^(18)F-FDG PET/MRI与MRI在食管癌患者术前T、N分期中应用价值的对比分析

Comparative analysis of the application value of ^(18)F-FDG PET/MRI and MRI in preoperative T,N staging of patients with esophageal cancer

目的比较^(18)F-氟脱氧葡萄糖(FDG)PET/MRI与MRI在食管癌患者术前T、N分期中的应用价值。方法回顾性分析2018年1月至2019年12月于空军军医大学第二附属医院行食管癌根治术的30例患者的临床资料与影像学资料,其中男性25例、女性5例,年龄42~77(62.9±8.0)岁。患者均在术前2周内行^(18)F-FDG PET/MRI检查,以术后组织病理学检查结果为分期的"金标准"。采用Kappa检验评估^(18)F-FDG PET/MRI和MRI对食管癌患者术前T、N分期与术后组织病理学分期的一致性;^(18)F-FDG PET/MRI与MRI对食管癌患者术前T、N分期准确率的比较采用χ^(2)检验;转移性淋巴结与良性淋巴结最大标准化摄取值(SUV_(max))、平均标准化摄取值(SUVmean)、表观扩散系数最小值(ADC_(min))、表观扩散系数平均值(ADC_(mean))的比较采用独立样本t检验。结果^(18)F-FDG PET/MRI与MRI对食管癌患者术前T分期和术后组织病理学分期的一致性均较强(Kappa值=0.757、0.698,均P<0.001);^(18)F-FDG PET/MRI和MRI对食管癌患者术前T分期诊断的准确率分别为83.3%(25/30)、80.0%(24/30),差异无统计学意义(χ^(2)=0.110,P>0.05)。^(18)F-FDG PET/MRI对食管癌患者术前N分期的诊断准确率高于MRI[76.7%(23/30)对66.7%(20/30)],且差异有统计学意义(χ^(2)=11.273,P<0.01)。转移性淋巴结的SUV_(max)和SUVmean均明显高于良性淋巴结(5.77±2.66对2.79±1.29,3.16±1.28对1.78±1.01),且差异均有统计学意义(t=6.39、5.96,均P<0.001);转移性淋巴结的ADC_(min)较良性淋巴结低(1.02±0.33对1.20±0.24),且差异有统计学意义(t=-3.81,P<0.001);两者ADC_(mean)的比较,差异无统计学意义(t=-1.52,P>0.05)。结论^(18)F-FDG PET/MRI在食管癌患者术前T分期中的价值与MRI相当,且其对食管癌患者术前N分期的诊断效能优于MRI,故可成为食管癌患者术前分期优选的无创检查方法。

Objective To compare the application value of ^(18)F-fluorodeoxyglucose(FDG)PET/MRI and MRI in the preoperative T and N staging of patients with esophageal cancer.Methods The clinical and imaging data of 30 patients who underwent radical resection for esophageal cancer in the Second Affiliated Hospital of the Air Force Military Medical University from January 2018 to December 2019 were retrospectively analyzed.The sample included 25 males and 5 females,aged 42-77(62.9±8.0)years old.All patients underwent ^(18)F-FDG PET/MRI examination within 2 weeks before operation,and the postoperative histopathological examination results were used as the"gold standard"for staging.The Kappa test was employed to evaluate the consistency of ^(18)F-FDG PET/MRI and MRI in the preoperative T and N staging of patients with esophageal cancer and in postoperative histopathological staging.The staging accuracy was compared using theχ^(2) test,and the values of the maximum standardized uptake(SUV_(max)),mean standardized uptake(SUVmean),apparent diffusion coefficient minimum vaalue(ADC_(min)),and apparent diffusion coefficient mean value(ADC_(mean))of metastatic lymph nodes and benign lymph nodes were compared using independent sample t test.Results ^(18)F-FDG PET/MRI and MRI showed strong consistency in the preoperative T staging and postoperative histopathological staging of patients with esophageal cancer(Kappa value=0.757,0.698;both P<0.001).The accuracy rates of ^(18)F-FDG PET/MRI and MRI in the diagnosis of preoperative T staging in patients with esophageal cancer were 83.3%(25/30)and 80.0%(24/30)respectively,with no significant difference(χ^(2)=0.110,P>0.05).The diagnostic accuracy of ^(18)F-FDG PET/MRI for preoperative N staging in patients with esophageal cancer was higher than that of MRI(76.7%(23/30)vs.66.7%(20/30)),and the difference was statistically significant(χ^(2)=11.273,P<0.01).The SUV_(max) and SUVmean values of the metastatic lymph nodes were higher than those of the benign lymph nodes(5.77±2.66 vs.2.79±1.29 and 3.16±1.28 vs.1.78±1.01,respectively),and the difference was statistically significant(t=6.39,5.96;both P<0.001).Furthermore,the ADC_(min) of metastatic lymph nodes was lower than that of benign lymph nodes(1.02±0.33 vs.1.20±0.24),and the difference was statistically significant(t=-3.81,P<0.001).In comparison,there was no statistical significance in the comparison of ADC_(mean)(t=-1.52,P>0.05).Conclusions The value of ^(18)F-FDG PET/MRI in the preoperative T staging of patients with esophageal cancer is comparable to that of MRI,while its diagnostic performance for preoperative N staging of patients with esophageal cancer is better than MRI.Thus,it can be considered the preferred non-invasive preoperative staging method for patients with esophageal cancer.