MRI联合序列对比MDCT在食管鳞癌T分期诊断效能的研究

Study on the diagnostic efficacy of combined MRI sequences contrast MDCT in T staging of esophageal squamous cell carcinoma

目的通过对比食管鳞癌MRI联合序列与多排螺旋计算机体层摄影(multi detector-row computed tomography,MDCT)的T分期诊断效能,为临床精准T分期提供参考依据。材料与方法前瞻性纳入90例福建省立医院活检证实为食管鳞癌的住院患者,皆有完整MRI联合序列(高分辨率T2-TSE-BLADE序列+高分辨率T1-STAR-VIBE-FS延迟增强序列)、MDCT增强检查数据。由两名影像科主治医师在双盲下分别进行评估,采用Kappa检验评估两名阅片者T分期一致性。参照术后病理金标准分别计算上述两种T分期方法的敏感度、特异度及约登指数;MRI联合序列、单模态序列、MDCT分期方法分别对照病理标准进行一致性Kappa分析。结果术后病理T分期:T1期22例(24.44%)、T2期22例(24.44%)、T3期34例(37.78%)、T4a期12例(13.33%)。两名阅片者两种T分期方法一致性检验Kappa值分别为0.97、0.86。结果显示:(1)MRI联合序列对T1~T3期的敏感度、特异度及约登指数均高于MDCT;(2)两种分期方法对T4a期的敏感度较低,特异度高,约登指数较低;(3)MRI联合序列、单模态序列、MDCT分期方法与病理标准一致性分析Kappa值从高到低分别为MRI联合序列(0.91)、T1-STAR-VIBE-FS(0.81)、T2-TSE-BLADE(0.78)、MDCT(0.71)。结论MRI联合序列对食管鳞癌T分期效能优于MDCT。

Objective:To compare the diagnostic efficacy between combined MRI sequences and multi detector-row computed tomography(MDCT)in T staging of esophageal squamous cell carcinoma,so as to provide a reference basis for clinical accurate T staging.Materials and Methods:Ninty patients with esophageal squamous cell carcinoma confirmed by biopsy in our hospital were prospectively collected.All of them had complete combined MRI sequences(high-resolution T2-TSE-BLADE sequence,high-resolution T1-STAR-VIBE-FS delayed enhancement sequence)and MDCT enhancement examination data.The evaluation was performed separately under double-blind by two attending radiologists,and the Kappa consistency test was used to evaluate the consistency of the T staging of the two subjects.The sensitivity,specificity and Yoden index of the above two T-staging methods were calculated according to the gold standard of postoperative pathology;the consistency of combined MRI sequences,single-mode sequence and MDCT staging were analyzed by Kappa consistency test according to the pathological criteria.Results:Postoperative pathological T staging:22 patients(24.44%)in T1 stage,22 patients(24.44%)in T2 stage,34 patients(37.78%)in T3 stage and 12 patients(13.33%)in T4a stage.The Kappa values of the consistency test of the two T staging methods for the two subjects were 0.97 and 0.86,respectively.The results of this study:(1)The sensitivity,specificity and Youden index of the combined MRI sequences for T1-T3 stages are higher than those of MDCT;(2)The two staging methods have low sensitivity,high specificity,and low Youden index for T4a;(3)The Kappa values from high to low were combined MRI sequences(0.91),T1-STAR-VIBE-FS(0.81),T2-TSE-BLADE(0.78)and MDCT(0.71).Conclusions:Combined MRI sequences are better than MDCT for T staging of esophageal squamous cell carcinoma.