastric junction

目的评估增强MRI检查对SiewertⅡ/Ⅲ型食管胃结合部腺癌术前诊断的价值。方法回顾性分析我院2018年1月至2020年5月收治的术后病理结果证实为SiewertⅡ/Ⅲ型食管胃结合部腺癌的76例患者影像学资料。由2位主治医师通过盲法对增强CT及增强MRI图像进行病灶测量及诊断,采用Kappa检验分析2种检查结果与病理结果的一致性。结果76例患者均在术前1周内行影像学检查,仅行增强CT检查27例,仅行增强MRI检查9例,同时行增强CT及增强MRI检查(间隔1 d)40例,获得术前增强CT检查图像67例,术前增强MRI图像49例。行增强CT检查的67例食管胃结合部腺癌患者中SiewertⅡ型35例、SiewertⅢ型32例,诊断正确56例,与病理结果一致性中等(Kappa值=0.672)。行增强MRI检查的49例食管胃结合部腺癌患者中SiewertⅡ型27例、SiewertⅢ型22例,诊断正确44例,与病理结果一致性较好(Kappa值=0.791)。术前增强MRI检查提示的阳性转移淋巴结与术后病理结果一致性欠佳(Kappa值=0.115),增强CT检查提示的阳性转移淋巴结与术后病理结果无一致性(Kappa值=-0.129)。以病理结果为金标准,增强MRI检查提示阳性转移淋巴结分组区域的准确率为59.2%(29/49),高于增强CT检查的41.8%(28/67)。结论术前增强MRI检查对食管胃结合部腺癌患者Siewert分型、阳性转移淋巴结分组区域的诊断准确性高于增强CT检查,可为临床治疗方法、手术路径的选择及淋巴结清扫范围提供有利证据。

Objective To evaluate the value of enhanced magnetic resonance imaging(MRI)in the preoperative diagnosis of Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Methods The imaging data of 76 patients with Siewert typeⅡ/ⅢAEG confirmed by postoperative pathology from Jan.2018 to May 2020 in our hospital were retrospectively analyzed.Two attending physicians measured and diagnosed the lesions on enhanced computed tomography(CT)and enhanced MRI images by blind method.The consistency between the 2 examination results and pathological results was analyzed by Kappa test.Results All 76 patients underwent imaging examination within 1 week before surgery:27 cases underwent enhanced CT only,9 cases underwent enhanced MRI only,and 40 cases underwent both(with an interval of 1 d).A total of 67 preoperative enhanced CT images and 49 preoperative enhanced MRI images were obtained.Among the 67 patients with AEG who underwent enhanced CT,there were 35 cases of Siewert typeⅡand 32 cases of Siewert typeⅢ,and the diagnosis was correct in 56 patients,showing moderate agreement with the pathological results(Kappa=0.672).Among the 49 patients with AEG who underwent enhanced MRI,there were 27 cases of Siewert typeⅡand 22 cases of Siewert typeⅢ,and the diagnosis was correct in 44 patients,showing good agreement with the pathological results(Kappa=0.791).The positive metastatic lymph nodes suggested by preoperative enhanced MRI were not consistent with the postoperative pathological results(Kappa=0.115),and the positive metastatic lymph nodes suggested by enhanced CT were also not consistent with the postoperative pathological results(Kappa=-0.129).With the pathological results as the gold standard,the accuracy of enhanced MRI in grouping positive metastatic lymph nodes was 59.2%(29/49),which was higher than that of enhanced CT(41.8%[28/67]).Conclusion The accuracy of preoperative enhanced MRI for Siewert classification and grouping areas of positive metastatic lymph nodes in AEG patients is higher than that of enhanced CT,which may provide favorable evidence for the clinical treatment,choice of surgical route and extent of lymph node dissection.